A Study Evaluating Efficacy and Safety of Mosunetuzumab in Combination With Polatuzumab Vedotin Compared to Rituximab in Combination With Gemcitabine Plus Oxaliplatin in Participants With Relapsed or Refractory Aggressive B-Cell Non-Hodgkin's Lymphoma (SUNMO)

May 5, 2026 updated by: Hoffmann-La Roche

A Randomized, Open-Label, Multicenter Phase III Study Evaluating Efficacy and Safety of Mosunetuzumab in Combination With Polatuzumab Vedotin in Comparison With Rituximab in Combination With Gemcitabine Plus Oxaliplatin in Participants With Relapsed or Refractory Aggressive B-Cell Non-Hodgkin's Lymphoma

This study will assess the efficacy and safety of mosunetuzumab in combination with polatuzumab vedotin (M+P) in participants with relapsed or refractory (R/R) diffuse-large B-cell lymphoma (DLBCL), high-grade B-cell lymphoma, transformed follicular lymphoma (trFL) and FL Grade 3B (FL3B) in comparison with a commonly used regimen in this participant population, rituximab, gemcitabine and oxaliplatin (R-GemOx).

Study Overview

Study Type

Interventional

Enrollment (Actual)

208

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Buenos Aires, Argentina, 1118
        • Hospital Aleman
      • Buenos Aires, Argentina, 1426
        • Instituto Alexander Fleming
      • Buenos Aires, Argentina, C1114AAN
        • Fundaleu
      • Ciudad Autonoma Buenos Aires, Argentina, C1181ACH
        • Hospital Italiano de Buenos Aires
      • São Paulo, Brazil
        • D'or Instituto de Pesquisa e Educação
    • Paraná
      • Curitiba, Paraná, Brazil, 81520-060
        • Hospital Erasto Gaertner
    • Rio Grande do Sul
      • Porto Alegre, Rio Grande do Sul, Brazil, 90035-903
        • Hospital das Clinicas - UFRGS
    • São Paulo
      • Ribeirão Preto, São Paulo, Brazil, 14048-900
        • Hospital das Clínicas FMRP-USP
      • São Paulo, São Paulo, Brazil, 01323-030
        • Hospital São José
    • Ontario
      • Hamilton, Ontario, Canada, L8V 5C2
        • Hamilton Health Sciences - Juravinski Cancer Centre
      • Toronto, Ontario, Canada, M5G 2M9
        • Princess Margaret Hospital
    • Quebec
      • Montreal, Quebec, Canada, H2L 4M1
        • Chum Hopital Notre Dame
      • Chengdu, China, 610041
        • Sichuan Cancer Hospital
      • Fuzhou, China, 350001
        • Fujian Medical University Union Hospital
      • Guangzhou, China, 510060
        • Cancer Center, Sun Yat-sen University of Medical Sciences
      • Tianjin, China, 300060
        • Tianjin cancer hospital
      • Wuhan, China, 430030
        • Tongji Hosp, Tongji Med. Col, Huazhong Univ. of Sci. & Tech
      • Zhengzhou, China, 450008
        • Henan Cancer Hospital
      • Beersheba, Israel, 8410101
        • Soroka Medical Center
      • Tel Aviv, Israel, 6423906
        • Ichilov Sourasky Medical Center
      • Fukuoka, Japan, 812-8582
        • Kyushu University Hospital
      • Hokkaido, Japan, 060-8648
        • Hokkaido University Hospital
      • Miyagi, Japan, 980-8574
        • Tohoku University Hospital
      • Osaka, Japan, 589-8511
        • Kindai University Hospital
      • Tokyo, Japan, 135-8550
        • The Cancer Institute Hospital of JFCR
      • Yamagata, Japan, 990-9585
        • Yamagata University Hospital
      • Distrito Federal, Mexico, 14080
        • Instituto Nacional De Cancerologia
      • México, Mexico
        • Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
    • Mexico CITY (federal District)
      • Mexico City, Mexico CITY (federal District), Mexico, 03100
        • Health Pharma Professional Research
      • Mexico City, Mexico CITY (federal District), Mexico, 11550
        • Superare Centro de Infusion S.A. de C.V.
    • Nuevo León
      • Monterrey, Nuevo León, Mexico, 64460
        • Hospital Universitario Dr. Jose E. Gonzalez
      • Auckland, New Zealand
        • Middlemore Clinical Trials
      • Arequipa, Peru, 5154
        • Instituto Regional de Enfermedades Neoplásicas del Sur
      • Lima, Peru, 41
        • Oncosalud Sac
      • Busan, South Korea, 49241
        • Pusan National University Hospital
      • Daejeon, South Korea, 35015
        • Chungnam National University Hospital
      • Seoul, South Korea, 03080
        • Seoul National University Hospital
      • Seoul, South Korea, 06351
        • Samsung Medical Center
      • Seoul, South Korea, 03722
        • Severance Hospital, Yonsei University Health System
      • Seoul, South Korea, 07345
        • Yeouido St. Mary's Hospital
      • Bangkok, Thailand, 10700
        • Siriraj Hospital
      • Bangkok, Thailand, 10330
        • Chulalongkorn University Hospital
      • Chiang Mai, Thailand, 50200
        • Chiang Mai Uni Hospital
      • Khon Kaen, Thailand, 40002
        • Srinagarind Hospital, Khon Kaen Uni
      • Ankara, Turkey (Türkiye), 06100
        • Ankara University Medical Faculty
      • Kocaeli, Turkey (Türkiye), 41400
        • Anadolu Health Center
      • Lzmir, Turkey (Türkiye), 35340
        • Dokuz Eylul Universitesi Tip Fakultesi
      • Samsun, Turkey (Türkiye), 55139
        • Ondokuz Mayis Univ. Med. Fac.
    • California
      • Duarte, California, United States, 91010
        • City of Hope Cancer Center
    • Missouri
      • Chesterfield, Missouri, United States, 63017
        • St. Luke's Hospital
    • Texas
      • Austin, Texas, United States, 78712
        • Ascension Seton Infusion Center
      • Houston, Texas, United States, 77030
        • MD Anderson Cancer Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1, or 2
  • CD20+ aggressive lymphoma as determined by the local hemopathology laboratory from the following diagnoses by 2016 World Health Organization classification of lymphoid neoplasms: DLBCL, not otherwise specified (NOS); high-grade B-cell lymphoma (NOS or double/triple hit); transformed follicular lymphoma; follicular lymphoma Grade 3b
  • Have disease relapsed or refractory to at least one prior systemic therapy for aggressive non-Hodgkin's lymphoma (aNHL)
  • Participants who have received only one prior line of therapy must be ineligible for autologous stem cell transplant (ASCT)
  • Measurable disease
  • Adequate hepatic, hematologic, and renal function
  • Estimated creatinine clearance (CrCl) ≥ 30 mL/min by Cockroft-Gault method or other institutional standard methods
  • Negative HIV test at screening. Participants with a positive HIV test at screening are eligible provided that, prior to enrollment, they are stable on anti-retroviral therapy for at least 4 weeks, have a CD4 count of at least 200 microliters, have an undetectable viral load, and have not had a history of opportunistic infection attributable to AIDS within the last 12 months

Exclusion Criteria:

  • Pregnant or breast feeding, or intending to become pregnant during the study or within 3 months after the final dose of mosunetuzumab, 9 months after the final dose of polatuzumab vedotin, 12 months after the final dose of rituximab, 6 months after the final dose of gemcitabine, 9 months after the final dose of oxaliplatin, and 3 months after the final dose of tocilizumab, as applicable
  • Inability to comply with protocol-mandated activity restrictions
  • Prior treatment with mosunetuzumab or other CD-20-directed bispecific antibodies, or R-GemOx or Gem-Ox
  • Prior treatment with polatuzumab vedotin, with the following exceptions: participants who have a documented response (partial response or complete response) to polatuzumab vedotin and an absence of PD within 12 months from the last dose of polatuzumab vedotin; participants who received up to 2 doses of a polatuzumab vedotin-containing regimen as bridging to CAR-T therapy, and either has a documented disease control (stable disease, partial response, or complete response), or were not assessed for response following treatment with polatuzumab vedotin
  • Contraindication to any component of the study treatment
  • Grade > 1 peripheral neuropathy
  • Participants with Grade > 1 persistent toxicity related to prior anti-lymphoma treatment (except for alopecia and anorexia, or other toxicities not considered a safety risk for the participant per investigator's judgment)
  • Received anti-lymphoma treatments with monoclonal antibodies, radio-immunoconjugates or antibody-drug conjugates (ADCs) within 4 weeks before the first dose of study treatment
  • Treatment with any chemotherapeutic agent, or treatment with any other anti-lymphoma agent (investigational or otherwise) within 4 weeks or 5 half-lives of the drug, whichever is shorter, prior to the first dose of study treatment
  • Treatment with radiotherapy within 2 weeks prior to the first dose of study treatment
  • ASCT within 100 days prior to the first study treatment administration
  • Prior treatment with chimeric antigen receptor (CAR) T cell therapy within 30 days before the first study treatment administration
  • Prior allogenic stem cell transplant (SCT)
  • Have had a solid organ transplantation
  • Known or suspected history of hemophagocytic lymphohistiocytosis (HLH)
  • History of confirmed progressive multifocal leukoencephalopathy
  • History of severe allergic or anaphylactic reactions to monoclonal antibody therapy (or recombination antibody-related fusion proteins)
  • History of other malignancy that could affect compliance with the protocol or interpretation of results, with the exception of malignancies with a negligible risk of metastasis or death
  • Currently have or have had a past history of central nervous system (CNS) involvement of lymphoma
  • Current or past history of CNS disease, such as stroke, epilepsy, CNS vasculitis, or neurodegenerative disease. Participants with a history of stroke who have not experienced a stroke or transient ischemic attack in the past 2 years and have no residual neurologic deficits as judged by the investigator, or with a history of epilepsy who have had no seizures in the past 2 years while not receiving any anti-epileptic medications, are allowed
  • Significant cardiovascular disease such as New York Heart Association Class III or IV cardiac disease, myocardial infarction within the last 6 months, unstable arrhythmias, or unstable angina
  • Significant active pulmonary disease
  • Participants with active symptoms of interstitial lung disease and/or pneumonitis, or those with a history of interstitial lung disease and/or pneumonitis within 6 months prior to the first dose of study treatment
  • Known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of the nail beds) at study enrollment, or any major episode of infection requiring treatment with IV antibiotics or hospitalization (relating to the completion of the course of antibiotics) within 2 weeks prior to the first study treatment administration
  • Known or suspected chronic active Epstein-Barr virus (EBV) infection
  • Recent major surgery within 4 weeks prior to the first study treatment administration
  • Positive test results for chronic hepatitis B infection
  • Acute or chronic hepatitis C virus (HCV) infection
  • Have been administered a live, attenuated vaccine within 4 weeks before the first dose of study treatment administration or anticipation that such a live, attenuated vaccine will be required during the study
  • Participants who have positive SARS-CoV-2 test within 7 days prior to enrollment (rapid antigen test result is acceptable)
  • History of autoimmune disease
  • Received investigational therapy, whether or not intended for lymphoma treatment, within 7 days prior to initiation of study treatment
  • Clinically significant history of liver disease, including viral or other hepatitis, or cirrhosis

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: M+P (Arm A)
Participants will receive subcutaneous (SC) mosunetuzumab plus intravenous (IV) polatuzumab vedotin (M+P). Mosunetuzumab will be administered on Days 1, 8, and 15 of Cycle 1, and thereafter on Day 1 of Cycles 2-8. Polatuzumab vedotin will be administered on Day 1 of each cycle up to Cycle 6. Cycle length = 21 days.
Participants will receive SC mosunetuzumab on Days 1, 8, and 15 of Cycle 1, and on Day 1 of Cycles 2-8 (cycle length = 21 days).
Participants will receive IV polatuzumab vedotin every three weeks (Q3W) for 6 cycles (cycle length = 21 days).
Participants will receive IV tocilizumab as needed to manage cytokine release syndrome (CRS) events.
Active Comparator: R-GemOx (Arm B)
Participants will receive IV rituximab, IV gemcitabine, and IV oxaliplatin (R-GemOx) on Day 1 of each cycle for 8 cycles. Cycle length = 14 days.
Participants will receive IV rituximab on Day 1 of each cycle for 8 cycles (cycle length = 14 days).
Participants will receive IV gemcitabine on Day 1 of each cycle for 8 cycles (cycle length = 14 days).
Participants will receive IV oxaliplatin on Day 1 of each cycle for 8 cycles (cycle length = 14 days).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Objective Response Rate (ORR) as Determined by the Independent Review Facility (IRF), According to Lugano Response Criteria 2014 (LRC) Using Positron Emission Tomography-computed Tomography (PET-CT) or CT Scans in Interim Analysis Population (IAP)
Time Frame: Up to approximately 23.8 months
ORR was defined as the percentage of participants with complete response (CR)/partial response (PR), per IRF, per Lugano Response Criteria. Percentages have been rounded off.
Up to approximately 23.8 months
Progression-free Survival (PFS) as Determined by the IRF, According to LRC Using PET-CT or CT Scans
Time Frame: Up to 32 months
PFS was defined as the time from randomization to first occurrence of disease progression (PD) or death from any cause, whichever occurred first, per IRF, per Lugano Response Criteria.
Up to 32 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
ORR as Determined by the IRF, According to LRC Using PET-CT or CT Scans in ITT Population
Time Frame: Up to 32 months
ORR was defined as the percentage of participants with complete response (CR)/partial response (PR), per IRF, per Lugano Response Criteria. Percentages have been rounded off.
Up to 32 months
ORR as Determined by the Investigator, According to LRC Using PET-CT or CT Scans in ITT Population
Time Frame: Up to approximately 58 months
ORR was defined as the percentage of participants with CR or PR, as determined by the investigator, per Lugano Response Criteria.
Up to approximately 58 months
Duration of Response (DoR) as Determined by the IRF, According to LRC Using PET-CT or CT Scans
Time Frame: Up to 32 months
DoR was defined as the time from first occurrence of documented PET-CT and/or CT-based objective response (OR) (CR/PR) to PD, or death from any cause, whichever occurred first, per IRF, per Lugano Response Criteria.
Up to 32 months
DoR as Determined by the Investigator, According to LRC Using PET-CT or CT Scans
Time Frame: Up to approximately 58 months
DoR=time from first occurrence of documented PET-CT and/or CT-based objective response (OR) (CR/PR) to PD, or death from any cause, whichever occurred first, per investigator, per Lugano Response Criteria.
Up to approximately 58 months
Overall Survival (OS)
Time Frame: Up to 32 months
OS was defined as the time from randomization to death from any cause. K-M method was used to estimate median OS.
Up to 32 months
PFS as Determined by the Investigator, According to LRC Using PET-CT or CT Scans
Time Frame: Up to approximately 58 months
PFS was defined as the time from randomization to first occurrence of PD or death from any cause, whichever occurred first, as determined by the investigator, per Lugano Response Criteria.
Up to approximately 58 months
Complete Response Rate (CRR) as Determined by the IRF, According to LRC Using PET-CT or CT Scans
Time Frame: Up to approximately 58 months
CRR was defined as the percentage of participants in whom CR was observed at any time during the study, based on PET-CT and/or CT scans, as determined by the IRF, per Lugano Response Criteria.
Up to approximately 58 months
CRR as Determined by the Investigator, According to LRC Using PET-CT or CT Scans
Time Frame: Up to approximately 58 months
CRR was defined as the percentage of participants in whom CR was observed at any time during the study, based on PET-CT and/or CT scans, as determined by the investigator, per Lugano Response Criteria.
Up to approximately 58 months
Duration of Complete Response (DOCR) as Determined by the IRF, According to LRC Using PET-CT or CT Scans
Time Frame: Up to 32 months
DOCR was defined as the time from first occurrence of a documented CR to PD, per IRF, per Lugano Response Criteria.
Up to 32 months
DOCR as Determined by the Investigator, According to LRC Using PET-CT or CT Scans
Time Frame: Up to approximately 58 months
DOCR=time from first occurrence of documented CR to PD, as determined by the investigator, per Lugano Response Criteria.
Up to approximately 58 months
Time to Deterioration in Physical Functioning (PF), as Measured by the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire-Core 30 (EORTC QLQ-C30)
Time Frame: Up to approximately 58 months
Time to deterioration in PF was defined as time from randomization to the first documentation of 10-point or more decrease, from baseline. EORTC QLQ-C30 is cancer-specific instrument consisting of 30 questions to evaluate 5 aspects of participant functioning (physical, emotional, role, cognitive, & social), 3 symptom scales (fatigue, nausea, vomiting, & pain), global health status (GHS)/quality of life (QoL), & 6 single items (dyspnea, insomnia, appetite loss, constipation, diarrhea & financial difficulties). Functioning scales were scored on a 4-point scale, ranging from 1=Not at all to 4=Very much. All EORTC scales & single-item measures were linearly transformed to a score range of 0-100. High score for a functioning scale indicated high/healthy level of functioning.
Up to approximately 58 months
Time to Deterioration in Fatigue Scale, as Measured by the EORTC QLQ-C30
Time Frame: Up to approximately 58 months
Time to deterioration in fatigue was defined as time from randomization to the first documentation of 10-point or more decrease, from baseline. EORTC QLQ-C30 is cancer-specific instrument consisting of 30 questions to evaluate 5 aspects of participant functioning (physical, emotional, role, cognitive, & social), 3 symptom scales (fatigue, nausea, vomiting, & pain), global health status (GHS)/quality of life (QoL), & 6 single items (dyspnea, insomnia, appetite loss, constipation, diarrhea & financial difficulties). Fatigue scale was scored on a 4-point scale, ranging from 1=Not at all to 4=Very much. All EORTC scales & single-item measures were linearly transformed to a score range of 0-100. High score for a fatigue scale indicated a high level of symptom severity.
Up to approximately 58 months
Time to Deterioration in Lymphoma Symptoms, as Measured by Functional Assessment of Cancer Therapy- Lymphoma Questionnaire (FACT- Lym LymS)
Time Frame: Up to approximately 58 months
Time to deterioration in lymphoma-specific symptoms was defined as the time from randomization to the first documentation of a 3-point or more decrease, from baseline. FACT-Lym is a cancer-specific scale used to assess health-related QoL aspects relevant to participants with lymphoma. The full measure consists of the FACT-G physical, social/family, emotional, and functional well-being scales (27 items), as well as lymphoma-specific symptoms subscale (LymS). The FACT-Lym Lyms consists of 15 items scored from 0-4, where 0="Not at all" and 4="very much". Scale score ranges from 0 to 60, where a high score indicated a better QoL.
Up to approximately 58 months
Number of Participants With Adverse Events (AEs)
Time Frame: Up to approximately 58 months
An AE was defined as any untoward medical occurrence in a participant or clinical study participant temporally associated with the use of a study treatment, whether or not considered related to the study treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study intervention.
Up to approximately 58 months
Number of Participants With Cytokine Release Syndrome (CRS) With Severity Determined by the American Society for Transplantation and Cell Therapy (ASTCT) Consensus Grading Scale
Time Frame: Up to approximately 58 months
CRS=supraphysiologic response following administration of any immune therapy that results in activation/engagement of endogenous or infused T cells and/or other immune effector cells. Symptoms may be progressive, including fever at onset, and may also include hypotension, capillary leak (hypoxia), and end-organ dysfunction. Severity of CRS was determined per ASTCT Consensus Grading Criteria, which categorizes CRS into 5 grades- Grade 1: Fever (≥38◦Celsius), with/without constitutional symptoms, in absence of hypotension & hypoxia; Grade 2: Fever with hypotension not requiring vasopressors and/or hypoxia requiring low-flow oxygen; Grade 3: Fever with hypotension requiring one vasopressor, with/without vasopressin, and/or hypoxia requiring high-flow oxygen; Grade 4: Fever accompanied by hypotension requiring multiple vasopressors (excluding vasopressin) and/or hypoxia requiring positive-pressure ventilation; Grade 5: death due to CRS.
Up to approximately 58 months
Number of Participants With Dose Interruptions, Dose Reductions and Study Treatment Discontinuation Due to AEs
Time Frame: Up to approximately 58 months
An AE was defined as any untoward medical occurrence in a participant or clinical study participant temporally associated with the use of a study treatment, whether or not considered related to the study treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of the study intervention. Participants who had dose interruptions or modifications or who discontinued study treatment due to AEs will be reported here.
Up to approximately 58 months
Dose Intensity of Mosunetuzumab
Time Frame: Up to approximately 58 months
Up to approximately 58 months
Change From Baseline in Peripheral Neuropathy (PN), as Measured by the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx)
Time Frame: Up to approximately 58 months
The FACT/GOG-Ntx is an 11-item patient-reported outcome that measures polatuzumab vedotin-induced PN. The scale contains 4 subscales to assess sensory neuropathy (4 items), hearing neuropathy (2 items), motor neuropathy (3 items), and dysfunction associated with neuropathy (2 items), which can be summed to create a total score. Each item is scored on a 5-point response scale that ranges from 0=not at all to 4=very much. The possible range for the scores is 0-44, with higher scores indicating more extreme neuropathy.
Up to approximately 58 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Study Director: Clinical Trials, Hoffmann-La Roche

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 25, 2022

Primary Completion (Actual)

February 17, 2025

Study Completion (Estimated)

February 28, 2027

Study Registration Dates

First Submitted

December 6, 2021

First Submitted That Met QC Criteria

December 20, 2021

First Posted (Actual)

December 29, 2021

Study Record Updates

Last Update Posted (Actual)

May 7, 2026

Last Update Submitted That Met QC Criteria

May 5, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

For eligible studies, qualified researchers may request access to individual patient level clinical data. See Roche's commitment to transparency of clinical study information here: https://go.roche.com/data_sharing

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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