Study of BEBT-908 Combined With Drugs in the Treatment of Relapsed/Refractory Diffuse Large B-Cell Lymphoma

A Multicenter, Open Phase Ib Study of the Safety and Efficacy of BEBT-908 Combined With Drugs in the Treatment of Relapsed/Refractory Diffuse Large B-Cell Lymphoma

This is a multicenter, open Phase Ib clinical study to evaluate the safety,efficacy and pharmacokinetics of BEBT-908 combined with Rituximab (R) or combined with Rituximab-Gemcitabine-Oxaliplatin (R-GemOx) or combined with Rituximab-Ifosfamide-Carboplatin-Etoposide (R-ICE) in the treatment of Relapsed/Refractory Diffuse Large B-Cell Lymphoma (R/R DLBCL).

Study Overview

• Status: Recruiting
• Conditions: Relapsed/Refractory Diffuse Large B-Cell Lymphoma
• Intervention / Treatment: Drug: BEBT-908 for Injection; Drug: Rituximab Injection; Drug: Gemcitabine Hydrochloride for Injection; Drug: Oxaliplatin Injection; Drug: Etoposide Injection; Drug: Ifosfamide for Injection; Drug: Carboplatin Injection

Detailed Description

This study sets up three cohorts, including BEBT-908 combined with R, BEBT-908 combined with R-ICE, and BEBT-908 combined with R-GemOx. The researchers decide whether to terminate the cohort study according to the safety and tolerability results of each cohort during the first cycle of medication. If the participants in the above three cohorts are unable to receive the treatment during the first cycle of medication, two alternative cohort studies will be conducted. Namely, BEBT-908 monotherapy (alternative cohort 1), adjustment of BEBT-908 combined with GemOx administration regimen (alternative cohort 2).

The study process for each participant includes a screening period, a treatment period, and a post-treatment follow-up period. During treatment, participants are evaluated for tumors every 6 weeks, follow up after termination of treatment with efficacy follow-up every 6 weeks for those without disease progression and survival follow-up every 3 months until disease progression (PD), death, emergence of intolerable toxicity, or withdrawal of informed consent (whichever occurred first).

• Study Type: Interventional
• Enrollment (Estimated): 75
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Kegang Jiang, Master; Phone Number: +86-18664786382; Email: kjiang@bebettermed.com

Study Locations

• China
  • Beijing
    • Beijing, Beijing, China, 100021
      • Recruiting
      • Cancer Hospital Chinese Academy of Medical Sciences
      • Contact: Xizhen Hu, Bachelor; Phone Number: +86-15802510972; Email: xhu@bebettermed.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. The subject is willing to sign the informed consent form (ICF) after comprehensive understanding;
2. Age ≥18 years and ≤75 years, both male and female;
3. The pathology was confirmed as diffuse large B-cell lymphoma according to the 2016 World Health Organization classification definition;
4. Evaluation by Positron Emission Computed Tomography (PET-CT) or Computed Tomography (CT) or Magnetic resonance imaging (MRI) using Lugano 2014 standard, with measurable lesion injection;
5. Must have recurrent or refractory diffuse large B-cell lymphoma after at least 1 systemic therapy, and at least 1 systemic therapy included CD20 antibody;
6. Eastern Cooperative Oncology Group (ECOG) scores 0-2 points;
7. Life expectancy >12 weeks;
8. The level of organ function must meet the following requirements:

Peripheral blood:

1. Absolute neutrophil count (ANC) ≥1000/μL;
2. Hemoglobin (HGB) ≥8g/dL;
3. Platelet count (PLT) ≥100,000/μL;

Liver function:

1. Serum total bilirubin ≤1.5×ULN (for patients with Gilbert syndrome, total bilirubin <3.0×ULN and Direct bilirubin within normal range);
2. Serum creatinine <1.5×ULN;
3. ALT, AST or ALP≤2.5×ULN (≤5×ULN when liver involvement occurs).

Exclusion Criteria:

1. Known severe allergy to the investigational drug or any of its excipients;

2. Due to the possibility of genotoxicity, mutagenicity and teratogenicity of the investigational drug, the following subjects should be excluded:

   1. Men and women who have not had sperm or egg preservation in vitro before the trial and plan to have another child within 5 years unless subsequent studies confirm reproductive safety;
   2. Pregnant or lactating women;
3. Primary central nervous system lymphoma or lymphoma invading the central nervous system;
4. Previous chronic lymphoma transformation (such as Richter syndrome, prelymphocytic leukemia, etc.);
5. There are other active malignant tumors requiring treatment that may interfere with the study;

6. Pre-trial treatment:

   1. Received any persistent or intermittent PI3K inhibitor and HDAC inhibitor prior to enrollment or received other small-molecule targeted drug therapy within 2 weeks;
   2. Received BEBT-908 (not allowed to be in all cohorts) or R-ICE (not allowed to be in cohorts with BEBT-908+R-ICE) or R-GemOx (not allowed to be in cohorts with BEBT-908+R-GemOx) prior to enrollment;
   3. Autologous hematopoietic stem cell transplantation within 3 months before enrollment;
   4. Received radiotherapy that affected the evaluation of the efficacy of the study or local supportive radiotherapy that affected the bone marrow function of the subjects within 3 months before enrollment;
   5. Received myelosuppressive chemotherapy or biotherapy within 3 weeks prior to enrollment;
   6. Used Chinese medicines and proprietary Chinese medicines with anti-tumor effects within 2 weeks before enrollment;
   7. Undergone major surgery other than tumor biopsy within 4 weeks prior to enrollment, or the side effects of surgery had not stabilized;
   8. Any hematopoietic colony-stimulating factor (e.g., granulocyte colony-stimulating factor G-CSF, granulocyte macrophage colony-stimulating factor GM-CSF) or thrombopoietin TPO were treated within 2 weeks prior to enrollment；
   9. Received prednisone >10mg daily (or another equivalent dose of glucocorticoid) within 7 days prior to enrollment;
   10. Received chimeric antigen receptor T cell immunotherapy (CAR-T therapy) within 3 months before enrollment;
7. Persistent grade 2 or higher [Common Terminology Criteria for Adverse Events V5.0 standard (CTCAE V5.0 standard)] toxicity after previous treatment (chemotherapy or biotherapy), not stable at enrollment (except alopecia);
8. Active clinical severe infection of grade 2 or above (CTCAE V5.0 standard);

9. Complicated diseases:

   1. diabetes mellitus with poor glycemic control (random glycemic value ≥11.1mmol/L after hypoglycemic treatment, or glycosylated hemoglobin（HbA1c）≥ 8.5%);
   2. severe lung disease (CTCAE V5.0 grade III-IV);
   3. Serious heart disease;
   4. have significant kidney or liver dysfunction;
   5. Poorly controlled active diseases such as hepatitis B or C;
   6. Known human immunodeficiency virus (HIV) positive;
   7. A history of mental illness, family history of mental illness, or mood disorder, as judged by the investigator or psychologist, and the researcher judged that they were not suitable for inclusion;
   8. Combination of anticoagulation and antiplatelet therapy is required during the study period;
   9. uncontrolled hypertension (systolic blood pressure ≥180mmHg and/or diastolic blood pressure ≥110mmHg);
   10. Serious physical disease combined with the risk of major bleeding or a history of major bleeding;
10. Combined with use of drugs that cause QT interval prolongation or torsional ventricular tachycardia;
11. Receiving cytochrome P450 (CYP) 3A4 isozyme suppressant or strongly induced drug therapy during the first 4 weeks of enrollment；
12. Participated in other clinical trials and used investigational drugs within 4 weeks before enrollment;
13. Any condition that the investigator determines to be unstable or likely to compromise the subject's safety and compliance with the study;
14. Subjects deemed unsuitable for treatment with this protocol by the investigator.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: BEBT-908 combined with R; BEBT-908 for Injection,dosage of administration:22.5mg/m^2，frequency and duration of administration:on the 1st,3rd,5th,8th,10th and 12th days of each cycle in the 1st to 6th cycles,and 21 days as a cycle. Rituximab Injection,dosage of administration:375 mg/m^2,frequency and duration of administration:on the 1st day of each cycle, and 21 days as a cycle.	Drug: BEBT-908 for Injection; BEBT-908 for Injection,dosage of administration:15mg/m^2 or 22.5mg/m^2，frequency and duration of administration:on the 1st,3rd,5th,8th,10th and 12th days of each cycle,and 21 days as a cycle.; Other Names: CUDC-908; Drug: Rituximab Injection; Rituximab Injection,dosage of administration:375 mg/m^2,frequency and duration of administration:on the 1st day of each cycle, and 21 days as a cycle.; Other Names: IDEC-C2B8
Experimental: BEBT-908 combined with R-GemOx; BEBT-908 for Injection,dosage of administration:15mg/m^2，frequency and duration of administration:on the 1st,3rd,5th,8th,10th and 12th days of each cycle in the 1st to 6th cycles,and 21 days as a cycle. Rituximab Injection,dosage of administration:375 mg/m^2,frequency and duration of administration:on the 1st day of each cycle in the 1st to 6th cycles, and 21 days as a cycle. Gemcitabine Hydrochloride for Injection，dosage of administration:1g/m^2,frequency and duration of administration:on the 2nd day of each cycle in the 1st to 6th cycles, and 21 days as a cycle. Oxaliplatin Injection,dosage of administration:100mg/m^2,frequency and duration of administration:on the 2nd day of each cycle in the 1st to 6th cycles, and 21 days as a cycle.	Drug: BEBT-908 for Injection; BEBT-908 for Injection,dosage of administration:15mg/m^2 or 22.5mg/m^2，frequency and duration of administration:on the 1st,3rd,5th,8th,10th and 12th days of each cycle,and 21 days as a cycle.; Other Names: CUDC-908; Drug: Rituximab Injection; Rituximab Injection,dosage of administration:375 mg/m^2,frequency and duration of administration:on the 1st day of each cycle, and 21 days as a cycle.; Other Names: IDEC-C2B8; Drug: Gemcitabine Hydrochloride for Injection; Gemcitabine Hydrochloride for Injection，dosage of administration:1g/m^2,frequency and duration of administration:on the 2nd day of each cycle, and 21 days as a cycle.; Other Names: NSC 613327; Drug: Oxaliplatin Injection; Oxaliplatin Injection，dosage of administration:100mg/m^2,frequency and duration of administration:on the 2nd day of each cycle, and 21 days as a cycle.; Other Names: NSC 266046
Experimental: BEBT-908 combined with R-ICE; BEBT-908 for Injection,dosage of administration:15mg/m^2，frequency and duration of administration:on the 1st,3rd,5th,8th,10th and 12th days of each cycle in the 1st to 6th cycles,and 21 days as a cycle. Rituximab Injection,dosage of administration:375 mg/m^2,frequency and duration of administration:on the 1st day of each cycle in the 1st to 6th cycles, and 21 days as a cycle. Etoposide Injection,dosage of administration:100mg/m^2，frequency and duration of administration:on the 1st,2nd and 3rd days of each cycle in the 1st to 6th cycles,and 21 days as a cycle. Ifosfamide for Injection,dosage of administration:5000mg/m^2,frequency and duration of administration:on the 2nd day of each cycle in the 1st to 6th cycles, and 21 days as a cycle. Carboplatin Injection，dosage of administration:based on AUC=5, single dose ≤800 mg，frequency and duration of administration:on the 2nd day of each cycle in the 1st to 6th cycles, and 21 days as a cycle.	Drug: BEBT-908 for Injection; BEBT-908 for Injection,dosage of administration:15mg/m^2 or 22.5mg/m^2，frequency and duration of administration:on the 1st,3rd,5th,8th,10th and 12th days of each cycle,and 21 days as a cycle.; Other Names: CUDC-908; Drug: Rituximab Injection; Rituximab Injection,dosage of administration:375 mg/m^2,frequency and duration of administration:on the 1st day of each cycle, and 21 days as a cycle.; Other Names: IDEC-C2B8; Drug: Etoposide Injection; Etoposide Injection,dosage of administration:100mg/m^2，frequency and duration of administration:on the 1st,2nd and 3rd days of each cycle,and 21 days as a cycle.; Other Names: VP-16213; Drug: Ifosfamide for Injection; Ifosfamide for Injection,dosage of administration:5000mg/m^2,24 hours of continuous intravenous drip，frequency and duration of administration:on the 2nd day of each cycle, and 21 days as a cycle.; Other Names: NSC109724; Drug: Carboplatin Injection; Carboplatin Injection，dosage of administration:based on AUC=5, single dose ≤800 mg，frequency and duration of administration:on the 2nd day of each cycle, and 21 days as a cycle.; Other Names: NSC 241240
Experimental: BEBE-908 monotherapy (alternative cohort 1); BEBT-908 for Injection,dosage of administration:22.5mg/m^2，frequency and duration of administration:on the 1st,3rd,5th,8th,10th and 12th days of each cycle in the 1st to 6th cycles,and 21 days as a cycle.	Drug: BEBT-908 for Injection; BEBT-908 for Injection,dosage of administration:15mg/m^2 or 22.5mg/m^2，frequency and duration of administration:on the 1st,3rd,5th,8th,10th and 12th days of each cycle,and 21 days as a cycle.; Other Names: CUDC-908
Experimental: BEBT-908 combined with R-GemOx（alternative cohort 2）; BEBT-908 for Injection,dosage of administration:22.5mg/m^2，frequency and duration of administration:on the 1st,3rd,5th,8th,10th and 12th days of each cycle in the 1st to 2nd cycles,and 21 days as a cycle. Rituximab Injection,dosage of administration:375 mg/m^2,frequency and duration of administration:on the 1st day of each cycle in the 3rd to 6th cycles, and 21 days as a cycle. Gemcitabine Hydrochloride for Injection，dosage of administration:1g/m^2,frequency and duration of administration:on the 2nd day of each cycle in the 3rd to 6th cycles, and 21 days as a cycle. Oxaliplatin Injection,dosage of administration:100mg/m^2,frequency and duration of administration:on the 2nd day of each cycle in the 3rd to 6th cycles, and 21 days as a cycle.	Drug: BEBT-908 for Injection; BEBT-908 for Injection,dosage of administration:15mg/m^2 or 22.5mg/m^2，frequency and duration of administration:on the 1st,3rd,5th,8th,10th and 12th days of each cycle,and 21 days as a cycle.; Other Names: CUDC-908; Drug: Rituximab Injection; Rituximab Injection,dosage of administration:375 mg/m^2,frequency and duration of administration:on the 1st day of each cycle, and 21 days as a cycle.; Other Names: IDEC-C2B8; Drug: Gemcitabine Hydrochloride for Injection; Gemcitabine Hydrochloride for Injection，dosage of administration:1g/m^2,frequency and duration of administration:on the 2nd day of each cycle, and 21 days as a cycle.; Other Names: NSC 613327; Drug: Oxaliplatin Injection; Oxaliplatin Injection，dosage of administration:100mg/m^2,frequency and duration of administration:on the 2nd day of each cycle, and 21 days as a cycle.; Other Names: NSC 266046

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ORR	Objective response rate	Every 6 weeks，assessed up to 24 months.
AE	Adverse event	From the first administration of the study drug to 28 days after the last administration of the study drug

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PFS	Progression-free survival	From date of administration until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 24 months
ORR-EoT	Objective response rate after completion of treatment	Every 6 weeks，assessed up to 6 treatment cycles (each cycle is 21 days).
OS	Overall Survival	From date of administration until date of death from any cause, assessed up to 24 months.
CBR	Clinical benefit rate	Every 6 weeks，assessed up to 24 months.
DOR	Duration of Response	Every 6 weeks，assessed up to 24 months.
DCR	Disease Control Rate	Every 6 weeks，assessed up to 24 months.
TTR	Treatment response time	Every 6 weeks，assessed up to 24 months.
Tmax	Time of peak Plasma Concentration	From 1 hour before dosing on day 1 and day 12 of the first cycle to 48 hours after dosing, and from 1 hour before dosing on day 8 and day 10 of the first cycle (each cycle is 21 days).
Cmax	Peak Plasma Concentration	From 1 hour before dosing on day 1 and day 12 of the first cycle to 48 hours after dosing, and from 1 hour before dosing on day 8 and day 10 of the first cycle (each cycle is 21 days).
t1/2	Half-life of plasma drug concentrations	From 1 hour before dosing on day 1 and day 12 of the first cycle to 48 hours after dosing, and from 1 hour before dosing on day 8 and day 10 of the first cycle (each cycle is 21 days).
AUC0-t	Area under the plasma concentration time curve from 0 hour to last time of quantifiable concentration after administration	From 1 hour before dosing on day 1 and day 12 of the first cycle to 48 hours after dosing, and from 1 hour before dosing on day 8 and day 10 of the first cycle (each cycle is 21 days).
CL	apparent plasma clearance	From 1 hour before dosing on day 1 and day 12 of the first cycle to 48 hours after dosing, and from 1 hour before dosing on day 8 and day 10 of the first cycle (each cycle is 21 days).

Collaborators and Investigators

• Sponsor: BeBetter Med Inc
• Investigators: Principal Investigator: Yuankai Shi, Phd, Cancer Institute and Hospital, Chinese Academy of Medical Sciences

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2023
• Primary Completion (Estimated): October 31, 2025
• Study Completion (Estimated): November 5, 2025

Study Registration Dates

• First Submitted: November 22, 2023
• First Submitted That Met QC Criteria: December 1, 2023
• First Posted (Estimated): December 11, 2023

Study Record Updates

• Last Update Posted (Estimated): December 11, 2023
• Last Update Submitted That Met QC Criteria: December 1, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: Safety; Efficacy; Drug combination; BEBT-908
• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Lymphoma, Non-Hodgkin; Lymphoma; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antirheumatic Agents; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Immunologic Factors; Antineoplastic Agents, Alkylating; Alkylating Agents; Antineoplastic Agents, Phytogenic; Topoisomerase II Inhibitors; Topoisomerase Inhibitors; Antineoplastic Agents, Immunological; Carboplatin; Etoposide; Oxaliplatin; Ifosfamide; Rituximab; Gemcitabine
• Other Study ID Numbers: GBMT-908-P06

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No