- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT07583810
Non-covalent BTK Inhibitor Nemtabrutinib in Combination With the CD20 Monoclonal Antibody Rituximab for the Treatment of Marginal Zone Lymphoma
A Phase II Study of the Non-Covalent BTK Inhibitor Nemtabrutinib in Combination With the CD20 Monoclonal Antibody Rituximab in Patients With Marginal Zone Lymphoma
Study Overview
Status
Conditions
Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate safety and tolerability of nemtabrutinib administered in combination with rituximab (NR) in patients with marginal zone lymphoma (MZL). (Safety lead-in) II. To evaluate efficacy of nemtabrutinib administered in combination with rituximab (NR) in patients with MZL based on complete response rate. (Phase 2)
SECONDARY OBJECTIVE:
I. To evaluate efficacy of nemtabrutinib administered in combination with rituximab in patients with MZL based on overall response rate (ORR), progression free survival, duration of response, and overall survival.
EXPLORATORY OBJECTIVE:
I. To evaluate B cell receptor pathway resistance mechanisms in non-responders and patients that relapse.
OUTLINE:
Patients receive nemtabrutinib orally (PO) once daily (QD) on days 1-28 of each cycle and rituximab intravenously (IV) on days 1, 8, 15, and 22 of cycles 1 and 3 and on day 1 of cycles 5-12. Cycles repeat every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity. After 12 cycles, patients with a complete response (CR) or partial response (PR) may optionally continue to receive nemtabrutinib PO QD for up to an additional 12 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo blood sample collection and positron emission tomography (PET)/computed tomography (CT), CT, or magnetic resonance imaging (MRI) throughout the study. Additionally, patients may optionally undergo bone marrow biopsy and tissue biopsy on study.
After completion of study treatment, patients are followed up at 30 days. Patients with CR after 24 cycles or with progressive disease (PD) after 12 cycles are followed every 3 months for up to 1 year. Patients with CR after 12 cycles may optionally follow up every 3 months for up to 2 years.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
California
-
Duarte, California, United States, 91010
- City of Hope Medical Center
-
Principal Investigator:
- Geoffrey Shouse
-
Contact:
- Geoffrey Shouse
- Phone Number: 626-218-2405
- Email: gshouse@coh.org
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Documented informed consent of the participant and/or legally authorized representative
- Assent, when appropriate, will be obtained per institutional guidelines
- Age: ≥ 18 years
- Eastern Cooperative Oncology Group (ECOG) ≤ 2
- Diagnosis of MZL including splenic marginal zone lymphoma (SMZL), extra nodal marginal zone lymphoma (ENMZL) and nodal marginal zone lymphoma (NMZL), established by histologic assessment
Requiring treatment for MZL. Patients receiving prior systemic therapy as well as treatment naïve patients are eligible
- Local radiotherapy not exceeding a total dose of 20 Gy at least 2 weeks prior the first dose of study therapy is allowed
Radiographically measurable lymphadenopathy or extra nodal lymphoid malignancy (as defined by Lugano Classification for non-Hodgkin lymphoma [NHL])
- Subjects with splenic MZL who do not meet the radiographically measurable disease criteria described herein are eligible for participation provided that bone marrow infiltration of MZL is histologically confirmed
- Subjects with skin extranodal marginal zone lymphoma (EMZL) who do not meet the radiographically measurable disease criteria described herein are eligible provided that skin lesion measures ≥ 1.5 cm in diameter and is documented by photo or there are multiple skin lesions measuring > 1cm in diameter on the body that cannot be incorporated in one radiation field and at least one of them is histologically confirmed as MZL
- Subjects with gastric extra nodal MZL histologically confirmed and need therapy but do not have measurable disease and in which response to treatment can be assess by multiple random gastric biopsies
- Subjects with conjunctival EMZL who do not meet the radiographically measurable disease criteria described herein are eligible provided that conjunctival lesion measures ≥ 1 cm in diameter and is documented by photo or there are multiple conjunctival lesions measuring together > 1 5cm that cannot be treated by radiation because of previous radiation therapy, contraindications to radiation and patient refusal to receive radiation therapy. At least one of these lesions needs be histologically confirmed as MZL
Willing to provide a lymph node or tissue biopsy from the most recent available archival tissue or undergo an incisional or excisional lymph node or tissue biopsy
- Subjects with splenic MZL who do not have a tumor to biopsy or an archival tumor tissue sample are eligible provided subject is willing to undergo a bone marrow biopsy or provide an archival bone marrow biopsy that was obtained before the date of the first dose of study treatment; bone marrow sample must show histologically confirmed infiltration of MZL
At least one of the following criteria for treatment initiation:
- Involvement of ≥ 3 nodal sites, each with diameter of ≥ 3 cm
- Any nodal or extra nodal tumor mass with a diameter of ≥ 5 cm
- B symptoms (fever ≥ 38 degrees Celsius of unclear etiology, night sweats, weight loss > 10% within the prior 6 months) or other symptoms attributed to disease or specific organ involvement associated with the relapse
- Risk of local compressive symptoms that may result in organ compromise
- Splenomegaly or splenic lesion without splenomegaly
- Leukopenia attributed to MZL (leukocytes < 1000/mm^3)
- Leukemia (> 5,000 lymphoma cells/mm^3)
- Threatened organ function, especially for extra nodal MZL
- Requirement for transfusion or growth factor support attributed to lymphoma
- Involvement of 2 or more extra nodal sites, with tumor/lesion in each extra nodal site ≥ 1 cm
- Progression or relapsed within 24 months after MZL diagnosis in patients previously treated with ≥ 1 line of systemic therapy
- Life expectancy > 3 months
- Prior adverse events (AEs) must be resolved to grade 1
Without bone marrow involvement: Absolute neutrophil count (ANC) ≥ 1,000/mm^3
- NOTE: Growth factor is not permitted within 7 days of ANC assessment unless cytopenia is secondary to disease involvement
With bone marrow involvement: ANC ≥ 500/mm^3
- NOTE: Growth factor is not permitted within 7 days of ANC assessment unless cytopenia is secondary to disease involvement
Without bone marrow involvement: Platelets ≥ 50,000/mm^3
- NOTE: Platelet transfusions are not permitted within 7 days of platelet assessment unless cytopenia is secondary to disease involvement.
With bone marrow involvement: Platelets ≥ 30,000/mm^3
- NOTE: Platelet transfusions are not permitted within 7 days of platelet assessment unless cytopenia is secondary to disease involvement.
Total bilirubin ≤ 1.5 x upper limit of normal (ULN)
- Subjects with documented history of Gilbert's syndrome and in whom total bilirubin elevations are accompanied by elevated indirect bilirubin are eligible
- Hemoglobin ≥ 8.0 g/dL
- Aspartate aminotransferase (AST) ≤ 2.5 x ULN or ≤ 5 x ULN in the presence of liver involvement by lymphoma
- Alanine aminotransferase (ALT) ≤ 2.5 x ULN or ≤ 5 x ULN in the presence of liver involvement by lymphoma
- Creatinine clearance of ≥ 45 mL/min/1.73 m^2 using the Modification of Diet in Renal Disease formula OR ≥ 45 mL/min by the Cockcroft-Gault formula
Seronegative for hepatitis C virus (HCV), hepatitis B virus (HBV) (surface antigen negative) OR
- If seropositive for HBV or HCV, nucleic acid quantitation must be performed. Viral load must be undetectable.
Patients with occult or prior HBV infection (defined as negative hepatitis B virus surface antigen [HBsAg] and positive hepatitis B core antibody [HBcAb]) may be included if HBV deoxyribonucleic acid (DNA) is undetectable, if they are willing to undergo DNA testing on day 1 of every cycle and every three months for at least 12 months after the last cycle of study treatment
Participants with HIV are eligible if they meet ALL the following:
- CD4 count > 350 cells/µL at screening
- The HIV viral load is below the detectable level as per locally available testing
Are on a stable antiretroviral therapy (ART) regimen for at least 4 weeks prior to study entry
- NOTE: ART includes drugs, which are NOT strong cytochrome P450 (CYP)3A4 inducers (participants receiving ART that are strong CYP3A4 inducers are not eligible to be included in the study)
HIV screening tests are not required unless:
- Known history of HIV infection
- As mandated by local health authority
Are compliant with their ART
- NOTE: If the participant has had an AIDS defining opportunistic infection in the past 12 months prior to screening, they are not eligible to be included in the study
Person of childbearing potential (POCBP): Negative urine or serum pregnancy test
- If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
Participants assigned male sex at birth:
If capable of producing sperm, the participant agrees to the following during the intervention period and for at least the time needed to eliminate each study intervention after the last dose of study intervention. The length of time required to continue contraception for each study intervention is:
- Nemtabrutinib: 12 days
- Rituximab: 3 months
- Abstains from penile-vaginal intercourse as their preferred and usual lifestyle (abstinent on a long-term and persistent basis) and agrees to remain abstinent OR
Uses contraception as detailed below unless confirmed to be azoospermic (vasectomized or secondary to medical cause, documented from the site personnel's review of the participant's medical records, medical examination, or medical history interview) as detailed below:
- Uses a penile/external condom plus nonparticipant of childbearing potential who is not currently pregnant and should also be advised of the benefit for that partner to use an additional method of contraception, as a condom may break or leak
- Note: Participants capable of producing ejaculate whose partner is pregnant or breastfeeding must agree to use penile/external condom during each episode of sexual activity in which the partner is at risk of drug exposure via ejaculate
- Contraceptive use by participants capable of producing sperm should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. If the contraception requirements in the local label for any of the study interventions are more stringent than the requirements above, the local label requirements are to be followed
Participants assigned female sex at birth:
A participant assigned female sex at birth is eligible to participate if not pregnant or breastfeeding, and at least one of the following conditions applies:
- Is not a person of childbearing potential (POCBP) OR
Is a POCBP and:
Uses a contraceptive method that is highly effective (with a failure rate of < 1% per year), with low user dependency, or is abstinent from penile-vaginal intercourse as their preferred and usual lifestyle (abstinent on a long-term and persistent basis), during the intervention period and for at least the time needed to eliminate each study intervention after the last dose of study intervention. The length of time required to continue contraception for each study intervention is:
- Nemtabrutinib: 1 month
- Rituximab: 12 months
- The investigator should evaluate the potential for contraceptive method failure (ie, noncompliance, recently initiated) in relationship to the first dose of study intervention. Contraceptive use by POCBPs should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. If the contraception requirements in the local label for any of the study interventions are more stringent than the requirements above, the local label requirements are to be followed.
- Has a negative highly sensitive pregnancy test (urine or serum) as required by local regulations within 24 hours (for urine test) or 72 hours (for serum test) before the first dose of study intervention. If a urine test cannot be confirmed as negative (e.g., an ambiguous result), a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive
- Abstains from breastfeeding during the study intervention period and for at least 30 days after study intervention with nemtabrutinib
- Medical history, menstrual history, and recent sexual activity has been reviewed by the investigator to decrease the risk for inclusion of a POCBP with an early undetected pregnancy
- Patients with gastrointestinal dysfunction and/or clinically significant medical condition of malabsorption, inflammatory bowel disease, chronic conditions which manifest with diarrhea, refractory nausea, vomiting or any other condition that will interfere significantly with drug absorption (e.g., gastric bypass surgery, gastrectomy)
Exclusion Criteria:
Evidence of diffuse large B-cell lymphoma (DLBCL) transformation
- Subjects with presumptive evidence of transformation based on clinical assessment of factors such as, but not limited to, increasing lactate dehydrogenase, rapidly worsening disease, or frequent B-symptoms, must be ruled out for a transformation to a more aggressive disease, such as DLBCL
- History of central nervous system lymphoma (either primary or metastatic) or leptomeningeal disease
- Active graft versus host disease
- Concurrent anticancer therapy (eg, chemotherapy, radiation therapy, surgery, immunotherapy, biologic therapy, hormonal therapy, investigational therapy, or tumor embolization)
- Allogeneic stem cell transplant within the last 6 months, or autologous stem cell transplant within the last 3 months before the date of the first dose of study treatment
Receipt of anticancer medications or investigational drugs within the following intervals before the date of the first dose of study treatment:
- < 10 weeks from completion of any radio- or toxin-immunoconjugates
- < 4 weeks for immunotherapy
- < 3 weeks for radiotherapy
- < 2 weeks for any investigational agent or other anticancer medications
- Steroids that are used for treatment of allergy or other underlying condition are permittable, but not steroids started to treat lymphoma. Subjects receiving corticosteroids must be at a dose level ≤ 10 mg/day within 7 days of the study treatment administration
- Inadequate recovery from adverse events related to prior therapy to grade ≤ 1 (excluding grade 2 alopecia and neuropathy)
- Prior non-covalent BTK inhibitor (prior covalent BTK inhibitors are allowed)
- Major surgery (under general anesthesia) within 30 days prior to therapy initiation
- Live vaccine within 30 days
- Use of strong cytochrome P450 3A4 (CYP3A4) inhibitors or inducers within 2 weeks of the first day of study therapy
History of prior malignancy except:
- Malignancy treated with curative intent and no known active disease present for ≥ 2 years prior to initiation of therapy
- Adequately treated non-melanoma skin cancer or lentigo maligna (melanoma in situ) without evidence of disease
- Adequately treated in situ carcinomas (e.g., cervical, esophageal, etc.) without evidence of disease
- Asymptomatic prostate cancer managed with "watch and wait" strategy
- Superficial bladder cancer
- Myelodysplastic syndrome which is clinically well controlled and no evidence of the cytogenetic abnormalities characteristic of myelodysplasia on the bone marrow at screening
- History of severe bleeding disorder defined as an ongoing congenital or acquired condition that leads to an increased likelihood of bleeding
Unstable cardiac disease as defined by one of the following:
- Acute myocardial infarction (MI) within the past 6 months
- NYHA (New York Heart Association) heart failure class III
- Unstable angina (angina symptoms at rest) or new-onset angina (begun within the last 3 months)
- Left ventricular ejection fraction (LVEF) < 45%
- Corrected QT interval (QTc) prolongation (defined as a Fridericia's formula-corrected QT interval [QTcF] > 450 msecs) or other significant electrocardiogram (ECG) abnormalities including second degree atrioventricular (AV) block type II, third degree AV block, or bradycardia (ventricular rate less than 50 beats/min)
- AIDS-defining opportunistic infection in the past 12 months prior to screening
- History or concurrent condition of interstitial lung disease and/or severely impaired lung function
- Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within 3 months before the start of study treatment
- History of organ transplant
- Known allergy/sensitivity to nemtabrutinib or any of the excipients; history of allergic reactions attributed to compounds of similar chemical or biologic composition to study agents
- Clinically significant uncontrolled illness
- Known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of nail beds) at study enrollment or any major episode of infection (as evaluated by the investigator) within 4 weeks prior to the first study treatment
- Primary or secondary central nervous system (CNS) lymphoma at the time of recruitment or history of CNS lymphoma
- POCBP: Pregnant or breastfeeding
- Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures
- Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Treatment (nemtabrutinib, rituximab)
Patients receive nemtabrutinib PO QD on days 1-28 of each cycle and rituximab IV on days 1, 8, 15, and 22 of cycles 1 and 3 and on day 1 of cycles 5-12.
Cycles repeat every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
After 12 cycles, patients with a CR or PR may optionally continue to receive nemtabrutinib PO QD for up to an additional 12 cycles in the absence of disease progression or unacceptable toxicity.
Patients also undergo blood sample collection and PET/CT, CT, or MRI throughout the study.
Additionally, patients may optionally undergo bone marrow biopsy and tissue biopsy on study.
|
Undergo MRI
Other Names:
Undergo blood sample collection
Other Names:
Given IV
Other Names:
Undergo PET/CT
Other Names:
Undergo bone marrow biopsy
Other Names:
Undergo CT or PET/CT
Other Names:
Given PO
Other Names:
Undergo tissue biopsy
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Incidence of unacceptable toxicity (Safety lead-in)
Time Frame: During cycle 1 (cycle length = 28 days)
|
Observed toxicities will be summarized by type, severity, and attribution.
|
During cycle 1 (cycle length = 28 days)
|
|
Complete response (CR) rate (Phase 2)
Time Frame: Up to 3 years
|
Will be defined as achieving a best response of CR at any time on the study prior to any disease progression or start of other non-protocol anti-lymphoma therapy.
CR rate will be estimated along with the 95% exact binomial confidence interval.
|
Up to 3 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Overall response rate (ORR)
Time Frame: Up to 3 years
|
Will be defined as achieving a best response of either CR or partial response (PR) any time on the study prior to any disease progression or start of other anti-lymphoma therapy.
ORR will be estimated along with the 95% exact binomial confidence interval.
|
Up to 3 years
|
|
Progression-free survival (PFS)
Time Frame: From start of protocol treatment to disease relapse/progression or death due to any cause, whichever occurs earlier, assessed up to 3 years
|
Will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error, 95% confidence interval will be constructed based on log-log transformation.
Median PFS will be estimated when possible.
|
From start of protocol treatment to disease relapse/progression or death due to any cause, whichever occurs earlier, assessed up to 3 years
|
|
Duration of response (DOR)
Time Frame: From the first achievement of PR or CR to the time of disease relapse/progression or death due to any cause, whichever earlier, assessed up to 3 years
|
Will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error, 95% confidence interval will be constructed based on log-log transformation.
Median DOR will be estimated when possible.
|
From the first achievement of PR or CR to the time of disease relapse/progression or death due to any cause, whichever earlier, assessed up to 3 years
|
|
Overall survival (OS)
Time Frame: From start of protocol treatment to death due to any cause, assessed up to 3 years
|
Will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error, 95% confidence interval will be constructed based on log-log transformation.
Median OS will be estimated when possible.
|
From start of protocol treatment to death due to any cause, assessed up to 3 years
|
|
Incidence of adverse events
Time Frame: Up to 30 days after last dose of study treatment
|
Will be recorded and graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 scale.
Observed toxicities will be summarized by type, severity, and attribution.
|
Up to 30 days after last dose of study treatment
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Geoffrey Shouse, City of Hope Medical Center
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Neoplasms
- Immune System Diseases
- Neoplasms by Histologic Type
- Lymphatic Diseases
- Lymphoproliferative Disorders
- Immunoproliferative Disorders
- Lymphoma, Non-Hodgkin
- Lymphoma, B-Cell
- Hemic and Lymphatic Diseases
- Lymphoma
- Lymphoma, B-Cell, Marginal Zone
- Amino Acids, Peptides, and Proteins
- Proteins
- Investigative Techniques
- Clinical Laboratory Techniques
- Diagnostic Techniques and Procedures
- Diagnosis
- Surgical Procedures, Operative
- Cytological Techniques
- Cytodiagnosis
- Antibodies, Monoclonal
- Antibodies
- Immunoglobulins
- Immunoproteins
- Blood Proteins
- Serum Globulins
- Globulins
- Diagnostic Techniques, Surgical
- Chemistry Techniques, Analytical
- Spectrum Analysis
- Antibodies, Monoclonal, Murine-Derived
- Rituximab
- Biopsy
- Specimen Handling
- Magnetic Resonance Spectroscopy
- CT-P10
- ARQ531
Other Study ID Numbers
- 260148 (Other Identifier: City of Hope Medical Center)
- P30CA033572 (U.S. NIH Grant/Contract)
- NCI-2026-03180 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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