A Prospective, Open-label, Randomized, Multicenter Phase-III Trial to Evaluate the Efficacy of Pirtobrutinib and Epcoritamab Compared With R-(Mini)-CHOP for Treatment of Patients With DLBCL-type Richter Transformation (CLLRT2)
The aim of the trial is to Evaluate the Efficacy of Pirtobrutinib and Epcoritamab Compared With R-(Mini)-CHOP for Treatment of Patients With DLBCL-type Richter Transformation
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
This trial is a phase 2 study and - according to the definitions of the ICH Harmonized Tripartite Guide-line E8 - a therapeutic exploratory type of study, which is designed as a prospective, multicenter, open label trial. The trial aims to investigate the efficacy and safety of a fixed-duration treatment ap-proach in patients aged 80 years or older and/or those exhibiting symptoms of frailty.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 2
Kontakter og lokationer
Studiesteder
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Melbourne, Australien, 3000
- Rekruttering
- Peter MacCallum Cancer Center
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Kontakt:
- Philip Thompson, Prof.
- Telefonnummer: +613 8559 5000
- E-mail: philip.thompson@petermac.org
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Copenhagen, Danmark, 2100
- Ikke rekrutterer endnu
- Rigshospitalet
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Kontakt:
- Caspar Da Cunha-Bang, MD
- Telefonnummer: +4535450410
- E-mail: Caspar.Da.Cunha-Bang@regionh.dk
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Dublin, Irland, Dublin 9
- Rekruttering
- Beaumont Hospital
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Kontakt:
- Patrick Thornton
- Telefonnummer: +613 8559 5000
- E-mail: philip.thompson@petermac.org
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Galway, Irland, H91 YR71
- Rekruttering
- University Hospital Galway
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Kontakt:
- Amjad Hayat
- Telefonnummer: +35391544281
- E-mail: amjad.hayat@hse.ie
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Cologne, Tyskland, 50937
- Rekruttering
- Uniklinik Köln
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Kontakt:
- Barbara Eichhorst, Prof.
- Telefonnummer: +4922147888220
- E-mail: barbara.eichhorst@uk-koeln.de
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Dresden, Tyskland, 01307
- Ikke rekrutterer endnu
- Technische Universitaet Dresden
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Kontakt:
- Johannes Schetelig, Prof.
- Telefonnummer: +493514585604
- E-mail: Johannes.Schetelig@ukdd.de
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Frankfurt, Tyskland, 60590
- Rekruttering
- Universitätsklinikum Frankfurt
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Kontakt:
- Sebastian Scheich
- Telefonnummer: +496963013767
- E-mail: s.scheich@med.uni-frankfurt.de
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Heidelberg, Tyskland, 69120
- Ikke rekrutterer endnu
- Universitätsklinikum Heidelberg
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Kontakt:
- Peter Dreger, Prof.
- Telefonnummer: +496221568030
- E-mail: Peter.Dreger@med.uni-heidelberg.de
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Kiel, Tyskland, 24105
- Ikke rekrutterer endnu
- Universitätsklinikum Schleswig-Holstein Campus Kiel
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Kontakt:
- Matthias Ritgen, Dr.
- Telefonnummer: +4943150022555
- E-mail: m.ritgen@med2.uni-kiel.de
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Ulm, Tyskland, 89081
- Rekruttering
- Universitätsklinik Ulm
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Kontakt:
- Christof Schneider, Dr.
- Telefonnummer: +4973150056012
- E-mail: christof.schneider@uniklinik-ulm.de
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Innsbruck, Østrig, 6020
- Ikke rekrutterer endnu
- Medizinische Universitaet Innsbruck
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Kontakt:
- Dominik Wolf, Prof.
- Telefonnummer: +4351250424003
- E-mail: mui-oversight@i-med.ac.at
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Vienna, Østrig, 1090
- Rekruttering
- Medizinische Universität Wien
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Kontakt:
- Alexander Gaiger
- Telefonnummer: +4314040044765
- E-mail: alexander.gaiger@meduniwien.ac.at
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
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Age ≥80 years OR considered frail defined by a frailty score of >2 on the FRAIL scale via the patient´s assessment
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Has documented treatment-naïve CLL or small lymphocytic lymphoma (SLL) according to iwCLL 2018 criteria3
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CLL/SLL requiring treatment according to the iwCLL 2018 criteria3
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Adequate marrow function independent of growth factor or transfusion support within 2 weeks of screening as follows, unless cytopenia is due to marrow involvement of CLL:
- Absolute neutrophil count ≥ 1.0 × 10^9/L
- Platelet counts ≥ 30 × 10^9/L; in cases of thrombocytopenia clearly due to marrow in-volvement of CLL (per the discretion of the investigator); platelet count should be ≥ 10 × 10^9/L if there is bone marrow involvement
- Total haemoglobin ≥ 9 g/dL (without transfusion support, unless anaemia is due to mar-row involvement of CLL)
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Adequate liver function as indicated by a total bilirubin, AST, and ALT ≤2 times the institutional upper limit of normal (ULN) value unless directly attributable to the patient's CLL or Gilbert's syndrome
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Adequate renal function defined by a value ≥30 mL/min, determined either by creatinine clearance directly measured with a 24-hour urine collection or via estimated GFR calculated according to the CKD-EPI equation or Cystatin C measurements (e.g. in sarcopenic patients).
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Negative serological testing for hepatitis B (HBsAg negative and anti-HBc negative; patients positive for anti-HBc may be included if PCR for HBV DNA is negative and HBV-DNA PCR is performed repeatedly until 6 months after last month of treatment), negative testing for hepa-titis C RNA within 6 weeks prior to registration
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Life expectancy ≥ 3 months
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In case of a recent previous (i.e. debulking) treatment, patients must have recovered from acute toxicities and treatment regimen must be stopped within the following time periods be-fore start of the study treatment in the CLL-Frail2 trial:
- chemotherapy ≥ 28 days
- antibody treatment ≥ 14 days
- corticosteroids may be applied until the start of the study therapy; these have to be re-duced to an equivalent of ≤ 20mg prednisolone per day during treatment
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Signed informed consent and, in the investigator's judgment, able to comply with the study protocol
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Ability and willingness to provide written informed consent and to adhere to the study visit schedule and other protocol requirements
Exclusion Criteria:
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1. Previous CLL-directed therapies 2. Transformation of CLL to aggressive NHL (Richter's transformation or pro-lymphocytic leu-kaemia) 3. Patients with a history of confirmed progressive multifocal leukoencephalopathy (PML) 4. Uncontrolled autoimmune condition 5. Malignancies other than CLL currently requiring systemic therapies (unless the malignant dis-ease is in a stable remission at the discretion of the treating physician) 6. Uncontrolled infection currently requiring systemic treatment 7. Any serious medical condition or abnormality in clinical laboratory tests that, in the investiga-tor's judgment, precludes the patient's safe participation in and completion of the study 8. Requirement of treatment with any moderate or strong CYP3A4 inhibitor or strong CYP3A4 inducer (≤ 14 days or 5 half-lives, whichever is shorter) before the first dose of study drug, or requiring ongoing treatment with a moderate or strong CYP3A inhibitor or a strong CYP3A in-ducer.
9. Requirement of therapy with phenprocoumon or other vitamin K antagonists 10. Known active infection with HIV, or serologic status reflecting active hepatitis B or C infection as follows:
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Presence of hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb). Patients with presence of HBcAb, but absence of HBsAg, are eligible if hepatitis B virus (HBV) DNA is undetectable (< 20 IU), and if they are willing to undergo monitoring for HBV reactivation
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Presence of hepatitis C virus (HCV) antibody. Patients with presence of HCV antibody are eligible if HCV RNA is undetectable 11. Major surgery within 4 weeks of the first dose of study drug 12. Any uncontrolled or clinically significant cardiovascular disease including the following:
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New York Heart Association class III or IV congestive heart failure
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History of clinically significant arrhythmias (eg, sustained ventricular tachycardia, ventricu-lar fibrillation, torsades de pointes) 13. History of severe bleeding disorder such as hemophilia A, hemophilia B, von Willebrand dis-ease if not CLL/SLL related, or history of spontaneous bleeding requiring blood transfusion or other medical intervention 14. Unable to swallow capsules or disease significantly affecting gastrointestinal function such as malabsorption syndrome, resection of the stomach or small bowel, bariatric surgery proce-dures, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction.
15. Use of investigational agents, e.g. monoclonal antibodies or other experimental drugs within clinical trials, which might interfere with the study drug within 28 days (or 5 times half-life [t1/2] of the compound, whichever is longer) prior to registration 16. Known hypersensitivity to zanubrutinib or sonrotoclax or any of the excipients 17. Pregnant women and nursing mothers (a negative pregnancy test is required for all women of childbearing potential within 7 days before start of treatment) 18. Fertile men or women of childbearing potential unless:
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surgically sterile or ≥ 2 years after the onset of menopause, or
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willing to use two methods of reliable contraception including one highly effective contra-ceptive method (Pearl Index <1) and one additional effective (barrier) method during study treatment and for 7 days after sonrotoclax and 30 days after zanubrutinib respec-tively 19. Vaccination with a live vaccine <28 days prior to registration 20. Legal incapacity 21. Prisoners or subjects who are institutionalized by regulatory or court order 22. Persons who are in dependence to the sponsor or an investigator
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Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
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Aktiv komparator: Arm A: R-(mini)-CHOP
Cycle 1-6 Day 1: Cyclophosphamide 750 mg/m2 iv Doxorubicin 50 mg/m2 iv Vincristine 1.4 mg/m2 (max 2 mg) iv Rituximab 375 mg/m2 iv Day 1-5: Prednisolone 100 mg po If R-CHOP-ineligible*, R-mini-CHOP3 is administered: Cycle 1-6 Day 1: Cyclophosphamide 400 mg/m2 iv Doxorubicin 25 mg/m2 iv Vincristine 1 mg iv Rituximab 375 mg/m2 iv or sc Day 1-5: Prednisolone 100 mg po |
750 mg/m2 iv (R-CHOP) or 400 mg/m2 iv (R-mini-CHOP) 50 mg/m2 iv (R-CHOP) or 25 mg/m2 iv (R-mini-CHOP) 1.4 mg/m2 iv (R-CHOP) or 1 mg/m2 iv (R-mini-CHOP) 375 mg/m2 iv (R-CHOP) or 375 mg/m2 iv or sc (R-mini-CHOP) |
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Eksperimentel: Arm B: Epcoritamab-Pirtobrutinib
12 cycles: Cycle 1 Day 1-21: Pirtobrutinib 200 mg QD po Day 1: Epcoritamab 0.16 mg sc Day 8: Epcoritamab 0.8 mg sc Day 15: Epcoritamab 48 mg sc Cycle 2-4 Day 1-21: Pirtobrutinib 200 mg QD po Day 1, 8, 15: Epcoritamab 48 mg sc Cycle 5+6 Day 1-21: Pirtobrutinib 200 mg QD po Day 1: Epcoritamab 48 mg sc Cycle 7-12: Day 1-28: Pirtobrutinib 200 mg QD po Day 1: Epcoritamab 48 mg sc For patients with CR, PR or SD after 12 cycles (=EO[C]T), maintenance treatment with pirtobrutinib 200 mg QD until unacceptable toxicity, disease progression or allogeneic stem cell transplantation will be offered. |
Cycle 1 Day 1-21: Pirtobrutinib 200 mg QD po Day 1: Epcoritamab 0.16 mg sc Day 8: Epcoritamab 0.8 mg sc Day 15: Epcoritamab 48 mg sc Cycle 2-28 Epcoritamab 48 mg sc
Andre navne:
Pirtobrutinib 200 mg QD po
Andre navne:
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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PFS
Tidsramme: approx. 40 months after first subject in
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Investigator-assessed progression-free survival (PFS) according to Lugano criteria |
approx. 40 months after first subject in
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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ORR
Tidsramme: approx. 40 months after first subject in
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Overall response rate (ORR) at the end of (combination) treatment according to Lugano criteria |
approx. 40 months after first subject in
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CRR
Tidsramme: approx. 40 months after first subject in
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Complete response rate (CRR) at the end of (combination) treatment according to Lugano criteria |
approx. 40 months after first subject in
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Best response according to Lugano criteria
Tidsramme: approx. 40 months after first subject in
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Best response according to Lugano criteria |
approx. 40 months after first subject in
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Undetectable minimal residual disease (uMRD)
Tidsramme: approx. 40 months after first subject in
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Undetectable minimal residual disease (uMRD) rates in peripheral blood at the end of (combination) treatment |
approx. 40 months after first subject in
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DOR
Tidsramme: approx. 40 months after first subject in
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Duration of response (DOR) according to Lugano criteria |
approx. 40 months after first subject in
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Overall survival (OS)
Tidsramme: approx. 40 months after first subject in
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Overall survival (OS) |
approx. 40 months after first subject in
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TTNT
Tidsramme: approx. 40 months after first subject in
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Time to next treatment (TTNT) |
approx. 40 months after first subject in
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TFS
Tidsramme: approx. 40 months after first subject in
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Treatment-free survival (TFS) |
approx. 40 months after first subject in
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SCT
Tidsramme: approx. 40 months after first subject in
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Proportion of patients receiving allogeneic stem cell transplantation (SCT) for consolidation |
approx. 40 months after first subject in
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Aminosyrer, peptider og proteiner
- Proteiner
- Organiske kemikalier
- Heterocykliske forbindelser
- Heterocykliske forbindelser, 2-ring
- Heterocykliske forbindelser, smeltet ring
- Kulbrinter
- Kulbrinter, cyklisk
- Kulhydrater
- Alkaloider
- Polycykliske aromatiske kulbrinter
- Kulbrinter, aromatisk
- Polycykliske forbindelser
- Glycosider
- Indoler
- Antistoffer, monoklonal
- Antistoffer
- Immunoglobuliner
- Immunoproteiner
- Blodproteiner
- Serum globuliner
- Globuliner
- Fosforamid -sennep
- Nitrogen sennepsforbindelser
- Sennepsforbindelser
- Kulbrinter, halogeneret
- Phosphoramider
- Organophosphorforbindelser
- Vinca alkaloider
- Secologanin tryptamin alkaloider
- Indole alkaloider
- Indolizidiner
- Indolizines
- Anthracycliner
- Naphthacenes
- Aminoglycosider
- Antistoffer, monoklonal, murint afledt
- Daunorubicin
- Rituximab
- Cyclofosfamid
- Doxorubicin
- Vincristine
- Pirtobrutinib
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- CLLRT2
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
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