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
Studie Overzicht
Toestand
Toestand
Conditie
Conditie
Interventie / Behandeling
Interventie / Behandeling
Gedetailleerde beschrijving
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.
Studietype
Studietype
Inschrijving (Geschat)
Inschrijving
Fase
Fase
- Fase 2
Contacten en locaties
Studie Locaties
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Melbourne, Australië, 3000
- Werving
- Peter MacCallum Cancer Center
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Contact:
- Philip Thompson, Prof.
- Telefoonnummer: +613 8559 5000
- E-mail: philip.thompson@petermac.org
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Copenhagen, Denemarken, 2100
- Nog niet aan het werven
- Rigshospitalet
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Contact:
- Caspar Da Cunha-Bang, MD
- Telefoonnummer: +4535450410
- E-mail: Caspar.Da.Cunha-Bang@regionh.dk
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Cologne, Duitsland, 50937
- Werving
- Uniklinik Köln
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Contact:
- Barbara Eichhorst, Prof.
- Telefoonnummer: +4922147888220
- E-mail: barbara.eichhorst@uk-koeln.de
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Dresden, Duitsland, 01307
- Nog niet aan het werven
- Technische Universitaet Dresden
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Contact:
- Johannes Schetelig, Prof.
- Telefoonnummer: +493514585604
- E-mail: Johannes.Schetelig@ukdd.de
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Frankfurt, Duitsland, 60590
- Werving
- Universitätsklinikum Frankfurt
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Contact:
- Sebastian Scheich
- Telefoonnummer: +496963013767
- E-mail: s.scheich@med.uni-frankfurt.de
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Heidelberg, Duitsland, 69120
- Nog niet aan het werven
- Universitätsklinikum Heidelberg
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Contact:
- Peter Dreger, Prof.
- Telefoonnummer: +496221568030
- E-mail: Peter.Dreger@med.uni-heidelberg.de
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Kiel, Duitsland, 24105
- Nog niet aan het werven
- Universitätsklinikum Schleswig-Holstein Campus Kiel
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Contact:
- Matthias Ritgen, Dr.
- Telefoonnummer: +4943150022555
- E-mail: m.ritgen@med2.uni-kiel.de
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Ulm, Duitsland, 89081
- Werving
- Universitätsklinik Ulm
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Contact:
- Christof Schneider, Dr.
- Telefoonnummer: +4973150056012
- E-mail: christof.schneider@uniklinik-ulm.de
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Dublin, Ierland, Dublin 9
- Werving
- Beaumont Hospital
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Contact:
- Patrick Thornton
- Telefoonnummer: +613 8559 5000
- E-mail: philip.thompson@petermac.org
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Galway, Ierland, H91 YR71
- Werving
- University Hospital Galway
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Contact:
- Amjad Hayat
- Telefoonnummer: +35391544281
- E-mail: amjad.hayat@hse.ie
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Innsbruck, Oostenrijk, 6020
- Nog niet aan het werven
- Medizinische Universitaet Innsbruck
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Contact:
- Dominik Wolf, Prof.
- Telefoonnummer: +4351250424003
- E-mail: mui-oversight@i-med.ac.at
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Vienna, Oostenrijk, 1090
- Werving
- Medizinische Universität Wien
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Contact:
- Alexander Gaiger
- Telefoonnummer: +4314040044765
- E-mail: alexander.gaiger@meduniwien.ac.at
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Deelname Criteria
Geschiktheidscriteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
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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Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Aantal wapens
Wapens en interventies
Deelnemersgroep / ArmDeelnemersgroep / Arm |
Interventie / BehandelingInterventie / Behandeling |
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Actieve vergelijker: 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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Experimenteel: 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
Andere namen:
Pirtobrutinib 200 mg QD po
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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PFS
Tijdsspanne: 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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Secundaire uitkomstmaten
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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ORR
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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)
Tijdsspanne: 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
Tijdsspanne: 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)
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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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Medewerkers en onderzoekers
Sponsor
Sponsor
Medewerkers
Medewerkers
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Studie start
Primaire voltooiing (Geschat)
Primaire voltooiing
Studie voltooiing (Geschat)
Studie voltooiing
Studieregistratiedata
Eerst ingediend
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Eerst geplaatst
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update geplaatst
Laatste update ingediend die voldeed aan QC-criteria
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
- Aminozuren, peptiden en eiwitten
- Eiwitten
- Organische chemicaliën
- Heterocyclische verbindingen
- Heterocyclische verbindingen, 2-ring
- Heterocyclische verbindingen, gefuseerd ring
- Koolwaterstoffen
- Koolwaterstoffen, cyclisch
- Koolhydraten
- Alkaloïden
- Polycyclische aromatische koolwaterstoffen
- Koolwaterstoffen, aromatisch
- Polycyclische verbindingen
- Glycosiden
- Indolen
- Antilichamen, monoklonaal
- Antilichamen
- Immunoglobulinen
- Immunoproteïnen
- Bloedeiwitten
- Serum -globulines
- Globulines
- Fosforamide mosterd
- Stikstofmosterdverbindingen
- Mosterdverbindingen
- Koolwaterstoffen, gehalogeneerd
- Fosforamides
- Organofosforverbindingen
- Vinca -alkaloïden
- Secologanin tryptamine alkaloïden
- Indol alkaloïden
- Indolizidines
- Indolizines
- Antracyclines
- Naftacenes
- Aminoglycosides
- Antilichamen, monoklonaal, van murine afgeleid
- Daunorubicine
- Rituximab
- Cyclofosfamide
- Doxorubicine
- Vincristine
- pirtobrutinib
Andere studie-ID-nummers
Andere studie-ID-nummers
- CLLRT2
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
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