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Efficacy and Safety Study of PCI-32765 Combine With Ofatumumab in CLL (PCYC-1109-CA)

Primary Purpose

B-cell Chronic Lymphocytic Leukemia, Small Lymphocytic Lymphoma, Prolymphocyctic Leukemia

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
PCI-32765
ofatumumab
Sponsored by
Pharmacyclics LLC.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for B-cell Chronic Lymphocytic Leukemia

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Subjects with histologically confirmed chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), prolymphocytic leukemia (PLL), or Richter's transformation arising out of CLL/SLL as defined by WHO classification of hematopoietic neoplasms and satisfying ≥ 1 of the following conditions:

    • Progressive splenomegaly and/or lymphadenopathy identified by physical examination or radiographic studies
    • Anemia (<11 g/dL) or thrombocytopenia (<100,000/μL) due to bone marrow involvement
    • Presence of unintentional weight loss > 10% over the preceding 6 months
    • NCI CTCAE Grade 2 or 3 fatigue
    • Fevers > 100.5 degree or night sweats for > 2 weeks without evidence of infection
    • Progressive lymphocytosis with an increase of > 50% over a 2 month period or an anticipated doubling time of < 6 months
    • Need for cytoreduction prior to stem cell transplant
  2. Subjects must have failed ≥ 2 prior therapies for CLL including a nucleoside analog or ≥ 2 prior therapies not including nucleoside analog if there is a contraindication to such therapy
  3. 10% expression of CD20 on CLL/SLL cells
  4. ECOG performance status ≤ 2
  5. Life expectancy ≥ 12 weeks
  6. Subjects must have organ and marrow function as defined below:

    • Absolute neutrophil count (ANC) ≥ 1000/µL in the absence of bone marrow involvement
    • Platelets ≥ 30,000/μL in the absence of bone marrow involvement
    • Total bilirubin ≤ 1.5 x institutional upper limit of normal unless due to Gilbert's disease
    • AST (SGOT) ≤ 2.5 x institutional upper limit of normal unless due to infiltration of the liver
    • Creatinine ≤ 2.0 mg/dL OR creatinine clearance ≥ 50 mL/min
  7. No history of prior exposure to ofatumumab
  8. Age ≥ 18 years
  9. Body weight ≥ 40 kg

Exclusion Criteria:

  1. A life-threatening illness, medical condition or organ system dysfunction which, in the investigator's opinion, could compromise the subject's safety, interfere with the absorption or metabolism of PCI-32765 PO, or put the study outcomes at undue risk
  2. Significant cardiovascular disease
  3. Any condition which could interfere with the absorption or metabolism of PCI-32765 including unable to swallow capsules, malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel or ulcerative colitis, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction
  4. Known history of Human Immunodeficiency Virus (HIV) or active infection with Hepatitis C Virus (HCV) or Hepatitis B Virus (HBV) or any uncontrolled active systemic infection
  5. Any anticancer immunotherapy, chemotherapy, radiotherapy, or experimental therapy within 4 weeks before first dose of study drug. Corticosteroids for disease-related symptoms are allowed provided 1 week washout occurs
  6. Active central nervous system (CNS) involvement by lymphoma
  7. Major surgery within 4 weeks before first dose of study drug
  8. Lactating or pregnant
  9. Known moderate to severe chronic obstructive pulmonary disease (COPD)
  10. History of prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer from which the subject has been disease free for at least 2 years or which will not limit survival to < 2 years
  11. History of Grade ≥ 2 toxicity continuing from prior anticancer therapy including radiation

Sites / Locations

  • The Ohio State University

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Group 1

Group 2

Group 3

Arm Description

In Group 1, PCI-32765 420 mg PO was administered daily for 1 cycle (28 days) before the start of ofatumumab IV dosing

In Group 2, PCI-32765 420 mg PO daily was initiated concomitantly with ofatumumab IV (PCI-32765 initiated on Day 2 of Cycle 1)

In Group 3, two cycles of ofatumumab IV were administered prior to the start of PCI-32765 420 mg PO daily

Outcomes

Primary Outcome Measures

Percentage of Participants Achieving Response
The primary endpoint for the study was overall response rate (ORR), defined as the proportion of participants who achieved a best overall response of complete response (CR), CR with incomplete blood count recovery (Cri), or partial response (PR), according to the guidelines from the International Workshop on Chronic Lymphocytic Leukemia (IWCLL1) published in 2008 for CLL participants and International Working Group for non-Hodgkin's lymphoma (IWG NHL) 2007 criteria for SLL participants, with the modification that treatment-related lymphocytosis will not be considered progressive disease, as evaluated by the investigators. Assessment of disease is based on radiological exams, physical exam, hematological evaluations and, when appropriate, bone marrow results.
Safety During Dose-Limiting Toxicity (DLT) Observation Period
Number of dose-limiting toxicities observed in the first 6 participants enrolled in treatment Groups 1 and 2

Secondary Outcome Measures

Number of Participants With Treatment Emergent Adverse Events (AEs)
Number of participants who had experienced at least one treatment emergent AE
Progression Free Survival (PFS) at 12 Months
Progressive disease for CLL (Hallek) is characterized by ≥1 of the following: Appearance of any new lesion, eg lymph nodes (> 1.5 cm), de novo hepatomegaly or splenomegaly, or other organ infiltrates Increase of ≥50% in longest diameter of any previous site in hepatomegaly or splenomegaly in blood lymphocytes with ≥5x109/L B cells with enlarging lymph node, liver, or spleen Progressive disease for B cell lymphoma (Cheson) is characterized by any new lesion or increase by ≥ 50% of previously involved sites from nadir: Appearance of a new lesion(s) >1.5 cm in any axis, ≥ 50% increase in the SPD of >1 node, or ≥50% increase in longest diameter of a previously identified node >1 cm in short axis Lesions PET+ if FDG-avid lymphoma or PET+ before therapy 50% increase from nadir in the SPD of any liver or spleen lesions New or recurrent BM involvement Increase of ≥50% in blood lymphocytes with ≥5x109/L B cells within enlarging lymph node, liver, or spleen

Full Information

First Posted
October 7, 2010
Last Updated
May 28, 2015
Sponsor
Pharmacyclics LLC.
Collaborators
Ohio State University
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1. Study Identification

Unique Protocol Identification Number
NCT01217749
Brief Title
Efficacy and Safety Study of PCI-32765 Combine With Ofatumumab in CLL
Acronym
PCYC-1109-CA
Official Title
An Open-label, Phase 1b/2, Safety and Efficacy Study of the Bruton's Tyrosine Kinase (Btk) Inhibitor, PCI-32765, and Ofatumumab in Subjects With Relapsed/Refractory Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Prolymphocytic Leukemia
Study Type
Interventional

2. Study Status

Record Verification Date
May 2015
Overall Recruitment Status
Completed
Study Start Date
December 2010 (undefined)
Primary Completion Date
June 2013 (Actual)
Study Completion Date
May 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Pharmacyclics LLC.
Collaborators
Ohio State University

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine the efficacy and safety of a fixed-dose, daily regimen of orally administered PCI-32765 combined with ofatumumab in subjects with relapsed/refractory CLL/SLL and related diseases

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
B-cell Chronic Lymphocytic Leukemia, Small Lymphocytic Lymphoma, Prolymphocyctic Leukemia, Richter's Transformation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
71 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Experimental
Arm Description
In Group 1, PCI-32765 420 mg PO was administered daily for 1 cycle (28 days) before the start of ofatumumab IV dosing
Arm Title
Group 2
Arm Type
Experimental
Arm Description
In Group 2, PCI-32765 420 mg PO daily was initiated concomitantly with ofatumumab IV (PCI-32765 initiated on Day 2 of Cycle 1)
Arm Title
Group 3
Arm Type
Experimental
Arm Description
In Group 3, two cycles of ofatumumab IV were administered prior to the start of PCI-32765 420 mg PO daily
Intervention Type
Drug
Intervention Name(s)
PCI-32765
Other Intervention Name(s)
ibrutinib
Intervention Description
420 mg PO daily
Intervention Type
Drug
Intervention Name(s)
ofatumumab
Other Intervention Name(s)
Arzerra
Intervention Description
per package insert as an IV infusion
Primary Outcome Measure Information:
Title
Percentage of Participants Achieving Response
Description
The primary endpoint for the study was overall response rate (ORR), defined as the proportion of participants who achieved a best overall response of complete response (CR), CR with incomplete blood count recovery (Cri), or partial response (PR), according to the guidelines from the International Workshop on Chronic Lymphocytic Leukemia (IWCLL1) published in 2008 for CLL participants and International Working Group for non-Hodgkin's lymphoma (IWG NHL) 2007 criteria for SLL participants, with the modification that treatment-related lymphocytosis will not be considered progressive disease, as evaluated by the investigators. Assessment of disease is based on radiological exams, physical exam, hematological evaluations and, when appropriate, bone marrow results.
Time Frame
The median follow-up time on study for all treated participants is 12.5 (range 0.5-19.6) months
Title
Safety During Dose-Limiting Toxicity (DLT) Observation Period
Description
Number of dose-limiting toxicities observed in the first 6 participants enrolled in treatment Groups 1 and 2
Time Frame
56 days for Group 1 and 28 days for Group 2
Secondary Outcome Measure Information:
Title
Number of Participants With Treatment Emergent Adverse Events (AEs)
Description
Number of participants who had experienced at least one treatment emergent AE
Time Frame
From first dose of study treatment to within 30 days of last dose or until study closure
Title
Progression Free Survival (PFS) at 12 Months
Description
Progressive disease for CLL (Hallek) is characterized by ≥1 of the following: Appearance of any new lesion, eg lymph nodes (> 1.5 cm), de novo hepatomegaly or splenomegaly, or other organ infiltrates Increase of ≥50% in longest diameter of any previous site in hepatomegaly or splenomegaly in blood lymphocytes with ≥5x109/L B cells with enlarging lymph node, liver, or spleen Progressive disease for B cell lymphoma (Cheson) is characterized by any new lesion or increase by ≥ 50% of previously involved sites from nadir: Appearance of a new lesion(s) >1.5 cm in any axis, ≥ 50% increase in the SPD of >1 node, or ≥50% increase in longest diameter of a previously identified node >1 cm in short axis Lesions PET+ if FDG-avid lymphoma or PET+ before therapy 50% increase from nadir in the SPD of any liver or spleen lesions New or recurrent BM involvement Increase of ≥50% in blood lymphocytes with ≥5x109/L B cells within enlarging lymph node, liver, or spleen
Time Frame
From first dose of study treatment until disease progression, death, or until 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects with histologically confirmed chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), prolymphocytic leukemia (PLL), or Richter's transformation arising out of CLL/SLL as defined by WHO classification of hematopoietic neoplasms and satisfying ≥ 1 of the following conditions: Progressive splenomegaly and/or lymphadenopathy identified by physical examination or radiographic studies Anemia (<11 g/dL) or thrombocytopenia (<100,000/μL) due to bone marrow involvement Presence of unintentional weight loss > 10% over the preceding 6 months NCI CTCAE Grade 2 or 3 fatigue Fevers > 100.5 degree or night sweats for > 2 weeks without evidence of infection Progressive lymphocytosis with an increase of > 50% over a 2 month period or an anticipated doubling time of < 6 months Need for cytoreduction prior to stem cell transplant Subjects must have failed ≥ 2 prior therapies for CLL including a nucleoside analog or ≥ 2 prior therapies not including nucleoside analog if there is a contraindication to such therapy 10% expression of CD20 on CLL/SLL cells ECOG performance status ≤ 2 Life expectancy ≥ 12 weeks Subjects must have organ and marrow function as defined below: Absolute neutrophil count (ANC) ≥ 1000/µL in the absence of bone marrow involvement Platelets ≥ 30,000/μL in the absence of bone marrow involvement Total bilirubin ≤ 1.5 x institutional upper limit of normal unless due to Gilbert's disease AST (SGOT) ≤ 2.5 x institutional upper limit of normal unless due to infiltration of the liver Creatinine ≤ 2.0 mg/dL OR creatinine clearance ≥ 50 mL/min No history of prior exposure to ofatumumab Age ≥ 18 years Body weight ≥ 40 kg Exclusion Criteria: A life-threatening illness, medical condition or organ system dysfunction which, in the investigator's opinion, could compromise the subject's safety, interfere with the absorption or metabolism of PCI-32765 PO, or put the study outcomes at undue risk Significant cardiovascular disease Any condition which could interfere with the absorption or metabolism of PCI-32765 including unable to swallow capsules, malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel or ulcerative colitis, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction Known history of Human Immunodeficiency Virus (HIV) or active infection with Hepatitis C Virus (HCV) or Hepatitis B Virus (HBV) or any uncontrolled active systemic infection Any anticancer immunotherapy, chemotherapy, radiotherapy, or experimental therapy within 4 weeks before first dose of study drug. Corticosteroids for disease-related symptoms are allowed provided 1 week washout occurs Active central nervous system (CNS) involvement by lymphoma Major surgery within 4 weeks before first dose of study drug Lactating or pregnant Known moderate to severe chronic obstructive pulmonary disease (COPD) History of prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer from which the subject has been disease free for at least 2 years or which will not limit survival to < 2 years History of Grade ≥ 2 toxicity continuing from prior anticancer therapy including radiation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Samantha Jaglowski, MD
Organizational Affiliation
Ohio State University
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
26813675
Citation
Fraietta JA, Beckwith KA, Patel PR, Ruella M, Zheng Z, Barrett DM, Lacey SF, Melenhorst JJ, McGettigan SE, Cook DR, Zhang C, Xu J, Do P, Hulitt J, Kudchodkar SB, Cogdill AP, Gill S, Porter DL, Woyach JA, Long M, Johnson AJ, Maddocks K, Muthusamy N, Levine BL, June CH, Byrd JC, Maus MV. Ibrutinib enhances chimeric antigen receptor T-cell engraftment and efficacy in leukemia. Blood. 2016 Mar 3;127(9):1117-27. doi: 10.1182/blood-2015-11-679134. Epub 2016 Jan 26.
Results Reference
derived
PubMed Identifier
26182309
Citation
Maddocks KJ, Ruppert AS, Lozanski G, Heerema NA, Zhao W, Abruzzo L, Lozanski A, Davis M, Gordon A, Smith LL, Mantel R, Jones JA, Flynn JM, Jaglowski SM, Andritsos LA, Awan F, Blum KA, Grever MR, Johnson AJ, Byrd JC, Woyach JA. Etiology of Ibrutinib Therapy Discontinuation and Outcomes in Patients With Chronic Lymphocytic Leukemia. JAMA Oncol. 2015 Apr;1(1):80-7. doi: 10.1001/jamaoncol.2014.218.
Results Reference
derived
PubMed Identifier
26116658
Citation
Jaglowski SM, Jones JA, Nagar V, Flynn JM, Andritsos LA, Maddocks KJ, Woyach JA, Blum KA, Grever MR, Smucker K, Ruppert AS, Heerema NA, Lozanski G, Stefanos M, Munneke B, West JS, Neuenburg JK, James DF, Hall N, Johnson AJ, Byrd JC. Safety and activity of BTK inhibitor ibrutinib combined with ofatumumab in chronic lymphocytic leukemia: a phase 1b/2 study. Blood. 2015 Aug 13;126(7):842-50. doi: 10.1182/blood-2014-12-617522. Epub 2015 Jun 26.
Results Reference
derived
PubMed Identifier
23886836
Citation
Dubovsky JA, Beckwith KA, Natarajan G, Woyach JA, Jaglowski S, Zhong Y, Hessler JD, Liu TM, Chang BY, Larkin KM, Stefanovski MR, Chappell DL, Frissora FW, Smith LL, Smucker KA, Flynn JM, Jones JA, Andritsos LA, Maddocks K, Lehman AM, Furman R, Sharman J, Mishra A, Caligiuri MA, Satoskar AR, Buggy JJ, Muthusamy N, Johnson AJ, Byrd JC. Ibrutinib is an irreversible molecular inhibitor of ITK driving a Th1-selective pressure in T lymphocytes. Blood. 2013 Oct 10;122(15):2539-49. doi: 10.1182/blood-2013-06-507947. Epub 2013 Jul 25.
Results Reference
derived
Links:
URL
http://Pharmacyclics.com
Description
www.pharmacyclics.com

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Efficacy and Safety Study of PCI-32765 Combine With Ofatumumab in CLL

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