Use of Venetoclax as Single Agent in Patients With Relapsed/Refractory BCL-2 Positive Peripheral T Cell Lymphoma
T-Cell Lymphoma Relapsed, T-Cell Lymphoma Refractory
About this trial
This is an interventional treatment trial for T-Cell Lymphoma Relapsed focused on measuring BCL-2 positive, PTCL-NOS, angioimmunoblastic T-cell lymphoma (AITL), T-follicular helper origin (TFH), Venetoclax, single agent
Eligibility Criteria
Inclusion criteria:
- Histologically documented diagnosis of BCL-2 positive PTCL-NOS, AITL, TFH as defined in the 2016 edition of the World Health Organization (WHO) classification. Only patients with percentage of BCL-2 positive tu-mor cells ≥ 25% in the relapse biopsy, if available, or otherwise in the ini-tial biopsy, will be included onto the study;
- Age ≥ 18 years
- Relapsed or refractory to at least one previous standard line of treatment
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 2
- At least one site of measurable nodal or extranodal disease at baseline ≥ 2.0 cm in the longest transverse diameter as determined by CT scan (MRI is allowed only if CT scan cannot be performed). Note: Patients with only bone marrow involvement are eligible
- Adequate hematological counts defined as follows:
- Absolute Neutrophil count (ANC) > 1.0 x 10^9/L unless due to bone marrow involvement by lymphoma
- Platelet count ≥ 50.000/mm^3 unless due to bone marrow involvement by lymphoma
- Adequate renal function defined as follows:
- Creatinine clearance ≥ 30 mL/min
- Adequate hepatic function per local laboratory reference range as follows:
- Aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 3.0 x ULN
- Bilirubin ≤1.5 x ULN (unless bilirubin rise is due to Gilbert's syn-drome or of non-hepatic origin)
- Subject understands and voluntarily signs an informed consent form ap-proved by an Independent Ethics Committee (IEC)/Institutional Review Board (IRB), prior to the initiation of any screening or study-specific pro-cedures
- Subject must be able to adhere to the study visit schedule and other pro-tocol requirements
- Subject must be able to swallow capsules or tablets
- Life expectancy ≥ 3 months
- Women must be:
- postmenopausal for at least 1 year (must not have had a natural menses for at least 12 months)
- surgically sterile (have had a hysterectomy or bilateral oophorectomy, tubal ligation, or otherwise be incapable of pregnancy),
- completely abstinent (periodic abstinence from intercourse is not per-mitted) or if sexually active, be practicing a highly effective method of birth control (e.g., prescription oral contraceptives, contraceptive injec-tions, contraceptive patch, intrauterine device, double barrier method (e.g.: condoms, diaphragm, or cervical cap, with spermicidal foam, cream, or gel, male partner sterilization) as local regulations permit, be-fore entry, and must agree to continue to use the same method of con-traception throughout the study. They must also be prepared to contin-ue birth control measures for at least 1 month after terminating treat-ment.
- women of childbearing potential must have a negative pregnancy test at screening
- Men must agree to use an acceptable method of contraception (fort themselves or female partners as listed above) for the duration of the study. Men must agree to use a double barrier method of birth control and to not donate sperm during the study and for 1 month after receiving the last dose of study drug.
Male even if surgically sterilized (i.e., status postvasectomy) must agree to 1 of the following:
- practice effective barrier contraception during the entire study treatment period and through 1 months after the last dose of study drug, or
- agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g., calendar, ovulation, symptothermal, postovulation methods for the female part-ner] and withdrawal are not acceptable methods of contraception)
Exclusion criteria
- Histological diagnosis different from BCL-2 positive PTCL-NOS, AITL, and TFH
- Allogeneic or autologous stem cell transplant within 6 months prior to the informed consent signature
- Treatment with any of the following within 7 days prior to the first dose of study drug:
- steroid therapy for anti-neoplastic intent
- moderate or strong cytochrome P450 3A (CYP3A) inhibitors (see Ap-pendix C for examples)
- moderate or strong CYP3A inducers (see Appendix C for examples)
- Subject has received any anti-cancer therapy including chemotherapy, immunotherapy, radiotherapy, investigational therapy, including targeted small molecule agents within 14 days prior to the first dose of study drug
- History of CNS involvement by lymphoma
- Administration or consumption of any of the following within 3 days prior to the first dose of study drug:
- grapefruit or grapefruit products
- Seville oranges (including marmalade containing Seville oranges)
- star fruit
- Previous treatment with a BCL-2 family protein inhibitor
- Subject is known to be positive for HIV (HIV testing is not required)
- Cardiovascular disease (NYHA class ≥2)
- Creatinine Clearance < 30 mL/min
- Significant history of neurologic, psychiatric, endocrinologic, metabolic, immunologic, or hepatic disease that would preclude participation in the study or compromise ability to give informed consent.
- Any history of other active malignancies within 3 years prior to study en-try, with the exception of adequately treated in situ carcinoma of the cer-vix uterine, basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin, previous malignancy confined and surgically re-sected with curative intent.
- Subject who has malabsorption syndrome or other condition which pre-cludes enteral route of administration.
- Evidence of other clinically significant uncontrolled condition(s) including, but not limited to uncontrolled and/or active systemic infection (viral, bac-terial or fungal)
- Active HBV positive hepatitis
- The following categories of patients HBV positive but with non evidence of active hepatitis may be considered for the study:
- HBsAg positive with HBV DNA < 2000 UI/ml (inactive carriers); HBV DNA > 2000 UI/ml is criteria of exclusion
- HBsAg negative but HBsAb positive
- HBsAg negative but HBcAb positive
- Patients HBsAg positive with HBV DNA < 2000 UI/ml and HBsAg nega-tive but HBcAb positive will be eligible for the study only if they accept to receive prophylactic Lamivudine 100 mg/daily for all the period of treatment and at least for 12 months after the end of therapy. Treatment with ABT-199 should be stopped in case of hepatitis reactivation.
- Active HCV positive hepatitis
- If female, the patient is pregnant or breast-feeding.
Sites / Locations
- Centro Riferimento Oncologico - S.O.C. Oncologia Medica A
- Policlinico S.Orsola-Malpighi - Istituto di Ematologia "Seragnoli"
- ASST Spedali Civili di Brescia - Ematologia
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano - Ematologia
- Istituto Scientifico San Raffaele - Unità Linfomi - Dipartimento Oncoematologia
- AOU Maggiore della Carità di Novara - SCDU Ematologia
- IRCCS Policlinico S. Matteo di Pavia - Div. di Ematologia
- Ospedale delle Croci - Ematologia
- Azienda Unità Sanitaria Locale-IRCCS - Arcispedale Santa Maria Nuova - Ematologia
- Azienda sanitaria-universitaria integrata Trieste-SC Ematologia
- Azienda Sanitaria Universitaria Integrata di Udine (A.S.U.I. Udine) - SOC Clinica Ematologica
- Ospedale di Circolo - U.O.C Ematologia
- ULSS 8 Berica - Ospedale S. Bortolo - Ematologia
Arms of the Study
Arm 1
Experimental
ARM1 - Venetoclax (ABT-199)
Venetoclax (ABT-199) will be administered orally at the dose of 800 mg once daily. Response evaluation will be performed initially after 3 cycles from the beginning of treatment with ABT-199 and then every 3 cycles during the first 12 cycles, every 4 cycles from cycle 13 to 24; for those patients still on therapy after 24 cycles, the response evaluation, after this time, will be performed every 6 cycles.