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Tazemetostat and Mosunetuzumab in Untreated Follicular Lymphoma

Primary Purpose

Follicular Lymphoma

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Mosunetuzumab
Tazemetostat Pill
Sponsored by
Weill Medical College of Cornell University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Follicular Lymphoma focused on measuring Mosunetuzumab, Follicular Lymphoma, Tazemetostat

Eligibility Criteria

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

Inclusion Criteria: Ability to comply with the study protocol Willing to use highly effective contraception, if of childbearing potential Diagnosed with follicular lymphoma (FL; Grades 1-3a) Received no prior systemic lymphoma therapy (local radiotherapy is not considered systemic therapy) Exclusion Criteria: Inability to take oral medication OR have malabsorption syndrome or any other uncontrolled gastrointestinal condition (eg, nausea, diarrhea, vomiting) that might impair the bioavailability of tazemetostat Grade 3b FL History of transformation of indolent disease to diffuse large B cell lymphoma Any prior history of myeloid malignancies, including myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) or myeloproliferative neoplasm (MPN) Any prior history of T cell lymphoblastic lymphoma (T-LBL)/ T cell lymphoblastic leukemia (T-ALL) Active or history of central nervous system lymphoma or leptomeningeal infiltration Prior standard or investigational systemic anti cancer therapy for lymphoma. Patients who have received prior XRT will not be excluded History of solid organ transplantation History of severe allergic or anaphylactic reaction to humanized, chimeric or murine monoclonal antibodies (MAbs) Known or suspected chronic active Epstein-Barr virus (EBV) infection Known or suspected history of hemophagocytic lymphohistiocytosis (HLH) Clinically significant history of liver disease, including viral or other hepatitis, or cirrhosis Active Hepatitis B or Hepatitis C infection HIV positive with CD4 count <200 and not currently taking antiretroviral therapy History of progressive multifocal leukoencephalopathy (PML) Active autoimmune disease requiring treatment History of autoimmune disease, including, but not limited to: myocarditis, pneumonitis, myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis Prior allogeneic stem cell transplant (SCT) Significant cardiovascular disease (e.g., New York Heart Association Class III or IV cardiac disease, myocardial infarction within the previous 6 months, unstable arrhythmia, or unstable angina) or significant pulmonary disease (such as obstructive pulmonary disease or history of bronchospasm) Major surgery other than for diagnosis within 28 days prior to Day 1 of Cycle 1 Day 1 or anticipation of a major surgical procedure during the course of the study Active central nervous system disease or underlying neurologic disease such as stroke or intracranial hemorrhage within 3 months prior to enrollment, history of seizure disorder, or history of neurogenerative disease History of pneumonitis or interstitial lung disease Pregnant or breastfeeding or intending to become pregnant during the study

Sites / Locations

  • Weill Cornell Medicine/NewYork-Presbyterian Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Subcutaneous Mosunetuzumab and Oral Tazemetostat

Arm Description

50 patients will be enrolled and treated with standard dosing of subcutaneous mosunetuzumab, and with oral tazemetostat by mouth twice daily at standard dosing (800 mg twice daily) beginning at the same time as mosunetuzumab initiation.

Outcomes

Primary Outcome Measures

Number of participants who achieve a complete response (CR) by completion of therapy, as determined by the Lugano Criteria
The proportion of patients who achieve complete response as per the Lugano criteria will be calculated and their 90% confidences will be computed with Clopper-Pearson method via exact binomial distribution.

Secondary Outcome Measures

Number of participants who experience cytokine release syndrome (CRS)
CRS will be assessed per American Society for Transplantation and Cellular Therapy (ASTCT) Consensus Grading
Number of participants who experience Immune effector cell-associated neurotoxicity syndrome (ICANS)
ICANS will be assessed per American Society for Transplantation and Cellular Therapy (ASTCT) Consensus Grading
Median Progression-Free Survival (PFS)
PFS is defined as the duration of time from start of treatment to time of progression or death from any cause. Patients will be followed for a maximum of approximately 10 years from the start of treatment.
Median Overall Survival (OS)
OS is defined as the duration of time from start of treatment to death from any cause. Patients will be followed for a maximum of approximately 10 years from the start of treatment.
Objective Response Rate (ORR) at the time of therapy completion, as defined by Lugano Criteria
ORR is defined as the proportion of patients who have a partial or complete response to therapy
Number of participants who achieve a Complete Response (CR) per Lugano's Criteria
Response and progression are evaluated according to the Lugano criteria for lymphoma response.
Median Duration of Response
The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease or death due to any cause, whichever occurs first is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).

Full Information

First Posted
August 8, 2023
Last Updated
September 6, 2023
Sponsor
Weill Medical College of Cornell University
Collaborators
Epizyme, Inc., Genentech, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05994235
Brief Title
Tazemetostat and Mosunetuzumab in Untreated Follicular Lymphoma
Official Title
A Phase II Trial of Tazemetostat Plus Mosunetuzumab in Untreated Follicular Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
September 2023 (Anticipated)
Primary Completion Date
September 2033 (Anticipated)
Study Completion Date
September 2033 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Weill Medical College of Cornell University
Collaborators
Epizyme, Inc., Genentech, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The goal of this study is to learn about the safety and effectiveness of the combination of tazemetostat pills in combination with mosunetuzumab injections for people with follicular lymphoma who haven't received treatment before. The investigators hypothesize that tazemetostat with mosunetuzumab has the potential to increase the efficacy of the product without compromising the safety. Tazemetostat is a drug that inhibits EZH2, an enzyme known to drive the development of B-cell lymphomas, and inhibiting it appears to have many effects that slow down lymphoma growth and enhance the immune system's ability to fight it. Tazemetostat is FDA-approved in previously treated follicular lymphoma and currently undergoing study in other lymphomas. Mosunetuzumab is a bispecific antibody therapy that is a therapeutic strategy that uses the immune system to fight lymphoma, called immunotherapy. Bispecific antibodies have two ends: one attaches to T cells in the immune system and the other attaches to lymphoma cells, helping guide our immune system to attack the cancer. Mosunetuzumab has been studied in follicular lymphoma that has previously been treated, with positive results. Mosunetuzumab is approved by the FDA to be given intravenously (directly into a vein) but is not yet approved by the FDA is not yet approved as an injection under the skin, which is how it is given in this study. They have not yet been studied in combination.
Detailed Description
This is a phase II, open-label study. Fifty patients with previously untreated follicular lymphoma will be enrolled and treated with standard dosing of subcutaneous mosunetuzumab, and with oral tazemetostat by mouth twice daily at standard dosing (800 mg twice daily) beginning at the same time as mosunetuzumab initiation. Mosunetuzumab and tazemetostat will be given in 28-day cycles for up to 12 cycles. Response assessments by PET/CT will occur at 12 weeks post-mosunetuzumab and again at 30 and 48 weeks for those with an ongoing response to treatment. Treatment with steroids, tocilizumab, growth factors, tumor lysis prophylaxis, and antibiotics may be used as per standard of care at our institution. Dose modifications are permitted for toxicity. There will be a follow-up visit after 2 years from starting the study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Follicular Lymphoma
Keywords
Mosunetuzumab, Follicular Lymphoma, Tazemetostat

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Subcutaneous Mosunetuzumab and Oral Tazemetostat
Arm Type
Experimental
Arm Description
50 patients will be enrolled and treated with standard dosing of subcutaneous mosunetuzumab, and with oral tazemetostat by mouth twice daily at standard dosing (800 mg twice daily) beginning at the same time as mosunetuzumab initiation.
Intervention Type
Drug
Intervention Name(s)
Mosunetuzumab
Intervention Description
Mosunetuzumab will be administered in weekly dose increments ("step-up dosing") during Cycle 1 and then on Day 1 of each cycle. Mosunetuzumab will be given in 28-day cycles for up to 12 cycles. Mosunetuzumab will be administered SC at the dose of 5 mg on Day 1, 45 mg on Day 8, and 45 mg on Day 15 in Cycle 1. Beginning with Cycle 2, it will be administered SC at the dose of 45 mg on Day 1. Each cycle lasts 4 weeks.
Intervention Type
Drug
Intervention Name(s)
Tazemetostat Pill
Other Intervention Name(s)
Tazverik
Intervention Description
Oral tazemetostat will be administered by mouth twice daily at standard dosing (800 mg twice daily) beginning at the same time as mosunetuzumab initiation until disease progression, unacceptable toxicity, or consent is withdrawn. Patients will remain on tazemetostat for up to twelve 28-day cycles from initiation of mosunetuzumab.
Primary Outcome Measure Information:
Title
Number of participants who achieve a complete response (CR) by completion of therapy, as determined by the Lugano Criteria
Description
The proportion of patients who achieve complete response as per the Lugano criteria will be calculated and their 90% confidences will be computed with Clopper-Pearson method via exact binomial distribution.
Time Frame
Estimated day 336
Secondary Outcome Measure Information:
Title
Number of participants who experience cytokine release syndrome (CRS)
Description
CRS will be assessed per American Society for Transplantation and Cellular Therapy (ASTCT) Consensus Grading
Time Frame
Day 0 to Day 28
Title
Number of participants who experience Immune effector cell-associated neurotoxicity syndrome (ICANS)
Description
ICANS will be assessed per American Society for Transplantation and Cellular Therapy (ASTCT) Consensus Grading
Time Frame
Day 0 to Day 28
Title
Median Progression-Free Survival (PFS)
Description
PFS is defined as the duration of time from start of treatment to time of progression or death from any cause. Patients will be followed for a maximum of approximately 10 years from the start of treatment.
Time Frame
For a maximum of approximately 10 years
Title
Median Overall Survival (OS)
Description
OS is defined as the duration of time from start of treatment to death from any cause. Patients will be followed for a maximum of approximately 10 years from the start of treatment.
Time Frame
For a maximum of approximately 10 years
Title
Objective Response Rate (ORR) at the time of therapy completion, as defined by Lugano Criteria
Description
ORR is defined as the proportion of patients who have a partial or complete response to therapy
Time Frame
Estimated to be day 336
Title
Number of participants who achieve a Complete Response (CR) per Lugano's Criteria
Description
Response and progression are evaluated according to the Lugano criteria for lymphoma response.
Time Frame
For a maximum of approximately 10 years
Title
Median Duration of Response
Description
The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease or death due to any cause, whichever occurs first is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).
Time Frame
For a maximum of approximately 10 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ability to comply with the study protocol Willing to use highly effective contraception, if of childbearing potential Diagnosed with follicular lymphoma (FL; Grades 1-3a) Received no prior systemic lymphoma therapy (local radiotherapy is not considered systemic therapy) Exclusion Criteria: Inability to take oral medication OR have malabsorption syndrome or any other uncontrolled gastrointestinal condition (eg, nausea, diarrhea, vomiting) that might impair the bioavailability of tazemetostat Grade 3b FL History of transformation of indolent disease to diffuse large B cell lymphoma Any prior history of myeloid malignancies, including myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) or myeloproliferative neoplasm (MPN) Any prior history of T cell lymphoblastic lymphoma (T-LBL)/ T cell lymphoblastic leukemia (T-ALL) Active or history of central nervous system lymphoma or leptomeningeal infiltration Prior standard or investigational systemic anti cancer therapy for lymphoma. Patients who have received prior XRT will not be excluded History of solid organ transplantation History of severe allergic or anaphylactic reaction to humanized, chimeric or murine monoclonal antibodies (MAbs) Known or suspected chronic active Epstein-Barr virus (EBV) infection Known or suspected history of hemophagocytic lymphohistiocytosis (HLH) Clinically significant history of liver disease, including viral or other hepatitis, or cirrhosis Active Hepatitis B or Hepatitis C infection HIV positive with CD4 count <200 and not currently taking antiretroviral therapy History of progressive multifocal leukoencephalopathy (PML) Active autoimmune disease requiring treatment History of autoimmune disease, including, but not limited to: myocarditis, pneumonitis, myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis Prior allogeneic stem cell transplant (SCT) Significant cardiovascular disease (e.g., New York Heart Association Class III or IV cardiac disease, myocardial infarction within the previous 6 months, unstable arrhythmia, or unstable angina) or significant pulmonary disease (such as obstructive pulmonary disease or history of bronchospasm) Major surgery other than for diagnosis within 28 days prior to Day 1 of Cycle 1 Day 1 or anticipation of a major surgical procedure during the course of the study Active central nervous system disease or underlying neurologic disease such as stroke or intracranial hemorrhage within 3 months prior to enrollment, history of seizure disorder, or history of neurogenerative disease History of pneumonitis or interstitial lung disease Pregnant or breastfeeding or intending to become pregnant during the study
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Tejasvi Kaur Sahni
Phone
646-962-9337
Email
tks4001@med.cornell.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Brittany Hobbie
Email
brh4008@med.cornell.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Samuel Yamshon, M.D.
Organizational Affiliation
Weill Medical College of Cornell University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Weill Cornell Medicine/NewYork-Presbyterian Hospital
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tejasvi Kaur Sahni
Email
tks4001@med.cornell.edu
First Name & Middle Initial & Last Name & Degree
Brittany Hobbie
Email
brh4008@med.cornell.edu
First Name & Middle Initial & Last Name & Degree
Samuel Yamshon, M.D.

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Tazemetostat and Mosunetuzumab in Untreated Follicular Lymphoma

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