A Study of Nemtabrutinib (MK-1026) in Participants With Relapsed or Refractory Hematologic Malignancies (ARQ 531-101/MK-1026-001)
Lymphoma, B-Cell, Small Lymphocytic Lymphoma, Chronic Lymphocytic Leukemia
About this trial
This is an interventional treatment trial for Lymphoma, B-Cell focused on measuring nemtabrutinib, Hematologic Malignancies, SLL, CLL, B-cell NHL, WM, BTK (Brutons tyrosine kinase), cancer, refractory, relapsed, Acalabrutinib, ArQule, BGB-3111, Blood Protein Disorders, Follicular Lymphoma, BTK Intolerant, C481, C481S, C481S Mutation, Cardiovascular Diseases, Chronic Lymphocytic Leukemia, DLBCL (Diffuse Large B-cell lymphoma), GS-4059, Hemorrhagic Disorders, Hemostatic Disorders, Ibrutinib, Immune System Diseases, Immunoproliferative Disorders, Leukemia, Leukemia, B-Cell, Leukemia, Lymphocytic, Chronic, B-Cell, Leukemia, Lymphoid, Lymphatic Diseases, Lymphoma, Lymphoma, B-Cell, Lymphoma, B-Cell, Marginal Zone, Lymphoma, Mantle-Cell, Lymphoma, Non-Hodgkin, Lymphoproliferative Disorders, Mantle Cell Lymphoma, Marginal zone lymphoma, Neoplasms, Neoplasms by Histologic Type, Neoplasms, Plasma Cell, NHL (Non-Hodgkins Lymphoma), ONO-4059, Paraproteinemias, Small Lymphocytic Lymphoma, Tirabrutinib, Vascular Diseases, Waldenstrom Macroglobulinemia, Zanubrutinib
Eligibility Criteria
Inclusion Criteria
Each prospective participant must meet ALL of the following inclusion criteria in order to be eligible for this study:
- Signed written informed consent granted prior to initiation of any study-specific procedures
- For the dose escalation cohorts, relapsed or refractory (R/R) participants with a diagnosis of B-cell Non-Hodgkin's lymphoma (NHL), chronic lymphocytic leukemia (CLL)/ small lymphocytic lymphoma (SLL) and Waldenstrom macroglobulinemia (WM) who have received at least two prior systemic therapies . Participants must have failed or are intolerant to standard therapies and cannot be a candidate for standard salvage regimens. Participants with low grade lymphoma must be progressing and requiring treatment
For the expansion cohorts, the following criteria must be met:
- Cohort A: R/R CLL/SLL participants with at least 2 prior systemic therapies and previously treated with a covalent Bruton's tyrosine kinase inhibitor (BTKi) who must have a documented Bruton's tyrosine kinase (BTK) mutation on C481 residue
- Cohort B: R/R CLL/SLL participants who have failed or were intolerant to a BTKi with documentation of the absence of BTK mutation on C481 residue. In this study, intolerance to standard therapy is defined as having experienced a grade 3 or higher adverse event that was caused by the standard therapy and resulted in treatment discontinuation
- Cohort C: Richter's transformation (RT) participants who have failed at least one prior therapy
- Cohort D: Follicular Lymphoma (FL) participants who have failed at least 2 prior systemic therapies and are histology grade 1, 2, or 3A
- Cohort E: Mantle Cell Lymphoma (MCL) participants who have failed at least 2 prior systemic therapies
- Cohort F: Marginal Zone Lymphoma (MZL) participants who have failed at least 2 prior systemic therapies
- Cohort G: High-grade B-cell lymphoma participants who have failed at least 2 prior systemic therapies and have known MYC and BCL2 and/or BCL6 translocations
- Cohort H: WM participants who have failed at least 2 prior systemic therapies
Disease status requirement:
- For CLL participanst symptomatic disease that mandates treatment (Hallek et al. 2018)
- For B-cell NHL participants, measurable disease by imaging scan
- For WM, serum immunoglobulin M (IgM) with a minimum IgM level of ≥ 2 times the upper limit of normal (ULN)
- Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
- Good organ function
- Creatinine clearance of ≥ 60 mL/min as estimated by the Cockcroft-Gault equation or by 24-hour urine collection
- Total bilirubin ≤ 1.5 x institutional ULN (total bilirubin of ≤ 3 x institutional ULN in participants with documented Gilbert's syndrome)
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 × institutional ULN
- Platelet count ≥ 50,000/µL
- Absolute neutrophil count (ANC) ≥ 1000/µL
- Hemoglobin (Hgb) ≥ 8.0 g/dL, stable for ≥ 1 week.
- For men and women of child-bearing potential, willing to use adequate contraception (e.g., latex condom, cervical cap, diaphragm, abstinence, etc.) for the entire duration of the study
- Female participants of child-bearing potential must have a negative serum pregnancy test within 14 days of the first day of drug dosing
- Ability to swallow oral medications without difficulty
Exclusion Criteria
Potential participants who meet ANY of the following exclusion criteria are not eligible for enrollment into this study:
- Had immunotherapy, radiotherapy, radioimmunotherapy, biological therapy, chemotherapy, or treatment with an investigational product within 5 half-lives or four weeks (whichever is shorter) prior to treatment initiation, or oral therapy within 5 half-lives or one week (whichever is shorter) prior to treatment initiation
- Transformation of follicular lymphoma (FL) to a more aggressive subtype of lymphoma or grade 3b FL
Participants currently being treated with the following drugs:
- cytochrome P 450 (CYP) 2C9 substrates with a narrow therapeutic index (such as warfarin, phenytoin)
- CYP 2C8 substrates with a narrow therapeutic index (such as paclitaxel)
- CYP 2C19 substrates with a narrow therapeutic index (such as S-mephenytoin)
- CYP 2D6 substrates with a narrow therapeutic index (such as thioridazine, pimozide)
- P-gp substrates with a narrow therapeutic index (such as digoxin) Note: A washout period of at least 5 times the half-life after the last dose of any of the above treatments is required for a participant to be eligible for study enrollment
- Prior allogeneic bone marrow transplant
- Active central nervous system (CNS) involvement
- Pregnant or breast-feeding women
- Has significant, ongoing co-morbid conditions which would preclude safe delivery of the study drug
- Uncontrolled illness including but not limited to ongoing or active infection, symptomatic congestive heart failure (New York Heart Association [NYHA] Class III or IV heart failure), unstable angina pectoris, cardiac arrhythmia, cardiac infarction in the past six months, and psychiatric illness that would limit compliance with study requirements
- QT corrected (QTc) prolongation (defined as a QTc > 450 msecs) or other significant electrocardiogram (ECG) abnormalities including 2nd degree atrioventricular (AV) block type II, 3rd degree AV block, or bradycardia (ventricular rate less than 50 beats/min). If the screening ECG has a QTc > 450 msecs, the ECG can be submitted for a centralized, cardiologic evaluation.
- Active human immunodeficiency virus (HIV) infection, Hepatitis B, or Hepatitis C infection.
- Other medical or psychiatric illness or organ dysfunction which, in the opinion of the Investigator, would either compromise the participant's safety or interfere with the evaluation of the safety of the study agent
- History of prior cancer within < 1 year, except for basal cell or squamous cell carcinoma of the skin, cervical cancer in situ or other in situ carcinomas
Sites / Locations
- Mayo Clinic Hospital ( Site 0140)
- UCLA Hematology & Oncology ( Site 0017)
- Colorado Blood Cancer Institute ( Site 0225)
- University of Michigan ( Site 0018)
- Mayo Clinic - Rochester ( Site 0138)
- Duke Cancer Center ( Site 0067)
- The Ohio State University Wexner Medical Center ( Site 0056)
- Tennessee Oncology, PLLC ( Site 0020)
- UT Southwestern Medical Center ( Site 0116)
- University of Utah, Huntsman Cancer Institute ( Site 0122)
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm 6
Arm 7
Arm 8
Arm 9
Arm 10
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Phase 1: Dose Escalation and Determination of RP2D
Phase 2: Expansion Cohort A
Phase 2: Expansion Cohort B
Phase 2: Expansion Cohort C
Phase 2: Expansion Cohort D
Phase 2: Expansion Cohort E
Phase 2: Expansion Cohort F
Phase 2: Expansion Cohort G
Phase 2: Expansion Cohort H
Phase 2: Expansion Food Effect Cohort I
Phase I: Dose Escalation and determination of RP2D, multiple dose levels of nemtabrutinib to be evaluated (Up to approximately 22 months).
Relapsed/Refractory chronic lymphocytic leukemia/small lymphocytic lymphoma (R/R CLL/SLL) participants with at least 2 prior systemic therapies and previously treated with a covalent Bruton's tyrosine kinase inhibitor (BTKi) who must have a documented BTK mutation on C481 residue receive up to 65 mg of nemtabrutinib per day orally in each cycle (Cycle length = 28 days) until progressive disease (PD), unacceptable adverse events (AEs), or discontinuation at investigator's discretion (up to approximately 64 months).
R/R CLL/SLL participants who have failed or were intolerant to a BTKi with documentation of the absence of BTK mutation on C481 residue receive up to 65 mg of nemtabrutinib per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 64 months).
Richter's transformation (RT) participants who have failed at least one prior therapy receive up to 65 mg of nemtabrutinib per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 64 months).
Follicular Lymphoma (FL) participants who have failed at least 2 prior systemic therapies and are histology grade 1, 2, or 3A receive up to 65 mg of nemtabrutinib per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 64 months).
Mantle Cell Lymphoma (MCL) participants who have failed at least 2 prior systemic therapies receive up to 65 mg of nemtabrutinib per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 64 months).
Marginal Zone Lymphoma (MZL) participants who have failed at least 2 prior systemic therapies receive up to 65 mg of nemtabrutinib per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 64 months).
High-grade B-cell lymphoma (BCL) participants who have failed at least 2 prior systemic therapies and have known MYC and BCL2 and/or BCL6 translocations confirmed by flourescence in situ hybridization (FISH) or overexpression by immunohistochemistry (IHC) receive up to 65 mg of nemtabrutinib per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 64 months).
Waldenström macroglobulinemia (WM) participants who have failed at least 2 prior systemic therapies receive up to 65 mg of nemtabrutinib per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 64 months).
B-cell Non-Hodgkin's lymphoma (NHL), CLL/SLL and WM participants receive up to 65 mg of nemtabrutinib fasted (1 hour prior to or 2 hours after meal) and non-fasted per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 64 months).