search
Back to results

Dasatinib In Waldenström Macroglobulinemia

Primary Purpose

Waldenstrom Macroglobulinemia, DASATINIB

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Dasatinib
Sponsored by
Jorge J. Castillo, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Waldenstrom Macroglobulinemia focused on measuring Waldenstrom Macroglobulinemia, DASATINIB

Eligibility Criteria

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

Inclusion Criteria:

  • Participants must meet the following criteria on screening examination to be eligible to participate. Screening evaluations including consent, physical exam, and laboratory assessments will be done within 30 days prior to Cycle 1 Day 1. Bone marrow biopsy & aspirate, and CT C/A/P will be done within 90 days prior to Cycle 1 Day 1.
  • Clinicopathological diagnosis of Waldenstrom's Macroglobulinemia
  • Known tumor expression of mutated MYD88 performed by a CLIA certified laboratory.
  • Participants must have a BTKCys481 and/or PLCγ2 mutation. Genomic alterations must be confirmed via sequencing performed at NeoGenomics Laboratories
  • At least one previous therapy, with ibrutinib as the most recent treatment. Participants may remain on ibrutinib therapy during screening. A 1 day washout before starting dasatinib is required.
  • Documented disease progression on last regimen (ibrutinib) per the Sixth International Workshop on WM. One or more of the following:
  • 25% increase in serum IgM level with at least 500 mg/dL absolute increase from nadir with re-confirmation
  • Progression of clinically significant disease related symptoms
  • Symptomatic disease meeting criteria for treatment using consensus panel criteria from the Second International Workshop on WM [26]. One or more of the following:

    • Constitutional symptoms
    • Progressive or symptomatic lymphadenopathy or splenomegaly
    • Hemoglobin <10 g/dL
    • Platelet count <100 k/uL
    • Symptomatic peripheral neuropathy
    • Systemic amyloidosis
    • Renal insufficiency
    • Symptomatic cryoglobulinemia
  • Age 18 years or older
  • Measurable disease, defined as presence of immunoglobulin M (IgM) paraprotein with a minimum serum IgM level of > 2 times the upper limit normal.
  • ECOG performance status ≤2 (Karnofsky ≥60%, see Appendix A)
  • Women of childbearing potential: Females of childbearing potential (FCBP) must agree to use two reliable forms of contraception simultaneously or have or will have complete abstinence from heterosexual intercourse during the following time periods related to this study: 1) while participating in the study; and 2) for at least 28 days after discontinuation from the study. FCBP must be referred to a qualified provider of contraceptive methods if needed.
  • Men must agree to use a latex condom during sexual contact with a female of childbearing potential (FCBP) even if they have had a successful vasectomy.
  • Participants must have normal organ and marrow function as defined below:

    • Absolute neutrophil count ≥500/ uL (Growth factor not permitted)
    • Platelets ≥50,000/ uL (Platelet transfusion not permitted)
    • Hemoglobin ≥ 7 g/dL (RBC transfusion permitted)
    • Total bilirubin ≤ 2 mg/dL
    • Potassium ≥ LLN
    • Magnesium ≥ LLN
    • AST(SGOT)/ALT(SGPT) ≤2.5 × institutional upper limit of normal
    • Estimated GFR ≥ 30 ml/min
  • Able to swallow pills.
  • Able to adhere to the study visit schedule and other protocol requirements.
  • Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  • Participants who exhibit any of the following conditions at screening will not be eligible for admission into the study:
  • Lactating or pregnant women.
  • Participants who are receiving any other investigational agents.
  • Prior therapy with BCR-ABL inhibitors.
  • Known CNS lymphoma.
  • Symptomatic hyperviscosity requiring urgent therapy.
  • Human Immunodeficiency Virus (HIV), active infection with Hepatitis B Virus (HBV), and/or Hepatitis C Virus (HCV).
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, pleural or pericardial effusion, unstable angina pectoris, cardiac arrhythmia, QT Prolongation, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Prolonged QTc interval on pre-entry electrocardiogram (> 450 msec)
  • History clinically significant ventricular arrhythmias such as ventricular tachycardia, ventricular fibrillation, or Torsades de pointes
  • Known history of alcohol or drug abuse
  • On any active therapy for other malignancies with the exception of topical therapies for basal cell or squamous cell cancers of the skin.
  • History of non-compliance to medical regimens.
  • Treatment with strong CYP3A4/5 inhibitors or inducers
  • Participants who are taking St. Johns Wort. Must discontinue at least 5 days before starting dasatinib.
  • Treatment with H2 Antagonists and proton pump inhibitors

Sites / Locations

  • Dana Farber Cancer InstituteRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Dasatinib

Arm Description

-- After the screening procedures confirm participation in the research study: The participant will be given a study drug-dosing calendar for each treatment cycle. Dasatinib: Oral Study Drug(s): Each study treatment cycle lasts 4 weeks during which time you will be taking the study drug one time per day. This will continue for up to 24 cycles.

Outcomes

Primary Outcome Measures

To evaluate the toxicity profile of dasatinib in WM patients who progressed on ibrutinib with BTK or PLCG2 mutations.
Number and type of toxicities experienced by patients related to dasatinib.

Secondary Outcome Measures

Overall Response Rate
Proportion of patients with MR, PR, VGPR, or CR to therapy.
Complete Response Rate
Proportion of patients with CR
Very good partial response rate
Proportion of patients with VGPR to therapy. (VGPR is >90% reduction in serum IgM from baseline)
Partial Response Rate
Proportion of patients with PR to therapy. (PR is 50-89% reduction in serum IgM from baseline)
Minimal Response Rate
Proportion of patients with Minor Responses to therapy. (MR is 25-49% reduction in serum IgM from baseline)
Stable Disease Rate
Proportion of patients with Stable disease to therapy. (SD is <25% reduction in serum IgM from baseline).
Progressive Disease Rate
Proportion of patients with a best response of PD to therapy. (PD is >25% increase in serum IgM from baseline).
Progression Free Survival
Kaplan Meier methodology
Time to Next Therapy (TTNT)
Kaplan Meier
Overall Survival
Kaplan Meier

Full Information

First Posted
October 2, 2019
Last Updated
March 22, 2022
Sponsor
Jorge J. Castillo, MD
Collaborators
Bristol-Myers Squibb
search

1. Study Identification

Unique Protocol Identification Number
NCT04115059
Brief Title
Dasatinib In Waldenström Macroglobulinemia
Official Title
Dasatinib in Patients With Waldenström Macroglobulinemia (WM) Progressing on Ibrutinib
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Recruiting
Study Start Date
November 4, 2019 (Actual)
Primary Completion Date
March 1, 2022 (Actual)
Study Completion Date
March 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Jorge J. Castillo, MD
Collaborators
Bristol-Myers Squibb

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
This is Phase I pilot, single center study designed to explore the safety of Dasatinib in symptomatic Waldenström Macroglobulinemia participants who are progressing on ibrutinib therapy with BTK Cys481 or PLCG2 mutations
Detailed Description
This research study is a Pilot Study, which is the first time investigators are examining this drug in patients with Waldenström Macroglobulinemia who have progressed on ibrutinib. Patients who fulfill eligibility criteria will be entered into the trial to receive Dasatinib After the screening procedures confirm participation in the research study: The participant will be given a study drug-dosing calendar for each treatment cycle. In this research study, the investigators are planning to give Dasatinib, which is a targeted therapy intended to treat cancer by binding to the target protein called BTK. BTK is believed to be an important target for treatment of patients with specific gene mutations. Some patients who have disease progression after taking ibrutinib have these gene mutations. Making treatment decisions based on genetic testing is investigational, and the FDA has not approved this genetic testing. The U.S. Food and Drug Administration (FDA) has not approved Dasatinib for Waldenström Macroglobulinemia but it has been approved for other uses. Dasatinib is produced by Bristol-Myers Squibb.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Waldenstrom Macroglobulinemia, DASATINIB
Keywords
Waldenstrom Macroglobulinemia, DASATINIB

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
6 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dasatinib
Arm Type
Experimental
Arm Description
-- After the screening procedures confirm participation in the research study: The participant will be given a study drug-dosing calendar for each treatment cycle. Dasatinib: Oral Study Drug(s): Each study treatment cycle lasts 4 weeks during which time you will be taking the study drug one time per day. This will continue for up to 24 cycles.
Intervention Type
Drug
Intervention Name(s)
Dasatinib
Other Intervention Name(s)
Sprycel
Intervention Description
Oral, daily, dosing per protocol, once a day for cycle
Primary Outcome Measure Information:
Title
To evaluate the toxicity profile of dasatinib in WM patients who progressed on ibrutinib with BTK or PLCG2 mutations.
Description
Number and type of toxicities experienced by patients related to dasatinib.
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Overall Response Rate
Description
Proportion of patients with MR, PR, VGPR, or CR to therapy.
Time Frame
2 years
Title
Complete Response Rate
Description
Proportion of patients with CR
Time Frame
2 years
Title
Very good partial response rate
Description
Proportion of patients with VGPR to therapy. (VGPR is >90% reduction in serum IgM from baseline)
Time Frame
2 years
Title
Partial Response Rate
Description
Proportion of patients with PR to therapy. (PR is 50-89% reduction in serum IgM from baseline)
Time Frame
2 years
Title
Minimal Response Rate
Description
Proportion of patients with Minor Responses to therapy. (MR is 25-49% reduction in serum IgM from baseline)
Time Frame
2 years
Title
Stable Disease Rate
Description
Proportion of patients with Stable disease to therapy. (SD is <25% reduction in serum IgM from baseline).
Time Frame
2 years
Title
Progressive Disease Rate
Description
Proportion of patients with a best response of PD to therapy. (PD is >25% increase in serum IgM from baseline).
Time Frame
2 years
Title
Progression Free Survival
Description
Kaplan Meier methodology
Time Frame
2 years
Title
Time to Next Therapy (TTNT)
Description
Kaplan Meier
Time Frame
2 years
Title
Overall Survival
Description
Kaplan Meier
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants must meet the following criteria on screening examination to be eligible to participate. Screening evaluations including consent, physical exam, and laboratory assessments will be done within 30 days prior to Cycle 1 Day 1. Bone marrow biopsy & aspirate, and CT C/A/P will be done within 90 days prior to Cycle 1 Day 1. Clinicopathological diagnosis of Waldenstrom's Macroglobulinemia Known tumor expression of mutated MYD88 performed by a CLIA certified laboratory. Participants must have a BTKCys481 and/or PLCγ2 mutation. Genomic alterations must be confirmed via sequencing performed at NeoGenomics Laboratories At least one previous therapy, with ibrutinib as the most recent treatment. Participants may remain on ibrutinib therapy during screening. A 1 day washout before starting dasatinib is required. Documented disease progression on last regimen (ibrutinib) per the Sixth International Workshop on WM. One or more of the following: 25% increase in serum IgM level with at least 500 mg/dL absolute increase from nadir with re-confirmation Progression of clinically significant disease related symptoms Symptomatic disease meeting criteria for treatment using consensus panel criteria from the Second International Workshop on WM [26]. One or more of the following: Constitutional symptoms Progressive or symptomatic lymphadenopathy or splenomegaly Hemoglobin <10 g/dL Platelet count <100 k/uL Symptomatic peripheral neuropathy Systemic amyloidosis Renal insufficiency Symptomatic cryoglobulinemia Age 18 years or older Measurable disease, defined as presence of immunoglobulin M (IgM) paraprotein with a minimum serum IgM level of > 2 times the upper limit normal. ECOG performance status ≤2 (Karnofsky ≥60%, see Appendix A) Women of childbearing potential: Females of childbearing potential (FCBP) must agree to use two reliable forms of contraception simultaneously or have or will have complete abstinence from heterosexual intercourse during the following time periods related to this study: 1) while participating in the study; and 2) for at least 28 days after discontinuation from the study. FCBP must be referred to a qualified provider of contraceptive methods if needed. Men must agree to use a latex condom during sexual contact with a female of childbearing potential (FCBP) even if they have had a successful vasectomy. Participants must have normal organ and marrow function as defined below: Absolute neutrophil count ≥500/ uL (Growth factor not permitted) Platelets ≥50,000/ uL (Platelet transfusion not permitted) Hemoglobin ≥ 7 g/dL (RBC transfusion permitted) Total bilirubin ≤ 2 mg/dL Potassium ≥ LLN Magnesium ≥ LLN AST(SGOT)/ALT(SGPT) ≤2.5 × institutional upper limit of normal Estimated GFR ≥ 30 ml/min Able to swallow pills. Able to adhere to the study visit schedule and other protocol requirements. Ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: Participants who exhibit any of the following conditions at screening will not be eligible for admission into the study: Lactating or pregnant women. Participants who are receiving any other investigational agents. Prior therapy with BCR-ABL inhibitors. Known CNS lymphoma. Symptomatic hyperviscosity requiring urgent therapy. Human Immunodeficiency Virus (HIV), active infection with Hepatitis B Virus (HBV), and/or Hepatitis C Virus (HCV). Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, pleural or pericardial effusion, unstable angina pectoris, cardiac arrhythmia, QT Prolongation, or psychiatric illness/social situations that would limit compliance with study requirements. Prolonged QTc interval on pre-entry electrocardiogram (> 450 msec) History clinically significant ventricular arrhythmias such as ventricular tachycardia, ventricular fibrillation, or Torsades de pointes Known history of alcohol or drug abuse On any active therapy for other malignancies with the exception of topical therapies for basal cell or squamous cell cancers of the skin. History of non-compliance to medical regimens. Treatment with strong CYP3A4/5 inhibitors or inducers Participants who are taking St. Johns Wort. Must discontinue at least 5 days before starting dasatinib. Treatment with H2 Antagonists and proton pump inhibitors
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jorge Castillo, MD
Phone
(617) 632-4218
Email
jorgej_castillo@dfci.harvard.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jorge Castillo, MD
Organizational Affiliation
Dana-Farber Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jorge J Castillo, MD
Phone
617-632-6045
Email
Jorgej_castillo@dfci.harvard.edu
First Name & Middle Initial & Last Name & Degree
Jorge J Castillo, MD

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
IPD Sharing Time Frame
Data can be shared no earlier than 1 year following the date of publication
IPD Sharing Access Criteria
Contact the Belfer Office for Dana-Farber Innovations (BODFI) at innovation@dfci.harvard.edu
Citations:
PubMed Identifier
36051045
Citation
Castillo JJ, Sarosiek S, Flynn CA, Leventoff C, Little M, White T, Meid K, Treon SP. A pilot study on dasatinib in patients with Waldenstrom macroglobulinemia progressing on ibrutinib. EJHaem. 2022 Jun 7;3(3):927-929. doi: 10.1002/jha2.493. eCollection 2022 Aug.
Results Reference
derived

Learn more about this trial

Dasatinib In Waldenström Macroglobulinemia

We'll reach out to this number within 24 hrs