Ibrutinib Monotherapy Versus Fixed-duration Venetoclax Plus Obinutuzumab Versus Fixed-duration Ibrutinib Plus Venetoclax in Patients With Previously Untreated Chronic Lymphocytic Leukaemia (CLL) (CLL17)
Chronic Lymphoid Leukemia
About this trial
This is an interventional treatment trial for Chronic Lymphoid Leukemia focused on measuring CLL
Eligibility Criteria
Inclusion Criteria:
- Documented CLL requiring treatment according to iwCLL criteria.
- Age at least 18 years.
- Life expectancy ≥ 6 months.
- Ability and willingness to provide written informed consent and to adhere to the study visit schedule and other protocol requirements.
Adequate bone marrow function independent of growth factor or transfusion support within 2 weeks of screening initiation as follows, unless cytopenia is due to CLL:
- Absolute neutrophil count ≥ 1.0 × 109/L
- Platelet counts ≥ 30 × 109/L; in cases of thrombocytopenia clearly due to CLL (per the discretion of the investigator), platelet count should be ≥ 10 × 109/L
- Total haemoglobin ≥ 9 g/dL (without transfusion support, unless anaemia is due to CLL)
GFR >30ml/min directly measured with 24hr urine collection, calculated according to the modified formula of Cockcroft and Gault (for men: GFR ≈ ((140 - age) x bodyweight)/ (72 x creatinine), for women x 0, 85) or an equally accurate method.
a. For patients with creatinine values within the normal range the calculation of the clearance is not necessary. Dehydrated patients with an estimated creatinine clearance less than 30 ml/min may be eligible if a repeat estimate after adequate hydration is > 30 ml/min.
- Adequate liver function as indicated by a total bilirubin ≤ 2 x, AST/ ALT ≤ 2.5 x the institutional ULN value, unless directly attributable to the patient's CLL or to Gilbert's Syndrome.
- Negative serological testing for hepatitis B (HbsAg negative and anti-HBc negative; patients positive for anti-HBc may be included if PCR for HBV DNA is negative and HBV-DNA PCR is performed every month until 12 months after last treatment cycle), negative testing for hepatitis C RNA within 6 weeks prior to registration for study screening (i.e. PCR only required when serology was positive).
- Eastern Cooperative Oncology Group Performance Status (ECOG) performance status 0-2.
Exclusion criteria:
- Any prior CLL-specific therapies (except corticosteroid treatment administered due to necessary immediate intervention; within the last 10 days before start of study treatment, only dose equivalents up to 20 mg prednisolone are permitted).
- Transformation of CLL (Richter transformation). When Richter transformation is suspected, PET-CT and/or biopsy should be performed to rule out transformation.
- Patients with a history of PML.
- An individual organ/ system impairment score of 4 as assessed by the CIRS definition limiting the ability to receive the study treatment or any other life-threatening illness, medical condition or organ system dysfunction that, in the investigator´s opinion, could compromise the patients' safety or interfere with the absorption or metabolism of the study drugs (e.g. inability to swallow tablets or impaired resorption in the gastrointestinal tract).
- Malignancies other than CLL currently requiring systemic therapies, not being treated with curative intent before (unless the malignant disease is in a stable remission due to the discretion of the treating physician or showing signs of progression after curative treatment.
- Uncontrolled or active infection.
- Patients with known infection with human immunodeficiency virus (HIV).
- Requirement of therapy with strong CYP3A4 and CYP3A5 inhibitors/ inducers (incl. up to 7 days prior to study treatment start).
- Anticoagulant therapy with warfarin or phenprocoumon, (alternative anticoagulation is allowed (e.g. DOACs), but patients must be properly informed about the potential risk of bleeding under treatment with ibrutinib).
- History of stroke or intracranial hemorrhage within 6 months prior to registration for study screening.
- Known bleeding disorders
- Child B / C liver cirrhosis
- Use of investigational agents which might interfere with the study drug within 28 days prior to registration for study screening.
- Vaccination with live vaccines 28 days prior to registration for study screening.
- Major surgery less than 30 days before start of study treatment.
- History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies, known sensitivity or allergy to murine products.
- Known hypersensitivity to any active substance or to any of the excipients of one of the drugs used in the trial.
- Pregnant women and nursing mothers (a negative pregnancy test is required for all women of childbearing potential within 7 days before start of study treatment; further pregnancy testing will be performed monthly).
Fertile men or women of childbearing potential unless:
- surgically sterile or ≥ 2 years after the onset of menopause
- willing to use two methods of reliable contraception including one highly effective contraceptive method (Pearl Index <1) and one additional effective (barrier) method during study treatment and for 18 months after the end of study treatment.
- Legal incapacity.
- Prisoners or subjects who are institutionalized by regulatory or court order.
- Persons who are in dependence to the sponsor or an investigator.
Sites / Locations
- LKH-Universtitätsklinikum Graz
- Landeskrankenhaus - Universitätskliniken Innsbruck
- Medizinische Universität Wien
- Hanusch Krankenhaus
- Wiener Gesundheitsverbund Klinik Ottakring
- Algemeen Ziekenhuis St. Jan
- Universitair Ziekenhuis Leuven
- Algemeen Ziekenhuis Delta
- Aalborg Universitetshospital
- Aarhus Universitetshospital
- Rigshospitalet
- Sydvestjysk Sygehus Esbjerg
- Regionshospitalet Holstebro
- Odense Universitetshospital
- Zealand University Hospital
- Lillebaelt Vejle Sygehus
- Helsinki University Hospital
- Tampere University Hospital
- Turku University Hospital
- Universitätsklinikum Augsburg
- Onkologische Schwerpunktpraxis Kurfürstendamm
- Charite Universitaetsmedizin - Campus Benjamin Franklin
- Helios Klinikum Berlin Buch
- Charite Universitätsmedizin - Campus Virchow Klinikum
- Ev. Diakoniekrankenhaus
- Gemeinschaftspraxis für Hämatologie & Onkologie
- Gemeinschaftspraxis Hämatologie Onkologie
- Universitätsklinik Carl Gustav Carus
- Sana Krankenhaus Benrath
- St. Georg Klinikum Eisenach
- ISP Erlangen Onkologische Schwerpunktpraxis
- Universitätsklinikum Erlangen
- Universitaetsklinikum Essen
- Onkologische Schwerpunktpraxis
- Centrum für Hämatologie und Onkologie Bethanien
- Universitätsklinikum Freiburg
- Uniklinikum Gießen und Marburg
- MVZ Onkologische Kooperation Harz
- Universitätsklinikum Hamburg-Eppendorf
- OncoResearch Lerchenfeld
- Evangelische Krankenhaus Hamm
- Onkologisches Ambulanzzentrum - MediProjekt
- Onkologische Schwerpunktpraxis Heidelberg
- Universitätsklinikum Heidelberg
- Marien Hospital Herne
- Universitätskliniken des Saarlandes
- Universitätsklinikum Jena
- Westpfalz-Klinikum GmbH
- Universitaetsklinikum Schleswig-Holstein Campus Kiel
- Praxis für Haematologie und Onkologie
- MVZ Hämatologie Onkologie Koblenz
- Universitätsklinik Köln
- H.O.T Onkologie Praxis Landshut
- Universitätsklinikum Leipzig
- Onkopraxis Probstheida
- Klinikum Lippe Lemgo
- St Vincenz Krankenhaus
- Lübecker Onkologische Schwerpunktpraxis
- Gemeinschaftspraxis Haematologie und Onkologie
- Universitätsklinikum Magdeburg
- Mannheimer Onkologie Praxis
- Praxis für Innere Medizin - Hämatologie und Onkologie
- Stauferklinikum Schwäbisch Gmünd
- Kliniken Maria Hilf
- München Klinik Schwabing
- Klinikum der Universitaet München - Grosshadern Campus
- Klinikum rechts der Isar - Technische Universitaet Muenchen
- Gemeinschaftspraxis für Hämatologie und Onkologie
- Klinikum Oldenburg
- Brüderkrankenhaus St. Josef Paderborn
- Gemeinschaftspraxis für Hämatologie und Onkologie
- Barmherzigen Brüder Krankenhaus
- Schwerpunktpraxis für Hämatologie & Onkologie - OncoPro GbR
- Universitätsklinik Rostock
- OnkoSaar Praxis für Hämatologie und Onkologie
- Zentrum für abulante Hämatologie und Onkologie
- Marienhospital Stuttgart
- Robert-Bosch-Krankenhaus
- Universitätsklinik Tübingen
- Universitätsklinikum Ulm
- MVZ Weiden GmbH
- Hämatologisch Onkologische Schwerpunktpraxis
- Cork University Hospital
- St Vincents University Hospital
- Mater Misericordiae University Hospital
- St. James's Hospital
- Beaumont Hospital
- University Hospital Galway
- University Hospital Limerick
- University Hospital Waterford
- Soroka University Medical Center
- Shamir Medical Center Assaf Harofeh
- Bnai-Zion Medical Center
- Hadassah Medical Center Ein Kerem University Hospital
- Meir Medical Center
- Galilee Medical Center
- Rabin Medical Center Beilinson Hospital
- Chaim Sheba Medical Center
- Kaplan Medical Center
- Tel Aviv Sourasky Medical Center
- Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele
- Azienda Ospedaliero Universitaria di Ferrara
- Ospedale dell'Angelo
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico
- ASST Grande Ospedale Metropolitano Niguarda
- IRCCS Ospedale San Raffaele
- Ospedale S. Maria della Misericordia
- Umberto I - Policlinico di Roma - Sapienza Università
- Gmelli University Hospital
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino
- Nordwest Ziekenhuisgroep, Locatie Alkmaar
- OLVG Amsterdam
- Amsterdam Universitair Medische Centra
- Rijnstate, Locatie Arnhem
- Amphia Ziekenhuis
- Reinier de Graaf Ziekenhuis
- Slingeland ziekenhuis
- Albert Schweitzer Ziekenhuis
- Ziekenhuis Gelderse Vallei
- Martini Ziekenhuis
- Ziekenhuis St Jansdal
- Medisch Centrum Leeuwarden
- Alrijne Ziekenhuis
- St. Antonius Ziekenhuis
- Canisius-Wilhelmina Ziekenhuis
- Maasstad Ziekenhuis
- Jeroen Bosch Ziekenhuis
- Franciscus Vlietland
- Ziekenhuis Rivierenland Tiel
- Diakonessenhuis
- VieCuri Medish Centrum
- Isala Zwolle
- Haukeland University Hospital
- Akershus University Hospital
- Oslo University Hospital
- St. Olavs Hospital Trondheim University Hospital
- Hospital Germans Trias i Pujol
- Vall d'Hebron University Hospital
- Hospital Clinic de Barcelona
- Hospital Duran i Reynals
- Hospital Universitario La Princesa
- Hospital Universitario Infanta Leonor
- Hospital Universitario 12 de Octubre
- Hospital Costa del Sol
- Hospital Universitario Central de Asturias
- Hospital Clinico Universitario de Salamanca
- Hospital Marques de Valdecilla
- Hospital Universitario Virgen de Valme
- Hospital Clinico Universitario Valencia
- Residencia Sanitaria La Fe - Valencia
- Hospital Clinico Universitario Lozano Blesa
- Soedra Aelvsborgs Sjukhus
- Falu Lasarett
- Sahlgrenska University Hospital
- Hallands Sjukhus Halmstad
- Universitetssjukhuset Linköping
- Sunderby Hospital
- Skåne University Hospital
- Karolinska University Hospital Solna
- Umeå University Hospital
- Uppsala University Hospital
- Hallands Sjukhus
- Örebro University Hospital
- Kantonsspital Aarau
- Kantonsspital Baden
- Universitätsspital Basel
- Ospedale Regionale Bellinzona e Valli
- Inselspital Bern
- Spitalzentrum Oberwallis
- Kantonsspital Graubünden
- HFR Fribourg Hôpital cantonal
- Hôpitaux Universitaires Genève
- Kantonsspital Baselland
- Luzerner Kantonsspital
- Spital Thurgau AG - Kantonsspital Münsterlingen
- Kantonsspital Olten
- Kantonsspital St. Gallen
- Spital Thun
- Kantonsspital Winterthur
- Stadtspital Triemli
- Universitätsspital Zuerich
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
I (Ibrutinib)
VG (Obinutuzumab + Venetoclax)
VI (Venetoclax + Ibrutinib)
Ibrutinib p.o. will be administered until occurrence of unacceptable toxicity, progression of CLL or end of trial, whichever occurs first.
12 cycles (q 28d): Obinutuzumab i.v. + Venetoclax p.o. will be administered for 6 cycles, followed by 6 additional cycles of Venetoclax alone
15 cycles (q 28d): Ibrutinib p.o. + Venetoclax p.o. will be administered for a total of 12 cycles with a prior Ibrutinib monotherapy lead-in of 3 cycles