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Orelabrutinib in Combination With R2 Regimen for R/R CD20+ B-cell Lymphoma

Primary Purpose

B-cell Lymphoma

Status
Unknown status
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Orelabrutinib tablet
Lenalidomide
Sponsored by
Puyang Oilfield General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for B-cell Lymphoma

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 1) Age ≥18 years old, ≤75 years old, gender is not limited;

    2) CD20+B cell lymphoma was confirmed by histopathology, with at least one intranode lesion larger than 1.5CM in length and extranodal lesion larger than 1.0CM in diameter.

    3) Patients with recurrent or refractory CD20+ B-cell lymphoma who have previously received ≥1 line and ≤5 line of different chemotherapy and/or targeted drug therapy failure and lack effective and standard treatment options;

    4) ECOG strength score 0-2;

    5) Medical records that have failed to respond to the latest systematic treatment (not reaching CR/PR) or disease progression after remission;

    6) Major organ functions meet the following criteria:

A) Blood routine: neutrophils absolute value ≥1.5×109/L, platelets ≥75×109/L, hemoglobin ≥75g/L; Absolute neutrophils if associated with bone marrow invasion

≥1.0×109/L, platelet ≥50×109/L, hemoglobin ≥75g/L;

B) Blood biochemistry: total bilirubin ≤1.5 times ULN, AST or ALT≤3 times ULN; Serum creatinine ≤1.5 ULN; Serum amylase ≤ULN;

C) Coagulation function: International standardized ratio (INR) ≤1.5 times ULN.

7) Expected survival ≥3 months;

8) Voluntarily sign written informed consent before screening.

Exclusion Criteria:

  • 1) Current or previous malignancy, unless radical therapy has been performed and there is no evidence of recurrence or metastasis in the past 5 years;

    2) Non-hematologic toxicity of previous antitumor therapy did not return to ≤ grade 1 (excluding hair loss)

    3) Have uncontrolled or significant cardiovascular disease

    7) Had active bleeding within 2 months prior to screening, or was taking anticoagulant drugs, or was considered by the investigator to have a clear tendency to bleeding;

    (8) Urine protein ≥2+, and 24 h urine protein quantification ≥ 2G /24 h;

    9) History of deep vein thrombosis or pulmonary embolism;

    10) The toxicity of the pre-screening treatment regimen has not recovered, and there are still toxicity reactions above grade 1;

    11) Subjects with clinically significant gastrointestinal abnormalities that may affect drug intake, transport or absorption (such as inability to swallow, chronic diarrhea, intestinal obstruction, etc.), or total gastrectomy;

    12) A history of organ transplantation or allogeneic bone marrow transplantation;

    13) Major surgery or minor surgery within 6 weeks prior to screening or 2 weeks prior to screening. Major surgery is surgery performed under general anesthesia, but endoscopic examination for diagnostic purposes is not considered major surgery. Insertion of vascular access devices will be exempt from this exclusion criterion;

    14) Known human immunodeficiency virus (HIV) infection, or active hepatitis B or C virus infection (positive results by POLYMERase chain reaction [PCR]).

    15) Current subjects with pulmonary fibrosis, interstitial pneumonia, pneumoconiosis, radiation pneumonia, drug-related pneumonia, and severe impairment of lung function;

    16) Suitable and ready for stem cell transplantation;

    17) Any mental or cognitive impairment that may limit his/her understanding, implementation and compliance with the informed consent;

    18) Subjects with drug and alcohol abuse;

    19) Pregnant and lactating women and subjects of childbearing age who do not want to take contraceptive measures;

    20) Combined with drugs with moderate to severe inhibitory effect or strong induction effect on cytochrome P450 CYP3A;

    21) Other conditions that the researcher considers unsuitable to participate in this study.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    The treatment group

    Arm Description

    Orelabrutinib 150mg once daily in a 28-day cycle. Lenalidomide 25mg once daily for 21 days and rituximab 375mg/m2 for 7 days

    Outcomes

    Primary Outcome Measures

    Complete response rate
    The proportion of patients receiving a OR2 regimens who are in remission

    Secondary Outcome Measures

    Full Information

    First Posted
    July 29, 2021
    Last Updated
    August 23, 2021
    Sponsor
    Puyang Oilfield General Hospital
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05014100
    Brief Title
    Orelabrutinib in Combination With R2 Regimen for R/R CD20+ B-cell Lymphoma
    Official Title
    A Multicenter Clinical Study of Orelabrutinib Combined With Lenalidomide and Rituximab (OR2) in the Treatment of Recurrent and Refractory CD20+ B-cell Lymphoma
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2021
    Overall Recruitment Status
    Unknown status
    Study Start Date
    September 1, 2021 (Anticipated)
    Primary Completion Date
    September 30, 2022 (Anticipated)
    Study Completion Date
    September 30, 2023 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Puyang Oilfield General Hospital

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No

    5. Study Description

    Brief Summary
    Obrutinib is a highly selective BTKi and has shown efficacy in CLL/MCL. This study aims to investigate the initial efficacy and safety of obrutinib combined with R2 regimen in the treatment of relapsed or refractory CD20+B cell lymphoma
    Detailed Description
    Bruton's tyrosine kinase (BTK), a member of the TEC family of non-receptor tyrosine proteins, is expressed in B lymphocytes, mast cells, macrophages, monocytes, neutrophils, etc., and is a key molecule in the signaling of B cell antigen receptor (BCR). The development and differentiation of B cells can be controlled by activating positive cell cycle regulators and differentiated cytokines, and the survival and proliferation of B cells can be controlled by regulating the expression of pro-apoptotic and anti-apoptotic proteins. BTK inhibitors inhibit B cell maturation and activation by targeting the BCR signaling pathway. Compared with other BTK inhibitors, orelabrutinib is highly selective. Previous studies showed that among 456 tested kinases, the inhibition rate of orelabrutinib only exceeded 90% at 1µM concentration, which is the BTK inhibitor with the highest kinase selectivity reported so far. It has shown a good safe treatment window in animal models, and its pharmacokinetic properties are far superior to those of ibrutinib. In the Phase I dose exploration study of orelabrutinib in Australia, the single dose was from 20mg/ day to 400mg/ day, and the continuous dose was from 100mg/ day to 200mg/ day. No serious adverse events related to the drug occurred, and no dosion-limiting toxicity was found. The main adverse reactions were headache, intubation pain, fatigue, etc. Most of them were mild and generally well tolerated, providing a reference for the selection of subsequent clinical drug dosage. Phase I/II clinical trials of orelabrutinib for MCL and CLL/SLL have been conducted in more than 20 centers across the country. Based on preliminary results observed in Phase I, obrutinib has demonstrated excellent safety and tolerability in patients with relapsed refractory MCL and CLL/SLL. Most of the adverse reactions were grade 1-2. Good results have been observed early on in patients. Good pharmacokinetic/pharmacokinetic properties. Several studies have shown that ibrutinib combined with lenalidomide and rituximab improves survival in patients with relapsed refractory diffuse large B-cell lymphoma. In addition, ibrutinib combined with lenalidomide and rituximab has been included in the expert recommendation of multiple relapsed and refractory B-cell lymphomas in the 2021CSCO Lymphoma Guidelines. In conclusion, orelabrutinib and lenalidomide combined with rituximab demonstrated good efficacy and tolerability in the treatment of relapsed refractory B-cell lymphoma. Moreover,orelabrutinib has better selectivity than ibrutinib, so we believe that orelabrutinib combined with lenalidomide and rituximab (OR2) may have better efficacy in the treatment of relapsed and refractory B-cell lymphoma, and there is no research report on this regimen. The application of this regimen may bring new hope for relapsed refractory B-cell lymphoma.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    B-cell Lymphoma

    7. Study Design

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

    8. Arms, Groups, and Interventions

    Arm Title
    The treatment group
    Arm Type
    Experimental
    Arm Description
    Orelabrutinib 150mg once daily in a 28-day cycle. Lenalidomide 25mg once daily for 21 days and rituximab 375mg/m2 for 7 days
    Intervention Type
    Drug
    Intervention Name(s)
    Orelabrutinib tablet
    Intervention Description
    Subjects received orelabrutinib150mg orally once daily for a 28-day cycle. Throughout the study period, all subjects continued treatment until one of the following conditions occurred: disease progression, intolerable toxicity, death, withdrawal of informed consent, or loss of follow-up
    Intervention Type
    Drug
    Intervention Name(s)
    Lenalidomide
    Other Intervention Name(s)
    RR
    Intervention Description
    Lenalidomide 25mg once daily for 21 days and rituximab 375mg/m2 for 7 days Throughout the study period, all subjects continued treatment until one of the following conditions occurred: disease progression, intolerable toxicity, death, withdrawal of informed consent, or loss of follow-up
    Primary Outcome Measure Information:
    Title
    Complete response rate
    Description
    The proportion of patients receiving a OR2 regimens who are in remission
    Time Frame
    Enrollment to the last patient complete 6cycles(each cycle is 28 days), an average of 1 year

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    75 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: 1) Age ≥18 years old, ≤75 years old, gender is not limited; 2) CD20+B cell lymphoma was confirmed by histopathology, with at least one intranode lesion larger than 1.5CM in length and extranodal lesion larger than 1.0CM in diameter. 3) Patients with recurrent or refractory CD20+ B-cell lymphoma who have previously received ≥1 line and ≤5 line of different chemotherapy and/or targeted drug therapy failure and lack effective and standard treatment options; 4) ECOG strength score 0-2; 5) Medical records that have failed to respond to the latest systematic treatment (not reaching CR/PR) or disease progression after remission; 6) Major organ functions meet the following criteria: A) Blood routine: neutrophils absolute value ≥1.5×109/L, platelets ≥75×109/L, hemoglobin ≥75g/L; Absolute neutrophils if associated with bone marrow invasion ≥1.0×109/L, platelet ≥50×109/L, hemoglobin ≥75g/L; B) Blood biochemistry: total bilirubin ≤1.5 times ULN, AST or ALT≤3 times ULN; Serum creatinine ≤1.5 ULN; Serum amylase ≤ULN; C) Coagulation function: International standardized ratio (INR) ≤1.5 times ULN. 7) Expected survival ≥3 months; 8) Voluntarily sign written informed consent before screening. Exclusion Criteria: 1) Current or previous malignancy, unless radical therapy has been performed and there is no evidence of recurrence or metastasis in the past 5 years; 2) Non-hematologic toxicity of previous antitumor therapy did not return to ≤ grade 1 (excluding hair loss) 3) Have uncontrolled or significant cardiovascular disease 7) Had active bleeding within 2 months prior to screening, or was taking anticoagulant drugs, or was considered by the investigator to have a clear tendency to bleeding; (8) Urine protein ≥2+, and 24 h urine protein quantification ≥ 2G /24 h; 9) History of deep vein thrombosis or pulmonary embolism; 10) The toxicity of the pre-screening treatment regimen has not recovered, and there are still toxicity reactions above grade 1; 11) Subjects with clinically significant gastrointestinal abnormalities that may affect drug intake, transport or absorption (such as inability to swallow, chronic diarrhea, intestinal obstruction, etc.), or total gastrectomy; 12) A history of organ transplantation or allogeneic bone marrow transplantation; 13) Major surgery or minor surgery within 6 weeks prior to screening or 2 weeks prior to screening. Major surgery is surgery performed under general anesthesia, but endoscopic examination for diagnostic purposes is not considered major surgery. Insertion of vascular access devices will be exempt from this exclusion criterion; 14) Known human immunodeficiency virus (HIV) infection, or active hepatitis B or C virus infection (positive results by POLYMERase chain reaction [PCR]). 15) Current subjects with pulmonary fibrosis, interstitial pneumonia, pneumoconiosis, radiation pneumonia, drug-related pneumonia, and severe impairment of lung function; 16) Suitable and ready for stem cell transplantation; 17) Any mental or cognitive impairment that may limit his/her understanding, implementation and compliance with the informed consent; 18) Subjects with drug and alcohol abuse; 19) Pregnant and lactating women and subjects of childbearing age who do not want to take contraceptive measures; 20) Combined with drugs with moderate to severe inhibitory effect or strong induction effect on cytochrome P450 CYP3A; 21) Other conditions that the researcher considers unsuitable to participate in this study.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Xuejun Guo, PHD
    Phone
    +86 13903930612
    Email
    pygxj@163.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Xuejun Guo, PHD
    Organizational Affiliation
    Puyang Oilfield General Hospital
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Citations:
    PubMed Identifier
    29610115
    Citation
    Ujjani C, Wang H, Skarbnik A, Trivedi N, Ramzi P, Khan N, Cheson BD. A phase 1 study of lenalidomide and ibrutinib in combination with rituximab in relapsed and refractory CLL. Blood Adv. 2018 Apr 10;2(7):762-768. doi: 10.1182/bloodadvances.2017015263.
    Results Reference
    background
    PubMed Identifier
    27697771
    Citation
    Ujjani CS, Jung SH, Pitcher B, Martin P, Park SI, Blum KA, Smith SM, Czuczman M, Davids MS, Levine E, Lewis LD, Smith SE, Bartlett NL, Leonard JP, Cheson BD. Phase 1 trial of rituximab, lenalidomide, and ibrutinib in previously untreated follicular lymphoma: Alliance A051103. Blood. 2016 Nov 24;128(21):2510-2516. doi: 10.1182/blood-2016-06-718106. Epub 2016 Oct 3.
    Results Reference
    background
    PubMed Identifier
    31331917
    Citation
    Goy A, Ramchandren R, Ghosh N, Munoz J, Morgan DS, Dang NH, Knapp M, Delioukina M, Kingsley E, Ping J, Beaupre DM, Neuenburg JK, Ruan J. Ibrutinib plus lenalidomide and rituximab has promising activity in relapsed/refractory non-germinal center B-cell-like DLBCL. Blood. 2019 Sep 26;134(13):1024-1036. doi: 10.1182/blood.2018891598. Epub 2019 Jul 22.
    Results Reference
    background
    PubMed Identifier
    33981831
    Citation
    Yu H, Wang X, Li J, Ye Y, Wang D, Fang W, Mi L, Ding N, Wang X, Song Y, Zhu J. Addition of BTK inhibitor orelabrutinib to rituximab improved anti-tumor effects in B cell lymphoma. Mol Ther Oncolytics. 2021 Apr 3;21:158-170. doi: 10.1016/j.omto.2021.03.015. eCollection 2021 Jun 25.
    Results Reference
    background

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    Orelabrutinib in Combination With R2 Regimen for R/R CD20+ B-cell Lymphoma

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