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Tazemetostat and Venetoclax in Relapsed/Refractory Non-Hodgkin Lymphoma

Primary Purpose

Lymphoma, Non-Hodgkin, Diffuse Large B Cell Lymphoma, Follicular Lymphoma

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Venetoclax
Tazemetostat
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 Lymphoma, Non-Hodgkin

Eligibility Criteria

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

Inclusion Criteria: Histologically confirmed, biopsy-proven diagnosis of FL or DLBCL. Subjects must have been treated with at least one prior line of therapy for lymphoma with evidence of disease progression. Subjects are eligible if they have progressed after ASCT OR if they are ineligible for ASCT Exclusion Criteria: Significant cardiovascular impairment, such as history of congestive heart failure, uncontrolled arterial hypertension, unstable angina, myocardial infarction, or stroke within 6 months of the first dose of study drug Known hypersensitivity to any of the study drugs History of other cancer (some exceptions apply) Known CNS (brain or spinal cord) involvement at diagnosis Richter's transformation from CLL Evidence of uncontrolled systemic infection (viral, bacterial, or fungal) Major surgery within 3 weeks prior to the start of study treatment Venous thrombosis or pulmonary embolism within the last 3 months before starting study Uncontrolled infection with human immunodeficiency virus (HIV) or human T-cell leukemia virus 1 Pregnant or lactating (people capable of becoming pregnant or getting someone else pregnant must be willing to use highly effective birth control) Malabsorption syndrome or other condition that precludes enteral route of administration Inability to swallow tablets Known allergy to both xanthine oxidase inhibitors and rasburicase Clinically significant history of liver disease, including but not limited to viral or other hepatitis, current alcohol abuse, or cirrhosis Active hepatitis C (defined as a positive HCV viral load) Chronic use of moderate or strong CYP3A4 modulators (inhibitor or inducer); chronic use of a P-gp inhibitor, or a P-gp substrate with a narrow therapeutic index; or use of certain other prohibited medications Prior exposure to either tazemetostat or venetoclax Prior history of T-LBL/T-ALL Previous solid organ transplant Requires the use of warfarin (because of potential drug-drug interactions that may potentially increase the exposure of warfarin) Vaccination with live vaccines within 28 days prior to treatment Consumed grapefruit or grapefruit products, Seville oranges (including marmalade containing Seville oranges), or star fruit within 3 days prior to the first dose of study drug

Sites / Locations

  • Weill Cornell Medicine/NewYork-Presberteryian HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Tazemetostat and Venetoclax

Arm Description

All participants will receive a combination of oral 800 mg tazemetostat BID and oral venetoclax. Since this is a phase 1 trial, the dose of venetoclax will be determined by the investigators per a sequential dose escalation (3+3). Participants will be provided study drug in the form of pills to take at home. Study participants will need to regularly come to the clinic for blood work, imaging, and to monitor and side effects. Participants may receive study drug until their cancer progresses or for up to 24 months.

Outcomes

Primary Outcome Measures

Maximum-tolerated dose (MTD) determination (Part 1)
In part 1 of this study, participants will be assigned a dose of venetoclax following a (3+3) dose escalation design and monitored for dose-limiting toxicities (DLTs) during the first treatment cycle. Based on observed DLTs observed in each dose level cohort, the maximum-tolerated dose will be determined. The # of patients experiencing a DLT among the evaluable patients for each dose level in part 1 will be tabulated.
Number of participants who experience dose-limiting toxicities (DLTs)
In part 1 of this study, participants will be assigned a dose of venetoclax following a (3+3) dose escalation design and monitored for dose-limiting toxicities (DLTs) during the first treatment cycle. Dose limiting toxicity (DLT) will be assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0 (NCI CTCAE v5.0).
Number of participants who experience adverse events (AEs), from baseline to 30 days after the last dose of study drug, as assessed by CTCAE v5.0
The safety analysis population will consist of all enrolled patients who receive at least one dose of study drug. AEs and SAEs will be tabulated by type, grade, and attribution for all patients overall and by treatment group. For each patient, and within each type of toxicity, the patient will be counted only once at the highest grade of that toxicity. Participants will be evaluated for AEs/SAEs from the time they sign the informed consent form until 30 days after their last dose of study drug.
Number of adverse events (AEs) by severity from baseline to 30 days, after the last dose of study drug as assessed, by CTCAE v5.0
The safety analysis population will consist of all enrolled patients who receive at least one dose of study drug. AEs and SAEs will be tabulated by type, grade, and attribution for all patients overall and by treatment group. For each patient, and within each type of toxicity, the patient will be counted only once at the highest grade of that toxicity. Participants will be evaluated for AEs/SAEs from the time they sign the informed consent form until 30 days after their last dose of study drug.

Secondary Outcome Measures

Number of Participants who Achieve Complete Response (CR)
CR will be assessed for all evaluable patients in parts 1+2 according to Lugano response criteria.
Number of Participants who Achieve Partial Response (PR)
PR will be assessed for all evaluable patients in parts 1+2 according to Lugano response criteria.
Overall Response Rate (ORR)
The ORR response rate is the proportion of patients with a best overall response of either complete response (CR) or partial response (PR) among all evaluable patients. ORR, CR, and PR will be assessed for all evaluable patients in parts 1+2 according to Lugano response criteria. The best overall response is the best response recorded from the start of treatment until progressive disease.
Duration of Response (DoR)
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 PD is objectively documented (taking as reference for PD the smallest measurements recorded since the treatment started). The duration of overall CR is measured from the time measurement criteria are first met for CR until the first date that recurrent disease is objectively documented. Duration of stable disease is measured from the start of the treatment until the criteria for progression are met, taking as reference the smallest measurements recorded since the treatment started.
Progression-Free Survival
PFS is defined as the duration of time from start of treatment to time of documentation of progression or death from any cause.
Overall Survival (OS)
OS is defined as the duration of time from start of treatment to death from any cause.

Full Information

First Posted
November 7, 2022
Last Updated
June 20, 2023
Sponsor
Weill Medical College of Cornell University
Collaborators
Genentech, Inc., Epizyme, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05618366
Brief Title
Tazemetostat and Venetoclax in Relapsed/Refractory Non-Hodgkin Lymphoma
Official Title
Phase I Trial of Tazemetostat in Combination With Venetoclax in Patients With Relapsed/Refractory Non-Hodgkin Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 7, 2023 (Actual)
Primary Completion Date
December 2026 (Anticipated)
Study Completion Date
December 2028 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Weill Medical College of Cornell University
Collaborators
Genentech, Inc., Epizyme, 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 clinical trial is to learn about how a combination of tazemetostat and venetoclax in people with relapsed/refractory Non-Hodgkin Lymphoma (R/R NHL). The main questions that this trial aims to answer are what is the best dose of venetoclax to give with tazemetostat to people with R/R NHL; what types of side effects do people with R/R NHL get when taking venetoclax with tazemetostat; and what effects does this combination have on R/R NHL. Participants will need to take pills by mouth every day and regularly come to the clinic for blood work and imagining to monitor side effects and cancer progression. Participants may receive study drugs for up to 24 months.
Detailed Description
This a phase 1, single arm, non-randomized trial of tazemetostat in combination with venetoclax in participants with two types of relapsed/refractory non-Hodgkin lymphoma. The purpose of this study is to evaluate the safety of the combination of tazemetostat and venetoclax in patients with relapsed/refractory (R/R) Follicular Lymphoma (FL) and Diffuse Large B-cell Lymphoma (DLBCL). This trial will be conducted in two parts. Part one will be a single-arm, open-label sequential dose escalation (3+3) of venetoclax in combination with a fixed dose of tazemetostat (800mg BID) to determine the maximum tolerated dose (MTD) of venetoclax. In part two, two expansion cohorts (R/R DLBCL and R/R FL) will be enrolled to further characterize the safety and tolerability of the combination, and to estimate the preliminary efficacy. Up to 18 participants will be enrolled in part 1 and 20 participants will be enrolled in part 2.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphoma, Non-Hodgkin, Diffuse Large B Cell Lymphoma, Follicular Lymphoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Tazemetostat and Venetoclax
Arm Type
Experimental
Arm Description
All participants will receive a combination of oral 800 mg tazemetostat BID and oral venetoclax. Since this is a phase 1 trial, the dose of venetoclax will be determined by the investigators per a sequential dose escalation (3+3). Participants will be provided study drug in the form of pills to take at home. Study participants will need to regularly come to the clinic for blood work, imaging, and to monitor and side effects. Participants may receive study drug until their cancer progresses or for up to 24 months.
Intervention Type
Drug
Intervention Name(s)
Venetoclax
Other Intervention Name(s)
Venclexta
Intervention Description
Participants will receive oral venetoclax taken once per day. The dose will be between 200 and 800 mg daily, with the exact dose determined by the protocol.
Intervention Type
Drug
Intervention Name(s)
Tazemetostat
Other Intervention Name(s)
Tazverik
Intervention Description
Tazemetostat 800mg taken orally, twice daily.
Primary Outcome Measure Information:
Title
Maximum-tolerated dose (MTD) determination (Part 1)
Description
In part 1 of this study, participants will be assigned a dose of venetoclax following a (3+3) dose escalation design and monitored for dose-limiting toxicities (DLTs) during the first treatment cycle. Based on observed DLTs observed in each dose level cohort, the maximum-tolerated dose will be determined. The # of patients experiencing a DLT among the evaluable patients for each dose level in part 1 will be tabulated.
Time Frame
Day 0 to 28
Title
Number of participants who experience dose-limiting toxicities (DLTs)
Description
In part 1 of this study, participants will be assigned a dose of venetoclax following a (3+3) dose escalation design and monitored for dose-limiting toxicities (DLTs) during the first treatment cycle. Dose limiting toxicity (DLT) will be assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0 (NCI CTCAE v5.0).
Time Frame
Day 0 to 28
Title
Number of participants who experience adverse events (AEs), from baseline to 30 days after the last dose of study drug, as assessed by CTCAE v5.0
Description
The safety analysis population will consist of all enrolled patients who receive at least one dose of study drug. AEs and SAEs will be tabulated by type, grade, and attribution for all patients overall and by treatment group. For each patient, and within each type of toxicity, the patient will be counted only once at the highest grade of that toxicity. Participants will be evaluated for AEs/SAEs from the time they sign the informed consent form until 30 days after their last dose of study drug.
Time Frame
Baseline through 25 months
Title
Number of adverse events (AEs) by severity from baseline to 30 days, after the last dose of study drug as assessed, by CTCAE v5.0
Description
The safety analysis population will consist of all enrolled patients who receive at least one dose of study drug. AEs and SAEs will be tabulated by type, grade, and attribution for all patients overall and by treatment group. For each patient, and within each type of toxicity, the patient will be counted only once at the highest grade of that toxicity. Participants will be evaluated for AEs/SAEs from the time they sign the informed consent form until 30 days after their last dose of study drug.
Time Frame
Baseline through 25 months
Secondary Outcome Measure Information:
Title
Number of Participants who Achieve Complete Response (CR)
Description
CR will be assessed for all evaluable patients in parts 1+2 according to Lugano response criteria.
Time Frame
Day 0 through 24 months
Title
Number of Participants who Achieve Partial Response (PR)
Description
PR will be assessed for all evaluable patients in parts 1+2 according to Lugano response criteria.
Time Frame
Day 0 through 24 months
Title
Overall Response Rate (ORR)
Description
The ORR response rate is the proportion of patients with a best overall response of either complete response (CR) or partial response (PR) among all evaluable patients. ORR, CR, and PR will be assessed for all evaluable patients in parts 1+2 according to Lugano response criteria. The best overall response is the best response recorded from the start of treatment until progressive disease.
Time Frame
Day 0 through 24 months
Title
Duration of Response (DoR)
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 PD is objectively documented (taking as reference for PD the smallest measurements recorded since the treatment started). The duration of overall CR is measured from the time measurement criteria are first met for CR until the first date that recurrent disease is objectively documented. Duration of stable disease is measured from the start of the treatment until the criteria for progression are met, taking as reference the smallest measurements recorded since the treatment started.
Time Frame
From date of treatment initiation until the date of first documented progression or date of death from any cause, whichever came first, as assessed at 5 years
Title
Progression-Free Survival
Description
PFS is defined as the duration of time from start of treatment to time of documentation of progression or death from any cause.
Time Frame
From date of treatment initiation until the date of first documented progression or date of death from any cause, whichever came first, as assessed at 5 years
Title
Overall Survival (OS)
Description
OS is defined as the duration of time from start of treatment to death from any cause.
Time Frame
From date of treatment initiation until the date of death from any cause, as assessed at 5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed, biopsy-proven diagnosis of FL or DLBCL. Subjects must have been treated with at least one prior line of therapy for lymphoma with evidence of disease progression. Subjects are eligible if they have progressed after ASCT OR if they are ineligible for ASCT Exclusion Criteria: Significant cardiovascular impairment, such as history of congestive heart failure, uncontrolled arterial hypertension, unstable angina, myocardial infarction, or stroke within 6 months of the first dose of study drug Known hypersensitivity to any of the study drugs History of other cancer (some exceptions apply) Known CNS (brain or spinal cord) involvement at diagnosis Richter's transformation from CLL Evidence of uncontrolled systemic infection (viral, bacterial, or fungal) Major surgery within 3 weeks prior to the start of study treatment Venous thrombosis or pulmonary embolism within the last 3 months before starting study Uncontrolled infection with human immunodeficiency virus (HIV) or human T-cell leukemia virus 1 Pregnant or lactating (people capable of becoming pregnant or getting someone else pregnant must be willing to use highly effective birth control) Malabsorption syndrome or other condition that precludes enteral route of administration Inability to swallow tablets Known allergy to both xanthine oxidase inhibitors and rasburicase Clinically significant history of liver disease, including but not limited to viral or other hepatitis, current alcohol abuse, or cirrhosis Active hepatitis C (defined as a positive HCV viral load) Chronic use of moderate or strong CYP3A4 modulators (inhibitor or inducer); chronic use of a P-gp inhibitor, or a P-gp substrate with a narrow therapeutic index; or use of certain other prohibited medications Prior exposure to either tazemetostat or venetoclax Prior history of T-LBL/T-ALL Previous solid organ transplant Requires the use of warfarin (because of potential drug-drug interactions that may potentially increase the exposure of warfarin) Vaccination with live vaccines within 28 days prior to treatment Consumed grapefruit or grapefruit products, Seville oranges (including marmalade containing Seville oranges), or star fruit within 3 days prior to the first dose of study drug
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Tejasvi Kaur Sahni
Phone
646-962-8189
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
Lisa Roth, M.D.
Organizational Affiliation
Weill Medical College of Cornell University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Weill Cornell Medicine/NewYork-Presberteryian Hospital
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tejasvi Kaur Sahni
Phone
646-962-9337
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
Lisa Roth, M.D.

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Tazemetostat and Venetoclax in Relapsed/Refractory Non-Hodgkin Lymphoma

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