Transplant-eligible relapsed or refractory (R/R) aggressive B-cell Non Hodgkin Lymphoma (B-NHL) MedDRA version: 20.0 Level: LLT Classification code 10029593 Term: Non-Hodgkin's lymphoma NOS System Organ Class: 100000004864 MedDRA version: 20.0 Level: HLGT Classification code 10025320 Term: Lymphomas non-Hodgkin's B-cell System Organ Class: 10005329 - Blood and lymphatic system disorders
Conditions
Sponsors
Celgene Corporation
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Subject is = 18 years and = 75 years of age at the time of signing the informed consent form (ICF). 2. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted. 3. Subject is willing and able to adhere to the study visit schedule and other protocol requirements. 4. ECOG performance status = 2. 5. Histologically proven diffuse large B-cell lymphoma (DLBCL) NOS (de novo or transformed FL), high grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with DLBCL histology (double/triple-hit lymphoma [DHL/THL]) or follicular lymphoma grade 3B. Enough tumor material must be available for confirmation by central pathology. If archival sample is before most recent relapse or no or insufficient archival sample is available, a new tumor biopsy is mandated to confirm diagnosis. Note: Subjects with secondary CNS involvement are eligible. 6. Refractory (SD, PD, PR or CR with relapse before 3 months) or relapsed (CR with relapse on or after 3 months) within 12 months from CD20 antibody and anthracycline containing first line therapy. 7. [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET) positive lesion at screening. 8. Adequate organ function, defined as: - Adequate bone marrow function as assessed by the Investigator - Serum creatinine 30 mL/min (estimated glomerular filtration rate [eGFR] by Cockcroft Gault see Appendix D for calculation) - Alanine aminotransferase (ALT) = 5 x ULN and total bilirubin < 2.0 mg/dL (or < 3.0 mg/dL for subjects with Gilbert's syndrome or lymphomatous infiltration of the liver) - Adequate pulmonary function, defined as = Grade 1 dyspnea according to Common Terminology Criteria for Adverse Events (CTCAE) and oxygen saturation (SaO2) = 92% on room air - Adequate cardiac function, defined as left ventricular ejection fraction (LVEF) = 40% as assessed by echocardiogram (ECHO) or multi-gated acquisition scan (MUGA) performed within 4 weeks of randomization 9. Adequate vascular access for leukapheresis 10. Subjects must agree to not donate blood, organs, sperm or semen, and egg cells for usage in other individuals while receiving as well as within 12 months after the JCAR017 infusion and until CAR T cells are no longer present by quantitative polymerase chain reaction (qPCR) on 2 consecutive tests, whichever occurs last. 11. Females of childbearing potential (FCBP) must: - Have a negative pregnancy test as verified by the Investigator prior to starting study therapy. She must agree to ongoing pregnancy testing during the course of the study, and after end of study treatment. This applies even if the subject practices true abstinence* from heterosexual contact. - Either commit to true abstinence* from heterosexual contact (which must be reviewed on a monthly basis and source documented) or agree to use, and be able to comply with, effective contraception without interruption. Contraception methods must include 1 highly effective and 1 additional effective (barrier) method of contraception from screening until at least 12 months after the JCAR017 infusion and until CAR T cells are no longer present by qPCR on 2 consecutive tests, whichever is later (Arm B) and until 12 months after the last chemotherapy (Arm A), - Agree to abstain from breastfeeding during study participation and for at least 3 months after the last dose of JCAR017 or until CAR
Exclusion criteria
Exclusion criteria: 1. Subject has any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study. 2. Subject has any condition including the presence of laboratory abnormalities, which would place the subject at unacceptable risk if participating in the study. 3. Subject has any condition that confounds the ability to interpret data from the study. 4. Subjects not eligible for hematopoietic stem cell transplantation (HSCT). 5. Subjects planned to undergo allogeneic stem cell transplantation. 6. Subjects with T cell rich/histiocyte rich large B-cell lymphoma (THRBCL), primary cutaneous large B-cell lymphoma, primary mediastinal B-cell lymphoma (PMBCL), EBV (Epstein-Barr virus) positive DLBCL of the elderly and Burkitt lymphoma, transformed indolent NHL except transformed FL. 7. Subjects with prior history of malignancies, other than aggressive R/R NHL, unless the subject has been free of the disease for = 2 years with the exception of the following noninvasive malignancies: - Basal cell carcinoma of the skin - Squamous cell carcinoma of the skin - Carcinoma in situ of the cervix - Carcinoma in situ of the breast - Incidental histologic finding of prostate cancer (T1a or T1b using the TNM [tumor, nodes, metastasis] clinical staging system) or prostate cancer that is curative. - Other completely resected stage 1 solid tumor with low risk for recurrence 8. Treatment with any prior gene therapy product 9. Subjects who have received previous CD19-targeted therapy. 10. History of or active hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) infection. 11. Subjects with uncontrolled systemic fungal, bacterial, viral or other infection (including tuberculosis) despite appropriate antibiotics or other treatment. 12. Active autoimmune disease requiring immunosuppressive therapy. 13. History of any one of the following cardiovascular conditions within the past 6 months prior to signing the ICF: Class III or IV heart failure as defined by the New York Heart Association (NYHA), cardiac angioplasty or stenting, myocardial infarction, unstable angina, or other clinically significant cardiac disease. 14. History or presence of clinically relevant central nervous system (CNS) pathology such as epilepsy, seizure, paresis, aphasia, stroke, severe brain injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, or psychosis. 15. Pregnant or nursing (lactating) women. 16. Use of the following: - Therapeutic doses of corticosteroids (defined as > 20 mg/day prednisone or equivalent) within 7 days prior to unstimulated leukapheresis. Physiologic replacement, topical, and inhaled steroids are permitted. - Cytotoxic chemotherapeutic agents that are not considered lymphotoxic (see below) must be stopped = 7 days prior to unstimulated leukapheresis. - Lymphotoxic chemotherapeutic agents (eg, cyclophosphamide, ifosfamide, bendamustine) prior to unstimulated leukapheresis. - Experimental agents within 4 weeks prior to signing the ICF unless no response or progressive disease (PD) is documented on the experimental therapy and at least 3 half-lives have elapsed prior to unstimulated leukapheresis. - Immunosuppressive therapies within 4 weeks prior to unstimulated leukapheresis (eg, calcineurin inhibitors, methotrexate or other chemotherapeutics, mycophenolate, rapamycin, thalidomide, immunosuppressive antibodies such as anti-tumor necrosis fac
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Main Objective: The primary objective of the study is to compare the efficacy in subjects treated with JCAR017 versus subjects treated according to standard of care (SOC) defined as event-free survival (EFS).;Secondary Objective: The key secondary objectives are to compare the efficacy in subjects treated with JCAR017 versus subjects treated according to SOC defined as complete response rate (CRR), progression-free survival (PFS) and overall survival (OS). - To compare other parameters of efficacy, defined as duration of response (DOR), overall response rate (ORR), PFS on next line of treatment (PFS-2) - To compare efficacy rates (EFS, PFS, OS) at 6, 12 and 24 months after randomization - To compare the safety defined as type and frequency of adverse events (AEs), serious adverse events (SAEs), and laboratory abnormalities - To compare the safety and efficacy in clinical, histological and molecular subgroups - To compare health-related quality of life (HRQoL) - To compare hospital resource utilization (HRU) - To describe the rate of completion of high dose chemotherapy (HDCT) and hematopoietic stem cell transplant (HSCT) - To assess the response 3 months after-HSCT;Primary end point(s): Primary Efficacy: Event-free survival (EFS): Time from randomization to death from any cause, progressive disease (PD), as assessed by the independent review committee (IRC) or start of new antineoplastic therapy, whichever occurs first.;Timepoint(s) of evaluation of this end point: Up to 3 years post-randomization | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary end point(s): Key Secondary Efficacy: 1. Complete response rate (CRR): Percentage of subjects achieving a complete response (CR) according to the Lugano Classification (Cheson, 2014) assessed by the IRC. 2. Progression-free survival (PFS): Time from randomization to PD, SD at 1st response assessment as per protocol schedule, as per IRC review or death from any cause, whichever occurs first. 3. Overall survival (OS): Time from randomization to time of death due to any cause. Secondary Efficacy: 1. Overall response rate (ORR): Percentage of subjects achieving an objective response of partial response (PR) or better according to the Lugano Classification (Cheson, 2014) as assessed by IRC review. 2. Duration of response (DOR): Time from first response to disease progression, start of new antineoplastic therapy or death from any cause. 3. PFS-2: Time from randomization to second objective disease progression or death from any cause, whichever is first. 4. EFS rate 5. PFS rate 6. OS rate See protocol for additional study endpoints;Timepoint(s) of evaluation of this end point: Key Secondary Efficacy: 1 and 2 - Up to 3 years post-randomization 3 - Up to last subject last visit Secondary Efficacy: 1, 2, 3 - Up to 3 years post-randomization 4, 5, 6 - At 6, 12 and 24 months post-randomization | — |
Countries
Belgium, Canada, France, Germany, Italy, Japan, Netherlands, Spain, Sweden, Switzerland, United Kingdom, United States
Contacts
Public ContactClinicalTrialDisclosure
Celgene Corporation
Outcome results
None listed