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Study Comparing Inotuzumab Ozogamicin In Combination With Rituximab Versus Defined Investigator's Choice In Follicular Non-Hodgkin's Lymphoma (NHL)

An Open-label, Randomized, Phase 3 Study Of Inotuzumab Ozogamicin (Cmc-544) Administered In Combination With Rituximab Compared To A Defined Investigator's Choice Therapy In Subjects With Relapsed Or Refractory, Cd22- Positive, Follicular B-cell Non Hodgkin's Lymphoma

Status
Terminated
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00562965
Enrollment
29
Registered
2007-11-26
Start date
2007-11-30
Completion date
2011-04-30
Last updated
2018-01-09

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Lymphoma, Follicular

Brief summary

This protocol is designed to assess the efficacy and safety of inotuzumab ozogamicin given with rituximab compared to a defined investigator's choice therapy. Subjects will be randomized to one of these two arms of the study.

Detailed description

On January 14th 2009, enrollment in the study was discontinued because of poor enrollment and because it was unlikely that the study would meet the estimated enrollment of approximately 978 subjects. The decision was not prompted by the identification of any safety signals in this or other studies. Active treatment and follow-up of the already enrolled subjects was continued. On July, 22th 2010 , the study was amended to shorten the long-term follow-up to one year after active treatment.

Interventions

DRUGinotuzumab ozogamicin

IV administration, 1.8mg/m² on day 2 of each cycle every 28 days, for up to 8 cycles.

DRUGrituximab

IV administration, 375 mg/m² on day 1 of each cycle every 28 days, for up to 8 cycles.

DRUGcyclophosphamide

intravenous cyclophosphamide at a dose of 750 mg/m2 on day 1

DRUGvincristine

intravenous vincristine at a dose of 1.4 mg/m2 (not to exceed 2 mg) on day 1

oral prednisone/prednisolone at a dose of 40 mg/m2 on days 1 through 5

DRUGmitoxantrone

mitoxantrone 10 mg/m2 intravenous on day 2

DRUGfludarabine

fludarabine 25 mg/m2 intravenous on days 2 through 4

DRUGdexamethasone

oral dexamethasone 20 mg/day on days 1-5

Sponsors

UCB Pharma
CollaboratorINDUSTRY
Pfizer
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Subjects with a diagnosis of CD20 and CD22-positive, follicular lymphoma, who have received 1 or 2 prior regimens, at least 1 of which should have contained administration of rituximab (either as a single agent or in combination). * Age 18 years or older. * ECOG performance status \<= 2. * ANC \>= 1.5 x 10\^9/L (1500/mL) and platelets \>= 75 x 10\^9/L (75,000/mL), serum creatinine \<= 1.5 x ULN and urine protein to creatinine ratio of \<= 0.5, total bilirubin \<= 1.5 x ULN, AST and ALT \<= 2.5 x ULN. * At least 1 measurable disease lesion that is \>= 1.5 cm x 1.5 cm by CT or MRI, in an area of no prior radiation therapy, or documented progression in an area that was previously irradiated.

Exclusion criteria

* Subjects with clinical evidence of transformation to a more aggressive subtype of lymphoma or grade 3b follicular lymphoma. * Subjects whose disease is rituximab refractory, meaning that they did not have a CR or PR, or that they experienced disease progression within 6 months from the initiation of the rituximab or rituximab containing treatment regimen administered immediately preceding study enrollment.

Design outcomes

Primary

MeasureTime frameDescription
Progression-Free Survival (PFS)Baseline until disease progression or death or up to 1 year after last dose of study drugPFS was defined as the time from randomization to disease progression or death due to any cause, whichever occurred first, censored at the last tumor evaluation date. PFS calculated as (Months) = (first event date minus randomization date plus 1) divided by 30.44.

Secondary

MeasureTime frameDescription
Percentage of Participants With Objective Response (OR)Baseline, every 6 to 12 weeks during treatment period, end of treatment (EOT) (42 days after last dose), every 12 weeks during follow-up for up to 1 year after the last dose of study drugOR was based on assessment of complete response(CR),unconfirmed CR(Cru),partial response(PR) as per International Response Criteria for Non-Hodgkin's Lymphoma.Confirmed response=response persists on repeat imaging at least 4 weeks after initial response.CR=complete disappearance of all detectable clinical/radiographic evidence of disease,lymph nodes regressed to normal size \[at least 1.5 centimeter(cm) or less\],spleen regressed,not palpable on physical examination,bone marrow infiltrate cleared on repeat aspiration/biopsy.PR=at least 50 percent (%) decrease in sum of product diameters of 6 greatest dominant nodes,no increase in other nodes,liver/spleen,no new sites of disease. CRu=residual lymph node greater than 1.5 cm in transverse diameter that has regressed more than 75% in product diameter.Individual nodes previously confluent,regressed more than 75% in product diameters.Indeterminate bone marrow (increased number/size of lymph aggregates without cytologic/architectural atypia).
Overall Survival Probability at Months 6, 12 and 24Baseline up to Month 6, 12, 24Overall survival was defined as the time from randomization to death due to any cause, censoring at the date of last contact or the end of the study. Participants who withdrew or lost to follow-up from study without having death documented were censored at the date of last contact. Kaplan-Meier estimates of the probability of survival at 6, 12 and 24 months was used to estimate the survival function.
Pharmacokinetics of Inotuzumab Ozogamicin in Combination With Rituximab0, 1, 168 hours on Cycle 1, 2; 0, 1, 2, 168 hours on Cycle 3, 4

Other

MeasureTime frameDescription
Number of Participants With Clinically Significant Change From Baseline in QT Interval FindingsBaseline up to 42 days post-treatmentAssessments of QT interval was performed only in rituximab + inotuzumab ozogamicinin group. QT interval corrected using Fridericia's formula (QTcF) and Bazett's formula (QTcB) was analyzed as per common terminology criteria for adverse events (CTCAE) version 3.0, where Grade 1 = mild AE, Grade 2 = moderate AE, Grade 3 = severe AE, Grade 4 = life-threatening or disabling AE, Grade 5 = death related to AE. Number of participants with change in CTCAE grading at post-baseline time point compared to the baseline were presented. The post-baseline value was defined as the maximum grade after the first dose date on or before the end of treatment.
Number of Participants With Grade 3 or 4 Treatment Emergent Adverse Events (TEAEs)Baseline up to 42 days post-treatmentAE=any untoward medical occurrence in participant who received study drug without regard to possibility of causal relationship. Grade 3 (Severe) events=unacceptable or intolerable events, significantly interrupting usual daily activity, require systemic drug therapy/other treatment. Grade 4 (Life-threatening) events caused participant to be in imminent danger of death. TEAE=between first dose of study drug and up to 42 days after last dose that were absent before treatment or that worsened relative to pretreatment state.
Number of Participants With Clinically Significant Change From Baseline in Laboratory FindingsBaseline up to 42 days post-treatment, disease follow up (every 12 weeks for a minimum of 1 year and up to 2 years)Criteria for laboratory test abnormality: Blood Chemistry (alkaline phosphatase \[greater than{\>}5\*upper limit of normal {ULN}, calcium \[less than {\<}1.75 millimole per liter {mmol/L}, creatinine \[\>3\*ULN\], glucose \[\>13.9 mmol/L\], phosphorous \[\<0.6 mmol/L\], potassium \[\<3 mmol/L\], aspartate transaminase \[\>5.0\*ULN\], total bilirubin \[\>3\*ULN\]), Coagulation (international normalized ratio \[\>2\*ULN\]), Hematology (hemoglobin \[\<80 grams/Liter\], lymphocytes \[\<0.5\*10\^9/L\], absolute neutrophil count \[\<1\*10\^9/L\], platelet count \[\<50\*10\^9/L\], WBC \[\<2.0\*10\^9/L\]).
Number of Participants With Clinically Significant Change From Baseline in Vital SignsBaseline up to 42 days post-treatment, disease follow up (every 12 weeks for a minimum of 1 year and up to 2 years)Criteria for determining significant change from baseline in vital signs abnormalities: heart rate value of \<40 beats per minute and value \>150 beats per minute, systolic blood pressure (SBP) of \<80 or \>210 millimeter of mercury (mmHg), diastolic blood pressure (DBP) of \<40 or \>130 mmHg, temperature \<32 or \>40 degree centigrade, and body weight\>=10% increase or decrease of body weight in kilogram (kg).

Countries

Argentina, Belgium, Canada, Hong Kong, India, Italy, Mexico, Poland, Portugal, Russia, South Africa, South Korea, Spain, United States

Participant flow

Recruitment details

Enrollment of participants started on 15 November 2007 and completed on 16 January 2009. The trial was terminated (07 April 2011) due to poor accrual of 29 out of 978 planned participants.

Participants by arm

ArmCount
Rituximab + Inotuzumab Ozogamicin
Participants received intravenous infusion of rituximab 375 milligram per square meter (mg/m\^2) of body surface area (BSA) on Day 1 followed by intravenous infusion of inotuzumab ozogamicin (CMC-544) 1.8 mg/m\^2 of BSA on Day 2 for each cycle up to 8 cycles. Each cycle was of 28 days.
15
Control Regimens R-CVP + R-FND
Participants received either regimen containing intravenous infusion of rituximab 375 mg/m\^2 of BSA along with intravenous infusion of cyclophosphamide 750 mg/m\^2 of BSA and vincristine 1.4 mg/m\^2 of BSA on Day 1 followed by oral prednisone/prednisolone 40 mg/m\^2 of BSA on Days 1 through 5 for up to 8 cycles (R-CVP); or regimen containing intravenous infusion of rituximab 375 mg/m\^2 of BSA on Day 1 followed by intravenous infusion of novantrone (mitoxantrone) 10 mg/m\^2 of BSA on Day 2, intravenous infusion of fludarabine 25 mg/m\^2 of BSA on Days 2 through 4, and oral dexamethasone 20 mg once daily on Days 1 through 5 for up to 8 cycles (R-FND). Each regimen cycle was of 21 days.
14
Total29

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeath24
Overall StudyLost to Follow-up10
Overall StudyOther01
Overall StudyWithdrawal by Subject01

Baseline characteristics

CharacteristicRituximab + Inotuzumab OzogamicinControl Regimens R-CVP + R-FNDTotal
Age, Continuous62.3 years
STANDARD_DEVIATION 11.4
60.9 years
STANDARD_DEVIATION 12.4
61.7 years
STANDARD_DEVIATION 11.7
Sex: Female, Male
Female
9 Participants6 Participants15 Participants
Sex: Female, Male
Male
6 Participants8 Participants14 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
15 / 1513 / 13
serious
Total, serious adverse events
6 / 156 / 13

Outcome results

Primary

Progression-Free Survival (PFS)

PFS was defined as the time from randomization to disease progression or death due to any cause, whichever occurred first, censored at the last tumor evaluation date. PFS calculated as (Months) = (first event date minus randomization date plus 1) divided by 30.44.

Time frame: Baseline until disease progression or death or up to 1 year after last dose of study drug

Population: Intent-to-treat population included all participants who were randomized in to the study.

ArmMeasureValue (MEDIAN)
Rituximab + Inotuzumab OzogamicinProgression-Free Survival (PFS)NA months
Control Regimens R-CVP + R-FNDProgression-Free Survival (PFS)16.4 months
Comparison: To detect a hazard ratio of 0.77 with 85% power using a 2-sided log-rank test at the 5% significance level, it was planned that approximately 978 participants were needed to be randomized but due to premature termination only 29 participants were randomized.p-value: 0.035895% CI: [0.04, 1.02]Cox proportional hazard regression model
Secondary

Overall Survival Probability at Months 6, 12 and 24

Overall survival was defined as the time from randomization to death due to any cause, censoring at the date of last contact or the end of the study. Participants who withdrew or lost to follow-up from study without having death documented were censored at the date of last contact. Kaplan-Meier estimates of the probability of survival at 6, 12 and 24 months was used to estimate the survival function.

Time frame: Baseline up to Month 6, 12, 24

Population: Intent-to-treat population included all participants who were randomized in to the study.

ArmMeasureGroupValue (NUMBER)
Rituximab + Inotuzumab OzogamicinOverall Survival Probability at Months 6, 12 and 24Overall Survival: Baseline up to Month 6100.0 percent chance of survival
Rituximab + Inotuzumab OzogamicinOverall Survival Probability at Months 6, 12 and 24Overall Survival: Baseline up to Month 1286.7 percent chance of survival
Rituximab + Inotuzumab OzogamicinOverall Survival Probability at Months 6, 12 and 24Overall Survival: Baseline up to Month 2486.7 percent chance of survival
Control Regimens R-CVP + R-FNDOverall Survival Probability at Months 6, 12 and 24Overall Survival: Baseline up to Month 692.3 percent chance of survival
Control Regimens R-CVP + R-FNDOverall Survival Probability at Months 6, 12 and 24Overall Survival: Baseline up to Month 1283.9 percent chance of survival
Control Regimens R-CVP + R-FNDOverall Survival Probability at Months 6, 12 and 24Overall Survival: Baseline up to Month 2467.1 percent chance of survival
p-value: 0.172795% CI: [0.05, 1.81]Cox proportional hazard regression model
Secondary

Percentage of Participants With Objective Response (OR)

OR was based on assessment of complete response(CR),unconfirmed CR(Cru),partial response(PR) as per International Response Criteria for Non-Hodgkin's Lymphoma.Confirmed response=response persists on repeat imaging at least 4 weeks after initial response.CR=complete disappearance of all detectable clinical/radiographic evidence of disease,lymph nodes regressed to normal size \[at least 1.5 centimeter(cm) or less\],spleen regressed,not palpable on physical examination,bone marrow infiltrate cleared on repeat aspiration/biopsy.PR=at least 50 percent (%) decrease in sum of product diameters of 6 greatest dominant nodes,no increase in other nodes,liver/spleen,no new sites of disease. CRu=residual lymph node greater than 1.5 cm in transverse diameter that has regressed more than 75% in product diameter.Individual nodes previously confluent,regressed more than 75% in product diameters.Indeterminate bone marrow (increased number/size of lymph aggregates without cytologic/architectural atypia).

Time frame: Baseline, every 6 to 12 weeks during treatment period, end of treatment (EOT) (42 days after last dose), every 12 weeks during follow-up for up to 1 year after the last dose of study drug

Population: Intent-to-treat population included all participants who were randomized in to the study.

ArmMeasureValue (NUMBER)
Rituximab + Inotuzumab OzogamicinPercentage of Participants With Objective Response (OR)93.3 percentage of participants
Control Regimens R-CVP + R-FNDPercentage of Participants With Objective Response (OR)64.3 percentage of participants
p-value: 0.0801Fisher Exact
Secondary

Pharmacokinetics of Inotuzumab Ozogamicin in Combination With Rituximab

Time frame: 0, 1, 168 hours on Cycle 1, 2; 0, 1, 2, 168 hours on Cycle 3, 4

Population: Data for this outcome measurement was not collected since pharmacokinetic parameters were not analyzed in this study due to very few number of participants with PK samples.

Other Pre-specified

Number of Participants With Clinically Significant Change From Baseline in Laboratory Findings

Criteria for laboratory test abnormality: Blood Chemistry (alkaline phosphatase \[greater than{\>}5\*upper limit of normal {ULN}, calcium \[less than {\<}1.75 millimole per liter {mmol/L}, creatinine \[\>3\*ULN\], glucose \[\>13.9 mmol/L\], phosphorous \[\<0.6 mmol/L\], potassium \[\<3 mmol/L\], aspartate transaminase \[\>5.0\*ULN\], total bilirubin \[\>3\*ULN\]), Coagulation (international normalized ratio \[\>2\*ULN\]), Hematology (hemoglobin \[\<80 grams/Liter\], lymphocytes \[\<0.5\*10\^9/L\], absolute neutrophil count \[\<1\*10\^9/L\], platelet count \[\<50\*10\^9/L\], WBC \[\<2.0\*10\^9/L\]).

Time frame: Baseline up to 42 days post-treatment, disease follow up (every 12 weeks for a minimum of 1 year and up to 2 years)

Population: Safety population included all participants who received at least 1 dose of a test article (either rituximab + inotuzumab ozogamicin or control regimens R-CVP + R-FND).

ArmMeasureGroupValue (NUMBER)
Rituximab + Inotuzumab OzogamicinNumber of Participants With Clinically Significant Change From Baseline in Laboratory FindingsDisease follow up8 participants
Rituximab + Inotuzumab OzogamicinNumber of Participants With Clinically Significant Change From Baseline in Laboratory FindingsBaseline up to 42 days post-treatment11 participants
Control Regimens R-CVP + R-FNDNumber of Participants With Clinically Significant Change From Baseline in Laboratory FindingsBaseline up to 42 days post-treatment12 participants
Control Regimens R-CVP + R-FNDNumber of Participants With Clinically Significant Change From Baseline in Laboratory FindingsDisease follow up7 participants
Other Pre-specified

Number of Participants With Clinically Significant Change From Baseline in QT Interval Findings

Assessments of QT interval was performed only in rituximab + inotuzumab ozogamicinin group. QT interval corrected using Fridericia's formula (QTcF) and Bazett's formula (QTcB) was analyzed as per common terminology criteria for adverse events (CTCAE) version 3.0, where Grade 1 = mild AE, Grade 2 = moderate AE, Grade 3 = severe AE, Grade 4 = life-threatening or disabling AE, Grade 5 = death related to AE. Number of participants with change in CTCAE grading at post-baseline time point compared to the baseline were presented. The post-baseline value was defined as the maximum grade after the first dose date on or before the end of treatment.

Time frame: Baseline up to 42 days post-treatment

Population: Safety population included all participants who received at least 1 dose of a test article. Here 'N' signifies those participants who were evaluable for this outcome measure.

ArmMeasureGroupValue (NUMBER)
Rituximab + Inotuzumab OzogamicinNumber of Participants With Clinically Significant Change From Baseline in QT Interval FindingsQTcB: BL normal, post-BL normal4 participants
Rituximab + Inotuzumab OzogamicinNumber of Participants With Clinically Significant Change From Baseline in QT Interval FindingsQTcB: BL normal, post-BL Grade 12 participants
Rituximab + Inotuzumab OzogamicinNumber of Participants With Clinically Significant Change From Baseline in QT Interval FindingsQTcB: BL normal, post-BL Grade 23 participants
Rituximab + Inotuzumab OzogamicinNumber of Participants With Clinically Significant Change From Baseline in QT Interval FindingsQTcF: BL normal, post-BL normal6 participants
Rituximab + Inotuzumab OzogamicinNumber of Participants With Clinically Significant Change From Baseline in QT Interval FindingsQTcF: BL normal, post-BL Grade 13 participants
Other Pre-specified

Number of Participants With Clinically Significant Change From Baseline in Vital Signs

Criteria for determining significant change from baseline in vital signs abnormalities: heart rate value of \<40 beats per minute and value \>150 beats per minute, systolic blood pressure (SBP) of \<80 or \>210 millimeter of mercury (mmHg), diastolic blood pressure (DBP) of \<40 or \>130 mmHg, temperature \<32 or \>40 degree centigrade, and body weight\>=10% increase or decrease of body weight in kilogram (kg).

Time frame: Baseline up to 42 days post-treatment, disease follow up (every 12 weeks for a minimum of 1 year and up to 2 years)

Population: Safety population included all participants who received at least 1 dose of a test article (either rituximab + inotuzumab ozogamicin or control regimens R-CVP + R-FND).

ArmMeasureGroupValue (NUMBER)
Rituximab + Inotuzumab OzogamicinNumber of Participants With Clinically Significant Change From Baseline in Vital SignsBaseline up to 42 days post-treatment0 participants
Rituximab + Inotuzumab OzogamicinNumber of Participants With Clinically Significant Change From Baseline in Vital SignsDisease follow up3 participants
Control Regimens R-CVP + R-FNDNumber of Participants With Clinically Significant Change From Baseline in Vital SignsBaseline up to 42 days post-treatment1 participants
Control Regimens R-CVP + R-FNDNumber of Participants With Clinically Significant Change From Baseline in Vital SignsDisease follow up2 participants
Other Pre-specified

Number of Participants With Grade 3 or 4 Treatment Emergent Adverse Events (TEAEs)

AE=any untoward medical occurrence in participant who received study drug without regard to possibility of causal relationship. Grade 3 (Severe) events=unacceptable or intolerable events, significantly interrupting usual daily activity, require systemic drug therapy/other treatment. Grade 4 (Life-threatening) events caused participant to be in imminent danger of death. TEAE=between first dose of study drug and up to 42 days after last dose that were absent before treatment or that worsened relative to pretreatment state.

Time frame: Baseline up to 42 days post-treatment

Population: Safety population included all participants who received at least 1 dose of a test article (either rituximab + inotuzumab ozogamicin or control regimens R-CVP + R-FND).

ArmMeasureValue (NUMBER)
Rituximab + Inotuzumab OzogamicinNumber of Participants With Grade 3 or 4 Treatment Emergent Adverse Events (TEAEs)12 participants
Control Regimens R-CVP + R-FNDNumber of Participants With Grade 3 or 4 Treatment Emergent Adverse Events (TEAEs)13 participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026