Lymphoma, Non-Hodgkin
Conditions
Keywords
inotuzumab ozogamicin, aggressive Non-Hodgkin lymphoma, diffuse large b-cell lymphoma, relapsed/refractory lymphoma
Brief summary
The purpose of this study is to evaluate the efficacy of inotuzumab ozogamicin plus rituximab in relapsed/refractory aggressive Non-Hodgkin lymphoma patients who are not candidates for intensive high-dose chemotherapy. Specifically, the goal is to demonstrate the superiority of this combination compared with an active comparator arm (investigator's choice of rituximab+bendamustine or rituximab+gemcitabine) using the primary endpoint of overall survival.
Interventions
1.8 mg/m2 on day 2 every 28 days by IV infusion, 3 to 6 cycles
375 mg/m2 on day 1 every 28 days by IV infusion, 3 to 6 cycles
rituximab 375 mg/m2 on days 1, 8, 15, and 22 of cycle 1, and day 1 of cycles 2 to 6, every 28 days by IV infusion, 3 to 6 cycles; gemcitabine 1000 mg/m2 on days 1, 8, and 15 every 28 days, 3 to 6 cycles
rituximab 375 mg/m2 on day 1 every 28 days by IV infusion, 3 to 6 cycles; bendamustine 120 mg/m2 on days 1 and 2 by IV infusion every 28 days, 3 to 6 cycles
Sponsors
Study design
Eligibility
Inclusion criteria
\-
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | From randomization up to 5 years after last dose or up to final study visit, whichever occurs first. | Overall Survival (OS) 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. The Kaplan-Meier method was used to determine OS. The hazard ratio and corresponding 95% 2-sided confidence interval were calculated using stratified Cox proportional hazard regression. |
| Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | Up to 20 weeks after the first dose of study drug | Includes all TEAEs: Any event that occurred after the first dose of study drug and was not present prior to study drug administration or worsened in severity after study drug administration.. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With A Best Overall Response of CR, Unconfirmed CR (unCR), PR, or Unconfirmed PR (unPR) Per NCI International Response Criteria for NHL | Up to 2 years from first study drug dose or up to final study visit, whichever occurs first, including but not limited to planned assessments scheduled approximately every 12 weeks. | CR is defined as disappearance of all detectable clinical evidence of disease (including cleared infiltrate on repeat bone marrow aspirate/biopsy if lymphoma involvement of bone marrow before treatment). Partial Response (PR) requires the following: 1. ≥50 % decrease in SPD of the six largest dominant nodes or nodal masses. 2. No increase in the size of other nodes, liver, or spleen. 3. Splenic and hepatic nodules must regress by ≥50% in the SPD, or for single nodules, in the greatest transverse diameter. 4. With the exception of splenic and hepatic nodules, involvement of other organs is usually assessable and no measurable disease should be present. 5. No new sites of disease. unCR and unPR means didn't have confirmatory assessment (including bone marrow assessment for CR). The 95% CI was determined using the exact method based on binomial distribution. |
| Duration of Response | Up to 2 years from first study drug dose or up to final study visit, whichever occurs first, including but not limited to planned assessments scheduled approximately every 12 weeks. | The duration of overall response is measured from the first date of response until the first date that the progressive disease (PD) or death is objectively documented. The hazard ratio and corresponding 95% 2-sided confidence interval were calculated using stratified Cox proportional hazard regression. |
| Progression-Free Survival (PFS) | From randomization up to 2 years or final study visit, whichever occurs first, including but not limited to planned assessments scheduled approximately every 12 weeks. | PFS is defined as time from date of randomization to date of progressive disease (PD, including investigator's claim of clinical progression), date of death from any cause, or initiation of a new treatment for the lymphoma due to persistent/refractory disease. The Kaplan-Meier method was used to determine PFS. The hazard ratio and corresponding 95% 2-sided confidence interval were calculated using stratified Cox proportional hazard regression. PD requires the following: 1. Appearance of any new lesion more than 1.5 cm in any axis during or at the end of treatment, even if other lesions are decreasing in size. 2. At least a 50% increase from nadir in the sum of the product diameters of any previously involved nodes, or in a single involved node, or the size of other lesions. 3. At least a 50% increase in the longest diameter of any single previously identified node more than 1 cm in its short axis. |
| Health Related Quality of Life as Assessed by the Functional Assessment of Cancer Therapy for Lymphoma (FACT-Lym) Questionnaire | Assessed at Day 1 of each cycle and 6-9 weeks after the last dose, Cycle 3 (Week 12) reported | FACT-Lym is a questionnaire that begins with 27 items covering four core Health-Related Quality of Life subscales: Physical Well-being (7 items), Social/Family Well-being (7), Emotional Well-being (6), and Functional Well-being (7). The FACT-Lym also includes an additional concerns subscale (15 items). It also asks participants about their concerns about lumps and swelling, fevers, infections, weight, appetite, emotional stability and treatment. The participants were requested to circle one number on a 0 to 4 points scale per line to indicate how true each statement has been for him/her during the past 7 days. FACT-Lym total score, which was reported, was derived based on FACT-Lym scoring guideline (Version 4). The range of FACT-Lym total score is 0 to 168. Higher scores mean better outcomes. The average post-baseline FACT-Lym total scores were computed at approximately Week 12. The overall treatment comparisons were estimated at approximately Week 12. |
| Health Status as Assessed by the European Quality of Life 5 Dimension (EQ-5D) Questionnaire | Assessed at Day 1 of each cycle and 6-9 weeks after the last dose, Cycle 3 (Week 12) reported | EQ-5D consists of a descriptive system and an EQ visual analogue scale. The descriptive system comprises the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, extreme problems. The scale, the best state is marked 100 and the worst state is marked 0, is to help the participant to say how good or bad a health state is. EQ-5D index, which was reported, was derived based on US weight. The range of EQ-5D index is -0.109 to 1.00. Higher scores mean better outcomes. The average post-baseline scores for EQ-5D index were computed at approximately Week 12. The overall treatment comparisons were estimated at approximately Week 12. |
| Percentage of Participants With A Best Overall Response of CR or Partial Response (PR) Per NCI International Response Criteria for NHL | Up to 2 years from first study drug dose or up to final study visit, whichever occurs first, including but not limited to planned assessments scheduled approximately every 12 weeks. | CR is defined as disappearance of all detectable clinical evidence of disease (including cleared infiltrate on repeat bone marrow aspirate/biopsy if lymphoma involvement of bone marrow before treatment). Partial Response (PR) requires the following: 1. ≥50 % decrease in SPD of the six largest dominant nodes or nodal masses. 2. No increase in the size of other nodes, liver, or spleen. 3. Splenic and hepatic nodules must regress by ≥50% in the SPD, or for single nodules, in the greatest transverse diameter. 4. With the exception of splenic and hepatic nodules, involvement of other organs is usually assessable and no measurable disease should be present. 5. No new sites of disease. The 95% CI was determined using the exact method based on binomial distribution. |
Countries
Belgium, Bulgaria, Canada, Croatia, Czechia, France, Germany, Hungary, India, Ireland, Japan, Lithuania, Mexico, Poland, Puerto Rico, Russia, Singapore, Slovakia, Spain, Sweden, Taiwan, Thailand, Ukraine, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Inotuzumab Ozogamicin+Rituximab Participants received rituximab 375 mg/m\^2 via IV infusion on Day 1 and inotuzumab ozogamicin 1.8 mg/m\^2 via IV infusion on Day 2 of each 28-day cycle for a maximum of 6 cycles. | 166 |
| Rituximab+Gemcitabine or Rituximab+Bendamustine Participants received either R-bendamustine (rituximab 375 mg/m\^2 via IV infusion on Day 1 and bendamustine 120 mg/m\^2 via IV infusion on Days 1 and 2 in 28-day cycles for a maximum of 6 cycles) or R-gemcitabine (rituximab 375 mg/m\^2 via IV infusion on Days 1, 8, 15 and 22 of Cycle 1 and on Day 1 for all other cycles, and gemcitabine 1000 mg/m\^2 via IV infusion on Days 1, 8 and 15 of each 28-day cycle for a maximum of 6 cycles). Choice of therapy was at the discretion of the investigator. | 172 |
| Total | 338 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 97 | 97 |
| Overall Study | Lost to Follow-up | 0 | 2 |
| Overall Study | Other | 6 | 4 |
| Overall Study | Terminated by Sponsor | 35 | 51 |
| Overall Study | Withdrawal by Subject | 21 | 17 |
Baseline characteristics
| Characteristic | Inotuzumab Ozogamicin+Rituximab | Rituximab+Gemcitabine or Rituximab+Bendamustine | Total |
|---|---|---|---|
| Age, Continuous | 68.6 Years STANDARD_DEVIATION 12.29 | 66.9 Years STANDARD_DEVIATION 11.4 | 67.7 Years STANDARD_DEVIATION 11.86 |
| Sex: Female, Male Female | 75 Participants | 75 Participants | 150 Participants |
| Sex: Female, Male Male | 91 Participants | 97 Participants | 188 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 155 / 164 | 158 / 167 |
| serious Total, serious adverse events | 61 / 164 | 63 / 167 |
Outcome results
Overall Survival
Overall Survival (OS) 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. The Kaplan-Meier method was used to determine OS. The hazard ratio and corresponding 95% 2-sided confidence interval were calculated using stratified Cox proportional hazard regression.
Time frame: From randomization up to 5 years after last dose or up to final study visit, whichever occurs first.
Population: ITT Population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Inotuzumab Ozogamicin+Rituximab | Overall Survival | 9.5 Months |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Overall Survival | 9.5 Months |
Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population)
Includes all TEAEs: Any event that occurred after the first dose of study drug and was not present prior to study drug administration or worsened in severity after study drug administration..
Time frame: Up to 20 weeks after the first dose of study drug
Population: Safety Population - included all participants who received at least 1 dose of test article (either inotuzumab ozogamicin administrated in combination with rituximab or investigator's choice). This population only excluded participants who never received any test article.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Inotuzumab Ozogamicin+Rituximab | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants with Grade 3 or 4 TEAE | 79.9 Percentage of Participants |
| Inotuzumab Ozogamicin+Rituximab | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants for study drug discontinuation | 25.0 Percentage of Participants |
| Inotuzumab Ozogamicin+Rituximab | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants with serious TEAE | 37.2 Percentage of Participants |
| Inotuzumab Ozogamicin+Rituximab | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants with dose reductions due to TEAEs | 27.4 Percentage of Participants |
| Inotuzumab Ozogamicin+Rituximab | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants with Grade 5 TEAE | 14.6 Percentage of Participants |
| Inotuzumab Ozogamicin+Rituximab | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants for study drug stopped temporarily | 31.1 Percentage of Participants |
| Inotuzumab Ozogamicin+Rituximab | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants with a TEAE | 98.8 Percentage of Participants |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants for study drug stopped temporarily | 46.1 Percentage of Participants |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants with a TEAE | 100.0 Percentage of Participants |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants with serious TEAE | 37.7 Percentage of Participants |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants with Grade 3 or 4 TEAE | 79.6 Percentage of Participants |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants with Grade 5 TEAE | 13.8 Percentage of Participants |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants for study drug discontinuation | 18.0 Percentage of Participants |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Percentage of Participants With a Treatment Emergent Adverse Event (TEAE) (Safety Population) | % participants with dose reductions due to TEAEs | 29.3 Percentage of Participants |
Duration of Response
The duration of overall response is measured from the first date of response until the first date that the progressive disease (PD) or death is objectively documented. The hazard ratio and corresponding 95% 2-sided confidence interval were calculated using stratified Cox proportional hazard regression.
Time frame: Up to 2 years from first study drug dose or up to final study visit, whichever occurs first, including but not limited to planned assessments scheduled approximately every 12 weeks.
Population: ITT population; only participants with a CR, unCR, PR, or unPR were included in the analysis
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Inotuzumab Ozogamicin+Rituximab | Duration of Response | 11.56 Months |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Duration of Response | 6.93 Months |
Health Related Quality of Life as Assessed by the Functional Assessment of Cancer Therapy for Lymphoma (FACT-Lym) Questionnaire
FACT-Lym is a questionnaire that begins with 27 items covering four core Health-Related Quality of Life subscales: Physical Well-being (7 items), Social/Family Well-being (7), Emotional Well-being (6), and Functional Well-being (7). The FACT-Lym also includes an additional concerns subscale (15 items). It also asks participants about their concerns about lumps and swelling, fevers, infections, weight, appetite, emotional stability and treatment. The participants were requested to circle one number on a 0 to 4 points scale per line to indicate how true each statement has been for him/her during the past 7 days. FACT-Lym total score, which was reported, was derived based on FACT-Lym scoring guideline (Version 4). The range of FACT-Lym total score is 0 to 168. Higher scores mean better outcomes. The average post-baseline FACT-Lym total scores were computed at approximately Week 12. The overall treatment comparisons were estimated at approximately Week 12.
Time frame: Assessed at Day 1 of each cycle and 6-9 weeks after the last dose, Cycle 3 (Week 12) reported
Population: ITT population
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Inotuzumab Ozogamicin+Rituximab | Health Related Quality of Life as Assessed by the Functional Assessment of Cancer Therapy for Lymphoma (FACT-Lym) Questionnaire | 120.07 Unit on a scale |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Health Related Quality of Life as Assessed by the Functional Assessment of Cancer Therapy for Lymphoma (FACT-Lym) Questionnaire | 116.96 Unit on a scale |
Health Status as Assessed by the European Quality of Life 5 Dimension (EQ-5D) Questionnaire
EQ-5D consists of a descriptive system and an EQ visual analogue scale. The descriptive system comprises the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, extreme problems. The scale, the best state is marked 100 and the worst state is marked 0, is to help the participant to say how good or bad a health state is. EQ-5D index, which was reported, was derived based on US weight. The range of EQ-5D index is -0.109 to 1.00. Higher scores mean better outcomes. The average post-baseline scores for EQ-5D index were computed at approximately Week 12. The overall treatment comparisons were estimated at approximately Week 12.
Time frame: Assessed at Day 1 of each cycle and 6-9 weeks after the last dose, Cycle 3 (Week 12) reported
Population: ITT population
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Inotuzumab Ozogamicin+Rituximab | Health Status as Assessed by the European Quality of Life 5 Dimension (EQ-5D) Questionnaire | 0.79 Unit on a scale |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Health Status as Assessed by the European Quality of Life 5 Dimension (EQ-5D) Questionnaire | 0.77 Unit on a scale |
Percentage of Participants With A Best Overall Response of CR or Partial Response (PR) Per NCI International Response Criteria for NHL
CR is defined as disappearance of all detectable clinical evidence of disease (including cleared infiltrate on repeat bone marrow aspirate/biopsy if lymphoma involvement of bone marrow before treatment). Partial Response (PR) requires the following: 1. ≥50 % decrease in SPD of the six largest dominant nodes or nodal masses. 2. No increase in the size of other nodes, liver, or spleen. 3. Splenic and hepatic nodules must regress by ≥50% in the SPD, or for single nodules, in the greatest transverse diameter. 4. With the exception of splenic and hepatic nodules, involvement of other organs is usually assessable and no measurable disease should be present. 5. No new sites of disease. The 95% CI was determined using the exact method based on binomial distribution.
Time frame: Up to 2 years from first study drug dose or up to final study visit, whichever occurs first, including but not limited to planned assessments scheduled approximately every 12 weeks.
Population: ITT Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Inotuzumab Ozogamicin+Rituximab | Percentage of Participants With A Best Overall Response of CR or Partial Response (PR) Per NCI International Response Criteria for NHL | 29.5 Percentage of Participants |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Percentage of Participants With A Best Overall Response of CR or Partial Response (PR) Per NCI International Response Criteria for NHL | 29.7 Percentage of Participants |
Percentage of Participants With A Best Overall Response of CR, Unconfirmed CR (unCR), PR, or Unconfirmed PR (unPR) Per NCI International Response Criteria for NHL
CR is defined as disappearance of all detectable clinical evidence of disease (including cleared infiltrate on repeat bone marrow aspirate/biopsy if lymphoma involvement of bone marrow before treatment). Partial Response (PR) requires the following: 1. ≥50 % decrease in SPD of the six largest dominant nodes or nodal masses. 2. No increase in the size of other nodes, liver, or spleen. 3. Splenic and hepatic nodules must regress by ≥50% in the SPD, or for single nodules, in the greatest transverse diameter. 4. With the exception of splenic and hepatic nodules, involvement of other organs is usually assessable and no measurable disease should be present. 5. No new sites of disease. unCR and unPR means didn't have confirmatory assessment (including bone marrow assessment for CR). The 95% CI was determined using the exact method based on binomial distribution.
Time frame: Up to 2 years from first study drug dose or up to final study visit, whichever occurs first, including but not limited to planned assessments scheduled approximately every 12 weeks.
Population: ITT Population
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Inotuzumab Ozogamicin+Rituximab | Percentage of Participants With A Best Overall Response of CR, Unconfirmed CR (unCR), PR, or Unconfirmed PR (unPR) Per NCI International Response Criteria for NHL | 41.0 Percentage of Participants |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Percentage of Participants With A Best Overall Response of CR, Unconfirmed CR (unCR), PR, or Unconfirmed PR (unPR) Per NCI International Response Criteria for NHL | 43.6 Percentage of Participants |
Progression-Free Survival (PFS)
PFS is defined as time from date of randomization to date of progressive disease (PD, including investigator's claim of clinical progression), date of death from any cause, or initiation of a new treatment for the lymphoma due to persistent/refractory disease. The Kaplan-Meier method was used to determine PFS. The hazard ratio and corresponding 95% 2-sided confidence interval were calculated using stratified Cox proportional hazard regression. PD requires the following: 1. Appearance of any new lesion more than 1.5 cm in any axis during or at the end of treatment, even if other lesions are decreasing in size. 2. At least a 50% increase from nadir in the sum of the product diameters of any previously involved nodes, or in a single involved node, or the size of other lesions. 3. At least a 50% increase in the longest diameter of any single previously identified node more than 1 cm in its short axis.
Time frame: From randomization up to 2 years or final study visit, whichever occurs first, including but not limited to planned assessments scheduled approximately every 12 weeks.
Population: ITT Population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Inotuzumab Ozogamicin+Rituximab | Progression-Free Survival (PFS) | 3.7 Months |
| Rituximab+Gemcitabine or Rituximab+Bendamustine | Progression-Free Survival (PFS) | 3.5 Months |