B-cell Small Lymphocytic Lymphoma Recurrent
Conditions
Keywords
follicular lymphoma, small lymphocytic lymphoma, marginal zone lymphoma, non-Hodgkin's lymphoma, indolent lymphoma
Brief summary
This was a Phase 1 multicenter study of bendamustine, rituximab and TRU-016 (BRT) in subjects with relapsed indolent B-cell lymphoma. This was a multiple-dose escalation study to determine the maximum-tolerated dose (MTD) of TRU-016 given in combination with rituximab and bendamustine and to determine a safe dosing regimen for the combination in up to 12 subjects with relapsed indolent lymphoma. The originally planned Phase 2 portion, an open-label, randomized study to evaluate the efficacy of BRT compared with BR, was not conducted.
Detailed description
This study was planned to be conducted in 2 parts: a Phase 1b component designed to determine a safe dosing regimen, and a Phase 2 component designed to evaluate the efficacy of BRT compared to BR in subjects with relapsed indolent lymphoma. The Phase 2 component was not conducted. This was an open-label, non randomized, multiple-dose escalation study to determine the MTD of BRT and to determine a safe dosing regimen for the combination in subjects with relapsed indolent lymphoma. The study consisted of a screening period lasting up to 21 days, a treatment period lasting up to 6 cycles (28 days each), and a 60-day follow-up period. Up to 12 subjects (2 cohorts of 6 subjects each) were planned for enrollment. Two dose levels (10 and 20 mg/kg) of TRU-016 combined with rituximab 375 mg/m2 and bendamustine 90 mg/m2 were evaluated during up to 6 cycles (28 days each). TRU-016 was administered by intravenous (IV) infusion on Days 1 and 15 of each cycle. Rituximab was administered by IV infusion on Day 2 of each cycle. Bendamustine was administered by IV infusion on Days 1 and 2 of each cycle. Subjects received study treatment for up to 6 cycles.
Interventions
DRUGTRU-016
100 mg TRU-016 lyophilized solution for infusion at 10 or 20 mg/kg (or 6 mg/kg, if necessary) on Days 1 and 15 of each 28 day cycle
DRUGBendamustine
Bendamustine by IV administration on Days 1 and 2 of each 28 day cycle.
DRUGRituximab
Rituximab by IV administration at 375 mg/m\^2 on Day 2 of each 28 day cycle.
Sponsors
Aptevo Therapeutics
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18 years or older 2. Histologically confirmed diagnosis of indolent non-Hodgkin's B-cell lymphoma (ie, follicular lymphoma, small lymphocytic lymphoma, and marginal zone lymphoma) that has relapsed (relapsed is defined as confirmed progressive disease (PD) after receiving the most recent prior therapy, or failure to achieve at least a partial response (PR) while receiving the most recent prior therapy) 3. At least one prior line of therapy for indolent lymphoma 4. Bi-dimensionally measurable disease with at least one lesion measuring \>=1.5 cm in a single dimension 5. Eastern Cooperative Oncology Group (ECOG) performance status of \<= 2 6. Creatinine clearance of \>40 mL/min as calculated by the Cockcroft-Gault method as follows: (140 - age) \* (weight in kg \[\* 0.85 if female\] / 72 \* serum creatinine level) 7. Adequate hepatic function, indicated as follows: * aspartate aminotransferase (AST) of \<2.5 x upper limit of normal (ULN) * alanine aminotransferase (ALT) of \<2.5 x ULN * total bilirubin of \<= 1.5 x ULN 8. Absolute neutrophil count (ANC) \>=1000/mm3 (1000/µL) 9. Platelet count \>= 100,000/mm3 10. Female subjects of child-bearing potential and male subjects must use an acceptable form of birth control for the duration of their study participation and for 6 months after completing study drug dosing; acceptable forms of birth control, unless dictated otherwise by local regulatory authorities 11. For women of childbearing potential, a negative serum pregnancy test result obtained during the screening period and a negative urine pregnancy test result within 24 hours before first administration of study drug 12. Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information
Exclusion criteria
1. Diagnosis of grade 3b follicular lymphoma or transformed lymphoma of any grade 2. Previously received TRU-016 3. Prior treatment with rituximab if subject discontinued rituximab due to unresolved toxicity 4. Refractory to bendamustine, defined as follows: * progression within 6 months of last dose of bendamustine * failed to achieve at least a PR while receiving bendamustine * discontinued bendamustine due to toxicity * received bendamustine within 6 months prior to first dose of study drug 5. Received chemotherapy, radiotherapy, or immunotherapy including investigational agents within 28 days prior to the first dose of study drug 6. Received therapeutic corticosteroids at doses equivalent to \>10 mg prednisone per day for longer than 5 days within 14 days prior to the first dose of study drug, except if needed as a pre-medication 7. Received filgrastim or equivalent within 14 days prior to screening (ie, collection of samples for laboratory tests) or pegfilgrastim within 28 days prior to screening (ie, collection of samples for laboratory tests) 8. Prior allogeneic bone marrow transplant 9. Prior autologous bone marrow transplant within 12 months prior to the first dose of study drug 10. Received blood or platelet infusion within 7 days prior to screening (ie, collection of samples for laboratory tests) 11. Previous or concurrent additional malignancy except non-invasive, non-melanomatous skin cancer or in situ carcinoma of the cervix, or other solid tumors if the subject has been disease-free for a minimum of 2 years prior to the first dose of study drug 12. Known central nervous system or leptomeningeal lymphoma 13. Any significant concurrent medical diseases or conditions, including but not limited to the following: * Clinically significant pulmonary dysfunction requiring oxygen therapy * An active infection (viral, bacterial, or fungal) requiring systemic therapy; subjects receiving prophylactic therapy are eligible 14. Known allergy to mannitol 15. History of positive serology for human immunodeficiency virus (HIV) 16. Positive serology for hepatitis B (surface antigen or core antibody) Note: If a positive test result for hepatitis B core antibody is due to immunoglobulin treatment, the subject may be enrolled if the hepatitis B viral deoxyribonucleic acid (DNA) is negative. 17. Positive serology for hepatitis C 18. Pregnant or breastfeeding 19. Other severe, acute, or chronic medical or psychiatric condition, laboratory abnormality, or difficulty complying with protocol requirements that may increase the risk associated with study participation or study drug administration or may interfere with safety 20. Any condition that, in the investigator's opinion, makes the subject unsuitable for study participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Response | Day 15 and Day 28 of even-numbered cycles | Response was assessed by the investigator on the basis of clinical, radiological, and pathological (i.e., bone marrow) criteria, using the IWG criteria (Cheson et al 2007). A CR is a complete disappearance of all detectable clinical evidence of disease and disease-related symptoms if present before therapy. A PR is at least a 50% decrease in sum of the product of the diameters (SPD) of up to 6 of the largest dominant nodes or nodal masses, no increase should be observed in the size of other nodes, liver or spleen, and no new sites of disease should be observed. |
Countries
United States
Participant flow
Recruitment details
Twelve adult patients, 6 in each dose group, were enrolled at 4 hospitals between May and October 2011.
Participants by arm
| Arm | Count |
|---|---|
| TRU-016 (10 mg/kg) +Bendamustine+Rituximab | 6 |
| TRU-016 (20 mg/kg) +Bendamustine+Rituximab | 6 |
| Total | 12 |
Baseline characteristics
| Characteristic | Total | TRU-016 (10 mg/kg) +Bendamustine+Rituximab | TRU-016 (20 mg/kg) +Bendamustine+Rituximab |
|---|---|---|---|
| Age, Continuous | 60.8 years STANDARD_DEVIATION 8.65 | 57.3 years STANDARD_DEVIATION 4.76 | 64.3 years STANDARD_DEVIATION 10.61 |
| Direct Anti-globulin Test Negative | 11 participants | 6 participants | 5 participants |
| Direct Anti-globulin Test Positive | 0 participants | 0 participants | 0 participants |
| Direct Anti-globulin Test unknown | 1 participants | 0 participants | 1 participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 1 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 11 Participants | 5 Participants | 6 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| FLIPI Highrisk (3-5 points) | 2 participants | 0 participants | 2 participants |
| FLIPI Intermediate risk (2 points) | 4 participants | 3 participants | 1 participants |
| FLIPI Low risk (0-1 points) | 6 participants | 3 participants | 3 participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 11 Participants | 5 Participants | 6 Participants |
| Sex: Female, Male Female | 4 Participants | 1 Participants | 3 Participants |
| Sex: Female, Male Male | 8 Participants | 5 Participants | 3 Participants |
| Staging at diagnosis Not done | 1 participants | 1 participants | 0 participants |
| Staging at diagnosis Stage 1 | 1 participants | 1 participants | 0 participants |
| Staging at diagnosis Stage 2 | 2 participants | 1 participants | 1 participants |
| Staging at diagnosis Stage 3 | 3 participants | 1 participants | 2 participants |
| Staging at diagnosis Stage 4 | 5 participants | 2 participants | 3 participants |
| Sum of product diameters | 37.9 cm2 STANDARD_DEVIATION 28.5 | 40.9 cm2 STANDARD_DEVIATION 26.5 | 35.0 cm2 STANDARD_DEVIATION 32.6 |
| Time since first diagnosis of primary cancer | 4.6 years STANDARD_DEVIATION 4 | 3.2 years STANDARD_DEVIATION 2.8 | 6.0 years STANDARD_DEVIATION 4.7 |
| β2-microglobulin | 2.6 MG/l STANDARD_DEVIATION 1.5 | 2.4 MG/l STANDARD_DEVIATION 1.3 | 2.9 MG/l STANDARD_DEVIATION 1.9 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 6 / 6 | 6 / 6 |
| serious Total, serious adverse events | 2 / 6 | 3 / 6 |
Outcome results
Primary
Response
Response was assessed by the investigator on the basis of clinical, radiological, and pathological (i.e., bone marrow) criteria, using the IWG criteria (Cheson et al 2007). A CR is a complete disappearance of all detectable clinical evidence of disease and disease-related symptoms if present before therapy. A PR is at least a 50% decrease in sum of the product of the diameters (SPD) of up to 6 of the largest dominant nodes or nodal masses, no increase should be observed in the size of other nodes, liver or spleen, and no new sites of disease should be observed.
Time frame: Day 15 and Day 28 of even-numbered cycles
Population: All treated subjects
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| TRU-016 (10 mg/kg) + Bendamustine + Rituximab | Response | Complete Response | 3 participants |
| TRU-016 (10 mg/kg) + Bendamustine + Rituximab | Response | Partial Response | 1 participants |
| TRU-016 (10 mg/kg) + Bendamustine + Rituximab | Response | Stable disease | 1 participants |
| TRU-016 (10 mg/kg) + Bendamustine + Rituximab | Response | Relapsed/progressive disease | 1 participants |
| 20 mg/kg of TRU 016 + Bendamustine + Rituximab | Response | Relapsed/progressive disease | 0 participants |
| 20 mg/kg of TRU 016 + Bendamustine + Rituximab | Response | Complete Response | 2 participants |
| 20 mg/kg of TRU 016 + Bendamustine + Rituximab | Response | Stable disease | 0 participants |
| 20 mg/kg of TRU 016 + Bendamustine + Rituximab | Response | Partial Response | 4 participants |