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KW-0761 or Investigator's Choice in Subjects With Previously Treated Adult T-cell Leukemia-Lymphoma (ATL)

Multi-Center, Open-Label, Randomized Study of Anti-CCR4 Monoclonal Antibody KW-0761 or Investigator's Choice in Subjects With Previously Treated Adult T-cell Leukemia-Lymphoma (ATL)

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01626664
Enrollment
71
Registered
2012-06-25
Start date
2012-06-30
Completion date
2018-02-28
Last updated
2024-04-25

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

Conditions

Adult T-cell Leukemia-Lymphoma

Keywords

Adult T cell Leukemia-Lymphoma (ATL)

Brief summary

The purpose of this study is to estimate the overall response rate of subjects with relapsed or refractory Adult T-cell Leukemia-Lymphoma (ATL).

Detailed description

CCR4 expression in ATL patients has been demonstrated to be very high and has been associated with shorter survival compared with CCR4-negative patients. KW-0761, a monoclonal antibody targeted to CCR4, has been shown to be safe and tolerable in several clinical trials in subjects with a variety of T-cell malignancies, including ATL, mycosis fungoides and Sézary syndrome. The objective of this study is to estimate the overall response rate of KW-0761 for subjects with relapsed or refractory ATL.

Interventions

BIOLOGICALKW-0761

1.0 mg/kg weekly x 4 in cycle 1 then every other week until progression

DRUGPralatrexate

30 mg/m2 weekly for 3 weeks followed by 1 week of no therapy until progression

DRUGgemcitabine plus oxaliplatin

gemcitabine 1000 mg/m2, followed by oxaliplatin 100 mg/m2 every 2 weeks until progression

DRUGDHAP

dexamethasone 40 mg on Day 1-4, cisplatin 100 mg/m2 on Day 1 followed by 2 doses of cytarabine 2000 mg/m2 every 4 weeks until progression

Sponsors

Kyowa Kirin, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

Inclusion criteria

* Males and female subjects ≥ 18 years of age * Confirmed diagnosis of ATL (excluding smoldering subtype) * Subjects must currently have evidence of disease in at least one of the following: * Lymph nodes * Extranodal masses * Spleen or liver * Skin * Peripheral blood * Bone marrow * Relapsed or refractory after at least one prior systemic therapy regimen for ATL; * Eastern Cooperative Oncology Group (ECOG) performance status score of ≤ 2 at study entry * Resolution of all clinically significant toxic effects of prior cancer therapy to grade ≤1 by the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0 (NCI-CTCAE, v.4.0) * Adequate hematological, hepatic and renal function

Exclusion criteria

* Smoldering subtype of ATL; * Lymphomatous or acute subtype subject with \> 2 prior systemic therapy regimens and who has not achieved a response (CR or PR) or maintained stable disease for at least 12 weeks on last immediate prior therapy; * History of allogeneic transplant; * Autologous hematopoietic stem cell transplant within 90 days of study entry; * Untreated human immunodeficiency virus (HIV) * Has known hepatitis C. Patients who are hepatitis C antibody positive but are hepatitis C quantitative PCR negative may be enrolled; * Has hepatitis B based on PCR testing for hepatitis B virus DNA. Patients who are hepatitis B core antibody positive but PCR negative may be enrolled if placed on appropriate anti-hepatitis B virus prophylaxis prior to commencing treatment with KW-0761. Patients who are hepatitis B core antibody positive based on prior vaccination need not receive prophylaxis; * Have had a malignancy in the past two years except non-melanoma skin cancers, melanoma in situ, localized cancer of the prostate with current PSA \< 0.1 µg/mL, treated thyroid cancer or cervical carcinoma in situ or ductal/lobular carcinoma in situ of the breast who is currently without evidence of disease; * Clinical evidence of central nervous system (CNS) involvement or metastasis. In subjects suspected of having CNS disease, an MRI of the brain and/or lumbar puncture should be done to confirm; * Psychiatric illness, disability or social situation that would compromise the subject's safety or ability to provide consent, or limit compliance with study requirements; * Significant uncontrolled intercurrent illness * Experienced allergic reactions to monoclonal antibodies or other therapeutic proteins; * Known active autoimmune diseases will be excluded (For example; Grave's disease; systemic lupus erythematosus; rheumatoid arthritis; Crohn's disease); * Is pregnant (confirmed by beta human chorionic gonadotrophin \[β-HCG\]) or lactating. * Prior treatment with KW-0761; * Initiation of treatment with systemic corticosteroids while on study is only permitted for acute and brief complications of underlying disease (e.g., hypercalcemia) or for treatment related side effects (e.g., including pre-medication for infusion reaction, nausea and vomiting). Subjects on systemic corticosteroids prior to enrollment must be off for 7 days before initiation of study treatment, unless specifically indicated for the treatment of hypercalcemia. (subjects may receive inhalation corticosteroids and replacement doses of systemic corticosteroids as needed); * Initiation of treatment with topical corticosteroids while on study is not permitted except to treat an acute rash. Subjects on a stable dose of medium or low potency topical corticosteroids for at least 4 weeks prior to Pre-treatment Visit may continue use at the same dose, although the investigator should attempt to taper the use to lowest dose tolerable; * Have had interferon-α and/or zidovudine within 1 week, or anti-neoplastic chemotherapy, radiation, immunotherapy, or investigational medications within 2 weeks of first study treatment; * Subjects on any immunomodulatory drug. Subjects on any immunomodulatory drug within 4 weeks of their first dose of KW-0761 are also excluded.

Design outcomes

Primary

MeasureTime frameDescription
Overall Response Rateevery 8 weeks from date of randomization until the date of first documented progression or date of death from any cause, whichever came firstOverall Response Rate was determined based on the response in all compartments (lymph nodes, extranodal masses, spleen/liver, skin, peripheral blood, and bone marrow), referencing Tsukasaki, 2009 as follows: Complete Response (CR) = All compartments involved with disease must be CR; Uncertified Complete Response (CRu) = \> 75% decrease in lymph nodes and/or extranodal disease with all other compartments involved with disease CR; Partial Response (PR) = If any compartment is CR/PR and all other compartments involved with disease are at least SD; Stable Disease (SD) = All compartments involved with disease are SD; Progressive Disease (PD) = PD in any compartment. Lymph node and extranodal masses response ≥50% decrease by CT, skin response ≥50% decrease in mSWAT score; blood response ≥50% decrease in malignant cells by flow cytometry; normal bone marrow if abnormal at baseline. PD equals New or ≥50% increase in any compartment.

Secondary

MeasureTime frameDescription
Progression Free SurvivalFrom date of randomization until the date of first documented progression, start of alternative therapy, or date of death from any cause, whichever came first, up to 36 monthsProgression-free survival was defined as the time from the first date of treatment until the date that PD or death was first reported. Disease progression included PD in any compartment per ATL response criteria, clinical progression at the end of the randomized treatment, or disease progression reported during the follow-up period. The date of PD was the earliest date at which disease progression could be declared.
Overall Survivalup to 36 monthsThe estimates and summary statistics for OS were calculated based on Kaplan-Meier method, and the median OS was 4.9 months for subjects randomized to the mogamulizumab group versus 6.87 months for subjects randomized to the Investigator's Choice group.
Change in Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) Total ScoreFrom date of randomization until the date of first documented progression, up to 36 monthsThe FACT-Lym consists of a 27-item general core questionnaire (i.e., Functional Assessment of Cancer Therapy - General \[FACT-G\]) and a 15-item disease-specific questionnaire (Lymphoma Subscale). The FACT-G includes 4 domains: physical well-being, social/family well-being, emotional well-being, and functional well-being. The total FACT-Lym score (0-168) was obtained by summing individual subscale scores. Higher scores for the scales indicate better quality of life. Change was calculated as the value at the last observation minus the value at baseline.

Countries

Belgium, Brazil, France, Peru, United Kingdom, United States

Participant flow

Participants by arm

ArmCount
KW-0761
anti-CCR4 monoclonal antibody KW-0761 (mogamulizumab) KW-0761: 1.0 mg/kg weekly x 4 in cycle 1 then every other week until progression
47
Investigator's Choice
Comparator is investigator's choice of pralatrexate or gemcitabine plus oxaliplatin or DHAP Pralatrexate: 30 mg/m2 weekly for 3 weeks followed by 1 week of no therapy until progression gemcitabine plus oxaliplatin: gemcitabine 1000 mg/m2, followed by oxaliplatin 100 mg/m2 every 2 weeks until progression DHAP: dexamethasone 40 mg on Day 1-4, cisplatin 100 mg/m2 on Day 1 followed by 2 doses of cytarabine 2000 mg/m2 every 4 weeks until progression
24
Total71

Baseline characteristics

CharacteristicKW-0761Investigator's ChoiceTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
12 Participants2 Participants14 Participants
Age, Categorical
Between 18 and 65 years
35 Participants22 Participants57 Participants
Age, Continuous55 years49 years53 years
Ethnicity (NIH/OMB)
Hispanic or Latino
9 Participants6 Participants15 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
31 Participants14 Participants45 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
7 Participants4 Participants11 Participants
Race/Ethnicity, Customized
Race
Asian
2 Participants1 Participants3 Participants
Race/Ethnicity, Customized
Race
Black or African American
32 Participants15 Participants47 Participants
Race/Ethnicity, Customized
Race
Not Applicable
6 Participants3 Participants9 Participants
Race/Ethnicity, Customized
Race
Other
1 Participants0 Participants1 Participants
Race/Ethnicity, Customized
Race
White
6 Participants5 Participants11 Participants
Region of Enrollment
Brazil
3 participants0 participants3 participants
Region of Enrollment
France
6 participants3 participants9 participants
Region of Enrollment
Peru
4 participants3 participants7 participants
Region of Enrollment
United Kingdom
9 participants4 participants13 participants
Region of Enrollment
United States
25 participants14 participants39 participants
Sex: Female, Male
Female
23 Participants14 Participants37 Participants
Sex: Female, Male
Male
24 Participants10 Participants34 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
10 / 471 / 2412 / 18
other
Total, other adverse events
45 / 4724 / 2417 / 18
serious
Total, serious adverse events
26 / 4710 / 249 / 18

Outcome results

Primary

Overall Response Rate

Overall Response Rate was determined based on the response in all compartments (lymph nodes, extranodal masses, spleen/liver, skin, peripheral blood, and bone marrow), referencing Tsukasaki, 2009 as follows: Complete Response (CR) = All compartments involved with disease must be CR; Uncertified Complete Response (CRu) = \> 75% decrease in lymph nodes and/or extranodal disease with all other compartments involved with disease CR; Partial Response (PR) = If any compartment is CR/PR and all other compartments involved with disease are at least SD; Stable Disease (SD) = All compartments involved with disease are SD; Progressive Disease (PD) = PD in any compartment. Lymph node and extranodal masses response ≥50% decrease by CT, skin response ≥50% decrease in mSWAT score; blood response ≥50% decrease in malignant cells by flow cytometry; normal bone marrow if abnormal at baseline. PD equals New or ≥50% increase in any compartment.

Time frame: every 8 weeks from date of randomization until the date of first documented progression or date of death from any cause, whichever came first

ArmMeasureGroupValue (NUMBER)
KW-0761Overall Response RateComplete Response2 participants
KW-0761Overall Response RateUncertified Complete Response0 participants
KW-0761Overall Response RatePartial Response11 participants
KW-0761Overall Response RateStable Disease0 participants
KW-0761Overall Response RateRelapsed Disease or Progressive Disease16 participants
KW-0761Overall Response RateNot Assessable18 participants
KW-0761Overall Response RateOverall Response Rate (Confirmed and Unconfirmed)13 participants
KW-0761Overall Response RateOverall Response Rate Confirmed5 participants
Investigator's ChoiceOverall Response RateOverall Response Rate Confirmed0 participants
Investigator's ChoiceOverall Response RateComplete Response0 participants
Investigator's ChoiceOverall Response RateRelapsed Disease or Progressive Disease13 participants
Investigator's ChoiceOverall Response RateUncertified Complete Response0 participants
Investigator's ChoiceOverall Response RateOverall Response Rate (Confirmed and Unconfirmed)2 participants
Investigator's ChoiceOverall Response RatePartial Response2 participants
Investigator's ChoiceOverall Response RateNot Assessable5 participants
Investigator's ChoiceOverall Response RateStable Disease4 participants
Secondary

Change in Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) Total Score

The FACT-Lym consists of a 27-item general core questionnaire (i.e., Functional Assessment of Cancer Therapy - General \[FACT-G\]) and a 15-item disease-specific questionnaire (Lymphoma Subscale). The FACT-G includes 4 domains: physical well-being, social/family well-being, emotional well-being, and functional well-being. The total FACT-Lym score (0-168) was obtained by summing individual subscale scores. Higher scores for the scales indicate better quality of life. Change was calculated as the value at the last observation minus the value at baseline.

Time frame: From date of randomization until the date of first documented progression, up to 36 months

Population: All participants in Intention-to-Treat who had both the values at baseline and last observation

ArmMeasureGroupValue (MEAN)Dispersion
KW-0761Change in Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) Total ScoreBaseline110.1 Units on a scaleStandard Deviation 22.15
KW-0761Change in Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) Total ScoreLast Observation Change from Baseline-12.1 Units on a scaleStandard Deviation 25.6
Investigator's ChoiceChange in Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) Total ScoreBaseline106.8 Units on a scaleStandard Deviation 25.84
Investigator's ChoiceChange in Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) Total ScoreLast Observation Change from Baseline-14.9 Units on a scaleStandard Deviation 25.56
Secondary

Overall Survival

The estimates and summary statistics for OS were calculated based on Kaplan-Meier method, and the median OS was 4.9 months for subjects randomized to the mogamulizumab group versus 6.87 months for subjects randomized to the Investigator's Choice group.

Time frame: up to 36 months

ArmMeasureGroupValue (MEDIAN)
KW-0761Overall SurvivalSubjects (%) Alive for at Least: 4 Months54.3 percentage of subjects
KW-0761Overall SurvivalSubjects (%) Alive for at Least: 1 Month87.0 percentage of subjects
KW-0761Overall SurvivalSubjects (%) Alive for at Least: 2 Months75.6 percentage of subjects
KW-0761Overall SurvivalSubjects (%) Alive for at Least: 3 Months59.1 percentage of subjects
KW-0761Overall SurvivalSubjects (%) Alive for at Least: 5 Months49.5 percentage of subjects
KW-0761Overall SurvivalSubjects (%) Alive for at Least: 6 Months44.3 percentage of subjects
Investigator's ChoiceOverall SurvivalSubjects (%) Alive for at Least: 5 Months54.2 percentage of subjects
Investigator's ChoiceOverall SurvivalSubjects (%) Alive for at Least: 4 Months66.7 percentage of subjects
Investigator's ChoiceOverall SurvivalSubjects (%) Alive for at Least: 3 Months70.8 percentage of subjects
Investigator's ChoiceOverall SurvivalSubjects (%) Alive for at Least: 1 Month91.7 percentage of subjects
Investigator's ChoiceOverall SurvivalSubjects (%) Alive for at Least: 6 Months54.2 percentage of subjects
Investigator's ChoiceOverall SurvivalSubjects (%) Alive for at Least: 2 Months79.2 percentage of subjects
Secondary

Progression Free Survival

Progression-free survival was defined as the time from the first date of treatment until the date that PD or death was first reported. Disease progression included PD in any compartment per ATL response criteria, clinical progression at the end of the randomized treatment, or disease progression reported during the follow-up period. The date of PD was the earliest date at which disease progression could be declared.

Time frame: From date of randomization until the date of first documented progression, start of alternative therapy, or date of death from any cause, whichever came first, up to 36 months

ArmMeasureGroupValue (MEDIAN)
KW-0761Progression Free SurvivalPFS Subjects (%) Alive for at Least: 1 Month47.5 percentage of subjects
KW-0761Progression Free SurvivalPFS Subjects (%) Alive for at Least: 2 Months29.8 percentage of subjects
KW-0761Progression Free SurvivalPFS Subjects (%) Alive for at Least: 3 Months24.4 percentage of subjects
KW-0761Progression Free SurvivalPFS Subjects (%) Alive for at Least: 4 Months18.3 percentage of subjects
KW-0761Progression Free SurvivalPFS Subjects (%) Alive for at Least: 5 Months18.3 percentage of subjects
KW-0761Progression Free SurvivalPFS Subjects (%) Alive for at Least: 6 Months12.2 percentage of subjects
Investigator's ChoiceProgression Free SurvivalPFS Subjects (%) Alive for at Least: 5 Months0 percentage of subjects
Investigator's ChoiceProgression Free SurvivalPFS Subjects (%) Alive for at Least: 1 Month44.1 percentage of subjects
Investigator's ChoiceProgression Free SurvivalPFS Subjects (%) Alive for at Least: 4 Months13.2 percentage of subjects
Investigator's ChoiceProgression Free SurvivalPFS Subjects (%) Alive for at Least: 2 Months33.0 percentage of subjects
Investigator's ChoiceProgression Free SurvivalPFS Subjects (%) Alive for at Least: 6 Months0 percentage of subjects
Investigator's ChoiceProgression Free SurvivalPFS Subjects (%) Alive for at Least: 3 Months26.4 percentage of subjects

Source: ClinicalTrials.gov · Data processed: Mar 8, 2026