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Ublituximab in Combination With Ibrutinib Versus Ibrutinib Alone in Participants With Previously Treated High-Risk Chronic Lymphocytic Leukemia (CLL)

A Phase 3, Randomized, Study to Assess the Efficacy and Safety of Ublituximab in Combination With Ibrutinib Compared to Ibrutinib Alone, in Patients With Previously Treated High-Risk Chronic Lymphocytic Leukemia (CLL)

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02301156
Acronym
GENUINE
Enrollment
126
Registered
2014-11-25
Start date
2015-01-27
Completion date
2020-04-01
Last updated
2022-05-20

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

Conditions

Chronic Lymphocytic Leukemia

Brief summary

This study evaluates the effect of the addition of ublituximab, a novel monoclonal antibody, to ibrutinib compared to ibrutinib alone on antitumor activity, as measured by the overall response rate (ORR = CR \[complete response\] + PR \[partial response\]) in previously treated Chronic Lymphocytic Leukemia (CLL) participants with high-risk cytogenetic features. Half of the participants will receive ublituximab in combination with ibrutinib, while the other half will receive ibrutinib alone.

Interventions

DRUGUblituximab

Administered as an IV infusion

DRUGIbrutinib

Administered orally

Sponsors

TG Therapeutics, 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

* Previously treated Chronic Lymphocytic Leukemia (CLL) requiring treatment * At least one high-risk cytogenetic feature defined by the presence of 17p deletion, 11q deletion and/or p53 mutation * Eastern Cooperative Oncology Group (ECOG) score of 0 to 2

Exclusion criteria

* Any major surgery, chemotherapy or immunotherapy within the last 21 days * Evidence of hepatitis B virus, hepatitis C virus or known human immunodeficiency virus (HIV) infection * Autologous hematologic stem cell transplant within 3 months of study entry. Prior Allogeneic hematologic stem cell transplant is excluded * Transformation of CLL to aggressive Non-Hodgkin's Lymphoma (NHL) (Richter's transformation) * Previous therapy with ibrutinib, or any drug that specifically inhibits Bruton's tyrosine kinase (BTK)

Design outcomes

Primary

MeasureTime frameDescription
Overall Response Rate (ORR)Up to 62 monthsORR: Percentage of participants with best overall response of partial response(PR) and complete response(CR). CR criteria: No evidence of new disease; Absolute lymphocyte count(ALC)\<4x10\^9/liter(L); Regression of all target nodal masses to ≤1.5 centimeters(cm) in longest diameter(LD); Normal spleen,liver size; Regression to normal of all nodal non-target disease and disappearance of all detectable; Non-nodal, non-target disease; Morphologically negative bone marrow; No lymphoid nodules; Absolute neutrophil count(ANC)\>1.5x10\^9/L,platelets≥100x10\^9/L,hemoglobin (Hgb)≥110 gram per liter(g/L). PR criteria: No evidence of new disease; Response in 2 of following if abnormal at baseline: ALC\<4x10\^9/L or \>=50% decrease from baseline in sum of products(SPD) of target nodal lesions; splenomegaly; hepatomegaly;\>=50% decrease from baseline in CLL marrow infiltrate/B-lymphoid nodules; response in any 1:ANC\>1.5x10\^9/L,platelets\>100x10\^9/L,Hgb\>110g/L or \>=50% increase over baseline in any of these.

Secondary

MeasureTime frameDescription
Complete Response (CR) RateUp to 62 monthsThe CR rate was defined as the percentage of participants who achieved CR. CR criteria: No evidence of new disease; ALC \<4 x 10\^9/L; Regression of all target nodal masses to normal size ≤1.5 cm in the LD; Normal spleen and liver size; Regression to normal of all nodal non-target disease and disappearance of all detectable; Non-nodal, non-target disease; Morphologically negative bone marrow; No lymphoid nodules; ANC \>1.5 x 10\^9/L, platelets ≥100 x 10\^9/L, Hgb ≥110 g/L.
Progression-Free Survival (PFS)From the randomization until the first documentation of PD or death whichever occurs first or up to 62 monthsPFS was defined as the time from the date of randomization until the date of first documentation of definitive disease progression (PD) or date of death from any cause, whichever occurs first. PD requires at least one of the following: New nodes \>1.5 cm in the LD and \>1.0 in longest perpendicular diameter (LPD), new or recurrent hepatomegaly or splenomegaly, new or reappearance of an unequivocal extra-nodal lesion, ≥50% increase from the nadir in the sum of products of target lesions, ≥50% increase in the LD of an individual node or extra-nodal mass, splenic/hepatic enlargement of ≥50% from nadir, unequivocal increase in the size of non-target disease, transformation to a more aggressive histology, decrease in platelet count or Hgb, \>50% decrease from the highest on-study platelet count, \>20 g/L decrease from the highest on-study Hgb.
Minimum Residual Disease (MRD) Negativity RateUp to 62 monthsMRD negativity rate was defined as the percentage of participants who were MRD negative post-baseline. If a participant was determined to be MRD negative by peripheral blood, a bone marrow aspirate was obtained to assess MRD in the bone marrow.
Time to Response (TTR)From the randomization up to 62 monthsTTR was defined as the interval from the randomization to the first documentation of CR or PR. CR criteria: No evidence of new disease; ALC \<4 x 10\^9/L; Regression of all target nodal masses to normal size ≤1.5 cm in the LD; Normal spleen and liver size; Regression to normal of all nodal non-target disease and disappearance of all detectable; Non-nodal, non-target disease; Morphologically negative bone marrow; No lymphoid nodules; ANC \>1.5 x 10\^9/L, platelets ≥100 x 10\^9/L, Hgb ≥110 g/L. PR criteria: No evidence of new disease; Response in 2 of following when abnormal at baseline: ALC\<4 x 10\^9/L or \>=50% decrease from baseline in SPD of target nodal lesions; splenomegaly; hepatomegaly; \>=50% decrease from baseline in CLL marrow infiltrate/B-lymphoid nodules; and Response in 1 of the following: ANC\>1.5 x 10\^9/L, platelets\>100 x 10\^9/L, Hgb\>110 g/L or \>=50% increase over baseline in any of these.
Percentage of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE)From the first dose up to 30 days after the last dose of study drug (up to 57.3 months)An adverse event (AE) is any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporarily associated with the use of a medicinal product, whether or not considered related to the medicinal product. TEAE is any AE that occur after first dosing of study medication and through the end of the study or through 30 days after the last dose of study treatment, or is considered treatment-related regardless of the start date of the event, or is present before first dosing of study medication but worsens in intensity or the investigator subsequently considers treatment-related.
Duration of Response (DOR)From the first dose of study drug until the first documentation of PD or death whichever occurs first or up to 62 monthsDOR:Interval from first documentation of CR/PR to first documentation of PD or death from any cause.CR:ALC\<4x10\^9/L;Regression to normal of target nodal masses,nodal non-target disease,and no detectable non-nodal,non-target disease;Normal spleen,liver size;Morphologically negative bone marrow,No lymphoid nodules;ANC\>1.5x10\^9/L,Platelets≥100x10\^9/L,Hgb≥110 g/L.PR:Response in 2 or more:ALC\<4x10\^9/L,\>=50% drop from baseline in ALC or SPD of target nodal lesions,Hepatosplenomegaly,\>=50% decrease from baseline in CLL marrow infiltrate/B-lymphoid nodules;Response in 1 or more:ANC\>1.5x10\^9/L,Platelets\>100x10\^9/L,Hgb\>110 g/L or \>=50% increase over baseline in any.PD:Response in 1 or more:new nodes,Hepatosplenomegaly,unequivocal extra-nodal lesion;≥50% increase from nadir in SPD of target lesions or LD of node/extra-nodal mass or Splenic/Hepatic size,Unequivocal increase in non-target disease,More aggressive histology;Drop of \>50% in platelets/\>20g/L in Hgb from highest on-study count.

Countries

Israel, United States

Participant flow

Recruitment details

A total of 126 participants were enrolled at investigative sites in Israel and the United States (US) from 27 January 2015 to 01 April 2020.

Pre-assignment details

Participants with previously treated Chronic Lymphocytic Leukemia (CLL) who had at least one high-risk cytogenetic abnormality were enrolled and randomized in a 1:1 ratio to receive either ublituximab in combination with ibrutinib or ibrutinib alone.

Participants by arm

ArmCount
Ublituximab + Ibrutinib
Participants received ublituximab IV infusion, up to 150 mg once on Day 1, 750 mg on Day 2, 900 mg on Days 8 and 15 of Cycle 1 (Cycle duration=28 days) followed by 900 mg on Day 1 of Cycles 2 to 6 and 900 mg on Day 1 of every 3rd cycle thereafter for up to 54.6 months along with ibrutinib 420 mg capsules, orally, QD in each 28-day cycle for up to 51.6 months.
64
Ibrutinib
Participants received ibrutinib 420 mg capsules, orally, QD in each 28-day cycle up to 56.3 months.
62
Total126

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event1314
Overall StudyDeath15
Overall StudyInvestigator Decision (includes non-compliance with study drug, investigator determined suitability)22
Overall StudyReason not Specified63
Overall StudySite Terminated by Sponsor at the End of Study2716
Overall StudyWithdrawal of Consent by Subject412

Baseline characteristics

CharacteristicUblituximab + IbrutinibTotalIbrutinib
Age, Continuous67.0 years67.1 years67.2 years
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants1 Participants0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
62 Participants121 Participants59 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
1 Participants4 Participants3 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
7 Participants13 Participants6 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants2 Participants1 Participants
Race (NIH/OMB)
White
56 Participants111 Participants55 Participants
Region of Enrollment
Israel
1 Participants1 Participants0 Participants
Region of Enrollment
United States
63 Participants125 Participants62 Participants
Sex: Female, Male
Female
20 Participants36 Participants16 Participants
Sex: Female, Male
Male
44 Participants90 Participants46 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
5 / 599 / 58
other
Total, other adverse events
59 / 5957 / 58
serious
Total, serious adverse events
38 / 5931 / 58

Outcome results

Primary

Overall Response Rate (ORR)

ORR: Percentage of participants with best overall response of partial response(PR) and complete response(CR). CR criteria: No evidence of new disease; Absolute lymphocyte count(ALC)\<4x10\^9/liter(L); Regression of all target nodal masses to ≤1.5 centimeters(cm) in longest diameter(LD); Normal spleen,liver size; Regression to normal of all nodal non-target disease and disappearance of all detectable; Non-nodal, non-target disease; Morphologically negative bone marrow; No lymphoid nodules; Absolute neutrophil count(ANC)\>1.5x10\^9/L,platelets≥100x10\^9/L,hemoglobin (Hgb)≥110 gram per liter(g/L). PR criteria: No evidence of new disease; Response in 2 of following if abnormal at baseline: ALC\<4x10\^9/L or \>=50% decrease from baseline in sum of products(SPD) of target nodal lesions; splenomegaly; hepatomegaly;\>=50% decrease from baseline in CLL marrow infiltrate/B-lymphoid nodules; response in any 1:ANC\>1.5x10\^9/L,platelets\>100x10\^9/L,Hgb\>110g/L or \>=50% increase over baseline in any of these.

Time frame: Up to 62 months

Population: ITT Population included all randomized participants.

ArmMeasureValue (NUMBER)
Ublituximab + IbrutinibOverall Response Rate (ORR)84.4 percentage of participants
IbrutinibOverall Response Rate (ORR)69.4 percentage of participants
p-value: 0.0463Cochran-Mantel-Haenszel
Secondary

Complete Response (CR) Rate

The CR rate was defined as the percentage of participants who achieved CR. CR criteria: No evidence of new disease; ALC \<4 x 10\^9/L; Regression of all target nodal masses to normal size ≤1.5 cm in the LD; Normal spleen and liver size; Regression to normal of all nodal non-target disease and disappearance of all detectable; Non-nodal, non-target disease; Morphologically negative bone marrow; No lymphoid nodules; ANC \>1.5 x 10\^9/L, platelets ≥100 x 10\^9/L, Hgb ≥110 g/L.

Time frame: Up to 62 months

Population: ITT Population included all randomized participants.

ArmMeasureValue (NUMBER)
Ublituximab + IbrutinibComplete Response (CR) Rate18.8 percentage of participants
IbrutinibComplete Response (CR) Rate4.8 percentage of participants
p-value: 0.0159Cochran-Mantel-Haenszel
Secondary

Duration of Response (DOR)

DOR:Interval from first documentation of CR/PR to first documentation of PD or death from any cause.CR:ALC\<4x10\^9/L;Regression to normal of target nodal masses,nodal non-target disease,and no detectable non-nodal,non-target disease;Normal spleen,liver size;Morphologically negative bone marrow,No lymphoid nodules;ANC\>1.5x10\^9/L,Platelets≥100x10\^9/L,Hgb≥110 g/L.PR:Response in 2 or more:ALC\<4x10\^9/L,\>=50% drop from baseline in ALC or SPD of target nodal lesions,Hepatosplenomegaly,\>=50% decrease from baseline in CLL marrow infiltrate/B-lymphoid nodules;Response in 1 or more:ANC\>1.5x10\^9/L,Platelets\>100x10\^9/L,Hgb\>110 g/L or \>=50% increase over baseline in any.PD:Response in 1 or more:new nodes,Hepatosplenomegaly,unequivocal extra-nodal lesion;≥50% increase from nadir in SPD of target lesions or LD of node/extra-nodal mass or Splenic/Hepatic size,Unequivocal increase in non-target disease,More aggressive histology;Drop of \>50% in platelets/\>20g/L in Hgb from highest on-study count.

Time frame: From the first dose of study drug until the first documentation of PD or death whichever occurs first or up to 62 months

Population: Participants in the ITT Population (included all randomized participants) who achieved either CR or PR were analyzed.

ArmMeasureValue (MEDIAN)
Ublituximab + IbrutinibDuration of Response (DOR)NA months
IbrutinibDuration of Response (DOR)39.1 months
p-value: 0.148695% CI: [0.263, 1.234]Log Rank
Secondary

Minimum Residual Disease (MRD) Negativity Rate

MRD negativity rate was defined as the percentage of participants who were MRD negative post-baseline. If a participant was determined to be MRD negative by peripheral blood, a bone marrow aspirate was obtained to assess MRD in the bone marrow.

Time frame: Up to 62 months

Population: ITT Population included all randomized participants.

ArmMeasureValue (NUMBER)
Ublituximab + IbrutinibMinimum Residual Disease (MRD) Negativity Rate45.3 percentage of participants
IbrutinibMinimum Residual Disease (MRD) Negativity Rate9.7 percentage of participants
p-value: <0.000195% CI: [21.39, 49.88]Cochran-Mantel-Haenszel
Secondary

Percentage of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE)

An adverse event (AE) is any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporarily associated with the use of a medicinal product, whether or not considered related to the medicinal product. TEAE is any AE that occur after first dosing of study medication and through the end of the study or through 30 days after the last dose of study treatment, or is considered treatment-related regardless of the start date of the event, or is present before first dosing of study medication but worsens in intensity or the investigator subsequently considers treatment-related.

Time frame: From the first dose up to 30 days after the last dose of study drug (up to 57.3 months)

Population: Safety Population included all participants who received at least one dose of study medication (ublituximab + ibrutinib or ibrutinib alone).

ArmMeasureValue (NUMBER)
Ublituximab + IbrutinibPercentage of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE)100 percentage of participants
IbrutinibPercentage of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE)100 percentage of participants
Secondary

Progression-Free Survival (PFS)

PFS was defined as the time from the date of randomization until the date of first documentation of definitive disease progression (PD) or date of death from any cause, whichever occurs first. PD requires at least one of the following: New nodes \>1.5 cm in the LD and \>1.0 in longest perpendicular diameter (LPD), new or recurrent hepatomegaly or splenomegaly, new or reappearance of an unequivocal extra-nodal lesion, ≥50% increase from the nadir in the sum of products of target lesions, ≥50% increase in the LD of an individual node or extra-nodal mass, splenic/hepatic enlargement of ≥50% from nadir, unequivocal increase in the size of non-target disease, transformation to a more aggressive histology, decrease in platelet count or Hgb, \>50% decrease from the highest on-study platelet count, \>20 g/L decrease from the highest on-study Hgb.

Time frame: From the randomization until the first documentation of PD or death whichever occurs first or up to 62 months

Population: ITT Population included all randomized participants.

ArmMeasureValue (MEDIAN)
Ublituximab + IbrutinibProgression-Free Survival (PFS)NA months
IbrutinibProgression-Free Survival (PFS)47.2 months
p-value: 0.096195% CI: [0.295, 1.113]Log Rank
Secondary

Time to Response (TTR)

TTR was defined as the interval from the randomization to the first documentation of CR or PR. CR criteria: No evidence of new disease; ALC \<4 x 10\^9/L; Regression of all target nodal masses to normal size ≤1.5 cm in the LD; Normal spleen and liver size; Regression to normal of all nodal non-target disease and disappearance of all detectable; Non-nodal, non-target disease; Morphologically negative bone marrow; No lymphoid nodules; ANC \>1.5 x 10\^9/L, platelets ≥100 x 10\^9/L, Hgb ≥110 g/L. PR criteria: No evidence of new disease; Response in 2 of following when abnormal at baseline: ALC\<4 x 10\^9/L or \>=50% decrease from baseline in SPD of target nodal lesions; splenomegaly; hepatomegaly; \>=50% decrease from baseline in CLL marrow infiltrate/B-lymphoid nodules; and Response in 1 of the following: ANC\>1.5 x 10\^9/L, platelets\>100 x 10\^9/L, Hgb\>110 g/L or \>=50% increase over baseline in any of these.

Time frame: From the randomization up to 62 months

Population: Participants in the ITT Population (included all randomized participants) who achieved either CR or PR were analyzed.

ArmMeasureValue (MEDIAN)
Ublituximab + IbrutinibTime to Response (TTR)2.0 months
IbrutinibTime to Response (TTR)3.9 months
p-value: 0.000495% CI: [1.399, 3.344]Log Rank

Source: ClinicalTrials.gov · Data processed: Feb 28, 2026