Chronic Lymphocytic Leukemia
Conditions
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
Administered as an IV infusion
Administered orally
Sponsors
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Overall Response Rate (ORR) | Up to 62 months | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complete Response (CR) Rate | Up to 62 months | 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. |
| Progression-Free Survival (PFS) | From the randomization until the first documentation of PD or death whichever occurs first or up to 62 months | 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. |
| Minimum Residual Disease (MRD) Negativity Rate | Up to 62 months | 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 to Response (TTR) | From the randomization up to 62 months | 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. |
| 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 months | 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. |
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
| Arm | Count |
|---|---|
| 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 |
| Total | 126 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 13 | 14 |
| Overall Study | Death | 1 | 5 |
| Overall Study | Investigator Decision (includes non-compliance with study drug, investigator determined suitability) | 2 | 2 |
| Overall Study | Reason not Specified | 6 | 3 |
| Overall Study | Site Terminated by Sponsor at the End of Study | 27 | 16 |
| Overall Study | Withdrawal of Consent by Subject | 4 | 12 |
Baseline characteristics
| Characteristic | Ublituximab + Ibrutinib | Total | Ibrutinib |
|---|---|---|---|
| Age, Continuous | 67.0 years | 67.1 years | 67.2 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 1 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 62 Participants | 121 Participants | 59 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 4 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 | 7 Participants | 13 Participants | 6 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 | 1 Participants | 2 Participants | 1 Participants |
| Race (NIH/OMB) White | 56 Participants | 111 Participants | 55 Participants |
| Region of Enrollment Israel | 1 Participants | 1 Participants | 0 Participants |
| Region of Enrollment United States | 63 Participants | 125 Participants | 62 Participants |
| Sex: Female, Male Female | 20 Participants | 36 Participants | 16 Participants |
| Sex: Female, Male Male | 44 Participants | 90 Participants | 46 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 5 / 59 | 9 / 58 |
| other Total, other adverse events | 59 / 59 | 57 / 58 |
| serious Total, serious adverse events | 38 / 59 | 31 / 58 |
Outcome results
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Ublituximab + Ibrutinib | Overall Response Rate (ORR) | 84.4 percentage of participants |
| Ibrutinib | Overall Response Rate (ORR) | 69.4 percentage of participants |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Ublituximab + Ibrutinib | Complete Response (CR) Rate | 18.8 percentage of participants |
| Ibrutinib | Complete Response (CR) Rate | 4.8 percentage of participants |
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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ublituximab + Ibrutinib | Duration of Response (DOR) | NA months |
| Ibrutinib | Duration of Response (DOR) | 39.1 months |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Ublituximab + Ibrutinib | Minimum Residual Disease (MRD) Negativity Rate | 45.3 percentage of participants |
| Ibrutinib | Minimum Residual Disease (MRD) Negativity Rate | 9.7 percentage of participants |
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).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Ublituximab + Ibrutinib | Percentage of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE) | 100 percentage of participants |
| Ibrutinib | Percentage of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE) | 100 percentage of participants |
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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ublituximab + Ibrutinib | Progression-Free Survival (PFS) | NA months |
| Ibrutinib | Progression-Free Survival (PFS) | 47.2 months |
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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Ublituximab + Ibrutinib | Time to Response (TTR) | 2.0 months |
| Ibrutinib | Time to Response (TTR) | 3.9 months |