Chronic Lymphocytic Leukemia
Conditions
Brief summary
This study evaluates the combination of ublituximab, a novel monoclonal antibody, and TGR-1202, a novel PI3K delta inhibitor compared to obinutuzumab and chlorambucil, and compared to ublituximab or TGR-1202 alone in Chronic Lymphocytic Leukemia (CLL) participants.
Interventions
Obinutuzumab: IV infusion
Ublituximab: IV infusion
TGR-1202: Oral daily dose
Chlorambucil: Oral dose
Sponsors
Study design
Eligibility
Inclusion criteria
* Treatment naïve or previously treated Chronic Lymphocytic Leukemia (CLL) requiring treatment * 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 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) * Prior therapy with obinutuzumab and/or chlorambucil or a PI3K delta inhibitor
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) Per International Workshop on Chronic Lymphocytic Leukemia (iwCLL) Criteria | From enrolment to the earlier of the first documentation of definitive disease progression (PD) or death (Up to 87 months) | PFS was defined as the interval from enrollment to the earlier of the first documentation of definitive disease progression (PD) or death from any cause. PD was appearance of new nodes \>1.5 centimetres (cm) in the longest diameter (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 diameters (SPD) 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 grams per Liter (g/L) decrease from the highest on-study hemoglobin (Hgb). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Response Rate (ORR) Per iwCLL Criteria | Up to 87 months | ORR=percent of participants who achieve complete response (CR), complete response with incomplete marrow recovery (CRi), partial response (PR) or nodular partial response (nPR).CR: No evidence of new disease; Absolute lymphocyte count(ALC)\<4x10\^9/liter(L);Regression of all target nodal masses to ≤1.5cm in 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;ANC \>1.5x10\^9/L,platelets≥100x10\^9/L,Hgb≥110 g/L.PR: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 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.CRi:for CR except with ANC\<1000/µL and/or platelets\<100. |
| Complete Response (CR) Rate | Up to 87 months | The CR rate is defined as the percentage of participants with a best overall response of complete response (CR) or complete response with incomplete marrow recovery (CRi). CR: No evidence of new disease; Absolute lymphocyte count(ALC)\<4x10\^9/L; Regression of all target nodal masses to ≤1.5 cm in 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; ANC\>1.5x10\^9/L,platelets≥100x10\^9/L,hemoglobin (Hgb)≥110 g/L. CRi was as for CR except with ANC \<1000/µL and/or platelets \<100,000/µL. |
| Minimal Residual Disease (MRD) Negativity Rate | From Cycle 6 until Cycle 15 (cycle length=28 days) up to approximately 81.5 months | MRD negativity rate is defined as the percentage of participants who are MRD negative. 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. |
| Duration of Response (DOR) | From first documentation of response to study treatment till disease progression/death (up to approximately 87 months) | DOR is defined as the interval from the first documentation of CR, CRi, PR, or nPR to the earlier of the first documentation of definitive disease progression or death from any cause. |
| Number of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE) | From first dose of study treatment up to end of study (up to approximately 87 months) | An adverse event (AE) is any untoward medical occurrence in a participant or clinical investigation participant administered a pharmaceutical product. An AE does not necessarily have to have a causal relationship with this treatment. An AE can therefore be 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. |
Countries
Israel, Italy, Poland, Russia, Spain, United Kingdom, United States
Participant flow
Recruitment details
Participants took part in the study at multiple investigative sites in the United States, Israel, Italy, Poland, Russian Federation, Spain and the United Kingdom from 19 November 2015 to 22 February 2023.
Participants by arm
| Arm | Count |
|---|---|
| Experimental: Arm A: Ublituximab + Umbralisib Participants received ublituximab, 150 milligrams (mg), intravenously (IV), on Day 1, 750 mg on Day 2, followed by 900 mg on Days 8 and 15 of Cycle 1 (cycle length=28 days), Day 1 of Cycles 2-6, and once every 3 cycles thereafter, along with umbralisib, 800 mg, orally, once daily during each cycle until disease progression, lack of tolerability, or until the treatment is commercially available or up to 87 months. | 210 |
| Active Comparator: Arm B: Obinutuzumab + Chlorambucil Participants received obinutuzumab 100 mg, IV on Day 1, 900 mg on Day 2, followed by 1000 mg on Days 8 and 5 of cycle 1 (cycle length = 28 days), Day 1 of Cycle 2-6 along with chlorambucil 0.5 milligrams per kilogram (mg/kg) tablet orally on Days 1 and 15 once daily during each cycle until disease progression, lack of tolerability, or until the treatment is commercially available or up to 87 months. | 211 |
| Experimental: Arm C: Ublituximab Participants received ublituximab, 150 mg, IV, on Day 1, 750 mg on Day 2, followed by 900 mg on Days 8 and 15 of Cycle 1 (cycle length=28 days), Day 1 of Cycles 2-6, and once every 3 cycles thereafter, until disease progression, lack of tolerability, or until the treatment is commercially available or up to 87 months. | 91 |
| Experimental: Arm D: Umbralisib Participants received umbralisib, 800 mg tablets, orally, once daily during each cycle (cycle length= 28 days) until removal from study or up to 87 months. | 91 |
| Total | 603 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 16 | 12 | 7 | 13 |
| Overall Study | Death | 29 | 10 | 11 | 11 |
| Overall Study | Initiation of Non-protocol Intervention | 5 | 3 | 0 | 0 |
| Overall Study | Investigator's Decision | 11 | 15 | 6 | 6 |
| Overall Study | Lack of Efficacy | 0 | 0 | 1 | 1 |
| Overall Study | Lost to Follow-up | 2 | 2 | 1 | 2 |
| Overall Study | Non-Compliance with Study | 1 | 0 | 0 | 0 |
| Overall Study | Progressive Disease Confirmed by Central Radiology | 75 | 113 | 38 | 43 |
| Overall Study | Reason Not Specified | 3 | 7 | 4 | 5 |
| Overall Study | Site Terminated by Sponsor | 29 | 12 | 13 | 5 |
| Overall Study | Unknown/Missing | 10 | 13 | 4 | 0 |
| Overall Study | Withdrawal by Subject of Consent or to Discontinue Treatment | 29 | 24 | 6 | 5 |
Baseline characteristics
| Characteristic | Experimental: Arm A: Ublituximab + Umbralisib | Total | Experimental: Arm D: Umbralisib | Experimental: Arm C: Ublituximab | Active Comparator: Arm B: Obinutuzumab + Chlorambucil |
|---|---|---|---|---|---|
| Age, Continuous | 66.2 years | 66.8 years | 66.3 years | 67.6 years | 67.1 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 3 Participants | 13 Participants | 3 Participants | 2 Participants | 5 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 193 Participants | 556 Participants | 83 Participants | 86 Participants | 194 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 14 Participants | 34 Participants | 5 Participants | 3 Participants | 12 Participants |
| Race/Ethnicity, Customized American Indian or Alaska Native | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Asian | 0 Participants | 3 Participants | 1 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Black or African American | 9 Participants | 25 Participants | 5 Participants | 5 Participants | 6 Participants |
| Race/Ethnicity, Customized Multiple | 2 Participants | 2 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Not Reported | 8 Participants | 18 Participants | 1 Participants | 2 Participants | 7 Participants |
| Race/Ethnicity, Customized Other | 1 Participants | 4 Participants | 2 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized White | 189 Participants | 549 Participants | 82 Participants | 83 Participants | 195 Participants |
| Sex: Female, Male Female | 75 Participants | 195 Participants | 30 Participants | 23 Participants | 67 Participants |
| Sex: Female, Male Male | 135 Participants | 408 Participants | 61 Participants | 68 Participants | 144 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 82 / 206 | 40 / 200 | 25 / 91 | 29 / 86 |
| other Total, other adverse events | 205 / 206 | 189 / 200 | 84 / 91 | 84 / 86 |
| serious Total, serious adverse events | 118 / 206 | 47 / 200 | 33 / 91 | 34 / 86 |
Outcome results
Progression-Free Survival (PFS) Per International Workshop on Chronic Lymphocytic Leukemia (iwCLL) Criteria
PFS was defined as the interval from enrollment to the earlier of the first documentation of definitive disease progression (PD) or death from any cause. PD was appearance of new nodes \>1.5 centimetres (cm) in the longest diameter (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 diameters (SPD) 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 grams per Liter (g/L) decrease from the highest on-study hemoglobin (Hgb).
Time frame: From enrolment to the earlier of the first documentation of definitive disease progression (PD) or death (Up to 87 months)
Population: The ITT population included all randomized participants, regardless of administration of study treatment (ublituximab, TGR-1202, obinutuzumab + chlorambucil, or ublituximab + TGR-1202).
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Experimental: Arm A: Ublituximab + Umbralisib | Progression-Free Survival (PFS) Per International Workshop on Chronic Lymphocytic Leukemia (iwCLL) Criteria | 33.2 Months |
| Active Comparator: Arm B: Obinutuzumab + Chlorambucil | Progression-Free Survival (PFS) Per International Workshop on Chronic Lymphocytic Leukemia (iwCLL) Criteria | 17.5 Months |
| Experimental: Arm C: Ublituximab | Progression-Free Survival (PFS) Per International Workshop on Chronic Lymphocytic Leukemia (iwCLL) Criteria | 32.9 Months |
| Experimental: Arm D: Umbralisib | Progression-Free Survival (PFS) Per International Workshop on Chronic Lymphocytic Leukemia (iwCLL) Criteria | 22.4 Months |
Complete Response (CR) Rate
The CR rate is defined as the percentage of participants with a best overall response of complete response (CR) or complete response with incomplete marrow recovery (CRi). CR: No evidence of new disease; Absolute lymphocyte count(ALC)\<4x10\^9/L; Regression of all target nodal masses to ≤1.5 cm in 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; ANC\>1.5x10\^9/L,platelets≥100x10\^9/L,hemoglobin (Hgb)≥110 g/L. CRi was as for CR except with ANC \<1000/µL and/or platelets \<100,000/µL.
Time frame: Up to 87 months
Population: The ITT population included all randomized participants, regardless of administration of study treatment (ublituximab, TGR-1202, obinutuzumab + chlorambucil, or ublituximab + TGR-1202). Percentages are rounded off to the nearest decimal point.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental: Arm A: Ublituximab + Umbralisib | Complete Response (CR) Rate | 5.7 percentage of participants |
| Active Comparator: Arm B: Obinutuzumab + Chlorambucil | Complete Response (CR) Rate | 1.4 percentage of participants |
| Experimental: Arm C: Ublituximab | Complete Response (CR) Rate | 3.3 percentage of participants |
| Experimental: Arm D: Umbralisib | Complete Response (CR) Rate | 0 percentage of participants |
Duration of Response (DOR)
DOR is defined as the interval from the first documentation of CR, CRi, PR, or nPR to the earlier of the first documentation of definitive disease progression or death from any cause.
Time frame: From first documentation of response to study treatment till disease progression/death (up to approximately 87 months)
Population: The ITT population included all randomized participants, regardless of administration of study treatment (ublituximab, TGR-1202, obinutuzumab + chlorambucil, or ublituximab + TGR-1202). Overall Number of Participants Analyzed is the number of participants with data available for analysis.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Experimental: Arm A: Ublituximab + Umbralisib | Duration of Response (DOR) | 32.9 months |
| Active Comparator: Arm B: Obinutuzumab + Chlorambucil | Duration of Response (DOR) | 21.9 months |
| Experimental: Arm C: Ublituximab | Duration of Response (DOR) | 47.5 months |
| Experimental: Arm D: Umbralisib | Duration of Response (DOR) | 29.3 months |
Minimal Residual Disease (MRD) Negativity Rate
MRD negativity rate is defined as the percentage of participants who are MRD negative. 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: From Cycle 6 until Cycle 15 (cycle length=28 days) up to approximately 81.5 months
Population: The ITT population included all randomized participants, regardless of administration of study treatment (ublituximab, TGR-1202, obinutuzumab + chlorambucil, or ublituximab + TGR-1202). Percentages are rounded off to the nearest decimal point.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental: Arm A: Ublituximab + Umbralisib | Minimal Residual Disease (MRD) Negativity Rate | 29.0 percentage of participants |
| Active Comparator: Arm B: Obinutuzumab + Chlorambucil | Minimal Residual Disease (MRD) Negativity Rate | 34.6 percentage of participants |
| Experimental: Arm C: Ublituximab | Minimal Residual Disease (MRD) Negativity Rate | 36.3 percentage of participants |
| Experimental: Arm D: Umbralisib | Minimal Residual Disease (MRD) Negativity Rate | 5.5 percentage of participants |
Number of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE)
An adverse event (AE) is any untoward medical occurrence in a participant or clinical investigation participant administered a pharmaceutical product. An AE does not necessarily have to have a causal relationship with this treatment. An AE can therefore be 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 first dose of study treatment up to end of study (up to approximately 87 months)
Population: The safety population included all randomized participants who had received at least one dose of study treatment (ublituximab, TGR-1202, obinutuzumab + chlorambucil, or ublituximab + TGR-1202
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Experimental: Arm A: Ublituximab + Umbralisib | Number of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE) | 205 Participants |
| Active Comparator: Arm B: Obinutuzumab + Chlorambucil | Number of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE) | 195 Participants |
| Experimental: Arm C: Ublituximab | Number of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE) | 88 Participants |
| Experimental: Arm D: Umbralisib | Number of Participants Experiencing at Least One Treatment-Emergent Adverse Event (TEAE) | 86 Participants |
Overall Response Rate (ORR) Per iwCLL Criteria
ORR=percent of participants who achieve complete response (CR), complete response with incomplete marrow recovery (CRi), partial response (PR) or nodular partial response (nPR).CR: No evidence of new disease; Absolute lymphocyte count(ALC)\<4x10\^9/liter(L);Regression of all target nodal masses to ≤1.5cm in 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;ANC \>1.5x10\^9/L,platelets≥100x10\^9/L,Hgb≥110 g/L.PR: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 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.CRi:for CR except with ANC\<1000/µL and/or platelets\<100.
Time frame: Up to 87 months
Population: The ITT population included all randomized participants, regardless of administration of study treatment (ublituximab, TGR-1202, obinutuzumab + chlorambucil, or ublituximab + TGR-1202). Percentages are rounded off to the nearest decimal point.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Experimental: Arm A: Ublituximab + Umbralisib | Overall Response Rate (ORR) Per iwCLL Criteria | 83.3 percentage of participants |
| Active Comparator: Arm B: Obinutuzumab + Chlorambucil | Overall Response Rate (ORR) Per iwCLL Criteria | 68.7 percentage of participants |
| Experimental: Arm C: Ublituximab | Overall Response Rate (ORR) Per iwCLL Criteria | 42.9 percentage of participants |
| Experimental: Arm D: Umbralisib | Overall Response Rate (ORR) Per iwCLL Criteria | 61.5 percentage of participants |