Lymphoma
Conditions
Keywords
Marginal zone lymphoma, phosphatidylinositol 3-kinase (PI3K)δ inhibitor, indolent (slow-growing) non-Hodgkin lymphoma B-cell lymphoma
Brief summary
The purpose of this study is to evaluate the safety and efficacy of two parsaclisib treatment regimens in participants diagnosed with relapsed or refractory marginal zone lymphoma (MZL) who are naive to or were previously treated with a Bruton's tyrosine kinase (BTK) inhibitor.
Interventions
Parsaclisib at the protocol-defined dose.
Sponsors
Study design
Eligibility
Inclusion criteria
* Men and women, aged 18 or older (except in South Korea, aged 19 or older). * Histologically confirmed marginal zone lymphoma, including extranodal, nodal, and splenic subtypes. * Radiographically measurable lymphadenopathy or extranodal lymphoid malignancy (defined as the presence of ≥ 1 lesion that measures \> 1.5 cm in the longest transverse diameter and ≥ 1.0 cm in the longest perpendicular diameter. * Participants with splenic MZL who do not meet the radiographically measurable disease criteria described herein are eligible for participation provided that bone marrow infiltration of MZL is histologically confirmed. * Participants must be willing to undergo an incisional or excisional lymph node or tissue biopsy or provide a lymph node or tissue biopsy from the most recent available archival tissue. * Eastern Cooperative Oncology Group performance status 0 to 2.
Exclusion criteria
* Evidence of diffuse large B-cell transformation. * History of central nervous system lymphoma (either primary or metastatic) or leptomeningeal disease. * Prior treatment with idelalisib, other selective PI3Kδ inhibitors, or a pan-PI3K inhibitor. * Allogeneic stem cell transplant within the last 6 months, or autologous stem cell transplant within the last 3 months before the date of the first dose of study treatment. * Active graft versus host disease. * Subjects positive for hepatitis B surface antigen or hepatitis B core antibody will be eligible if they are negative for HBV-DNA. Subjects positive for anti-HCV antibody will be eligible if they are negative for HCV-RNA.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR) Based on Lugano Classification Criteria | Up to approximately 161 weeks | ORR=percentage of participants with complete response(CR) or partial response(PR) per revised response criteria for lymphomas,determined by independent review committee(IRC).Criteria for CR:1.Target nodes/nodal masses of lymph nodes,extralymphatic sites regressed to≤1.5cm in longest dimension transverse diameter of lesion(LDi);2.Absence of non-measured lesion;3.Organ enlargement regressed to normal;4.No new lesions;5.Normal bone marrow morphology;if indeterminate,immunohistochemistry negative.Criteria for PR:1.Lymph nodes,extralymphatic sites- ≥50%decrease in sum of product of perpendicular diameters for multiple lesions(SPD)of up to 6 target measurable nodes,extranodal sites;if lesion is too small to measure on computed tomography(CT),assign 5mm×5mm as default;if no longer visible,0×0mm.Node \>5mm×5mm but smaller than normal,use actual measurement.2.Absent/regressed non-measured lesions,no increase.3.Organ enlargement-Spleen regressed by \>50%in length beyond normal.4.No new lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complete Response Rate (CRR) Based on Lugano Classification Criteria | Up to 1305 days | CRR is defined as the percentage of participants with a CR as determined by an IRC. The criteria for CR included: 1.Target nodes/nodal masses of lymph nodes and extralymphatic sites must regress to ≤ 1.5 cm in LDi; 2. Absence of non-measured lesion; 3.Organ enlargement regressed to normal; 4.No new lesions; 5.Bone marrow must be normal by morphology; if indeterminate, immunohistochemistry negative. |
| Progression-Free Survival (PFS) | Up to 1305 days | PFS is defined as the time from the date of the first dose of study treatment until the earliest date of disease progression, as determined by radiographic disease assessment provided by an IRC, or death from any cause. |
| Duration of Response (DOR) | Up to 1305 days | DOR=time from first documented evidence of CR or PR until disease progression or death from any cause among participants who achieve an objective response as determined by IRC. Criteria for CR: 1.Target nodes/nodal masses of lymph nodes and extralymphatic sites must regress to ≤ 1.5 cm in LDi; 2. Absence of non-measured lesion; 3.Organ enlargement regressed to normal; 4.No new lesions; 5.Bone marrow must be normal by morphology; if indeterminate, immunohistochemistry negative. The criteria for PR included: 1.Lymph nodes and extralymphatic sites- a. ≥50% decrease in SPD of up to 6 target measurable nodes and extranodal sites; b. when a lesion is too small to measure on CT, assign 5 mm×5 mm as the default; c.when no longer visible, 0×0 mm. For a node \>5 mm×5 mm but smaller than normal, use actual measurement. 2.Non-measured lesions- Absent/regressed, but no increase. 3. Organ enlargement-Spleen must have regressed by \>50% in length beyond normal. 4.No new lesions. |
| Best Percent Change From Baseline in Target Lesion Size | Up to 1305 days | Target lesion size is measured by the sum of the product of diameters of all target lesion sizes and is determined by the IRC. The best percent change from Baseline is defined as the largest decrease, or smallest increase (if no decrease available), from Baseline in target lesion sizes on/before new (next-line) anti-lymphoma therapy during the study. Baseline is the last nonmissing measurement obtained before the first administration of study drug. A negative percent change from Baseline indicates improvement. |
| Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | From first dose of study drug up to 1980 days | An adverse event (AE) is any untoward medical occurrence associated with use of a drug in humans, whether or not considered drug related, that occurs after a participant provides informed consent. A TEAE is any AE either reported for the first time or worsening of a pre-existing event after first dose of study drug and within 30 days of the last administration of study drug regardless of starting new anti-lymphoma therapy. A SAE is any untoward medical occurrence that results in death, is life-threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, leads to a congenital anomaly/birth defect or is considered to be an important medical event that may not result in death, be immediately life-threatening, or require hospitalization but may be considered serious when, based on appropriate medical judgment, the event may jeopardize the participant or may require medical or surgical intervention. |
| Overall Survival (OS) | Up to 2354 days | OS is defined as the time from the date of the first dose of study treatment until death from any cause. |
Countries
Argentina, Australia, Belgium, Denmark, France, Germany, Israel, Italy, Poland, Spain, United Kingdom, United States
Participant flow
Recruitment details
This study enrolled participants at 46 study centers in the United States, Italy, Israel, France, Spain, Poland, Belgium, Great Britain, and Germany.
Pre-assignment details
A total of 110 participants diagnosed with relapsed or refractory marginal zone lymphoma were enrolled into two cohorts based on previous treatment with ibrutinib as Cohort 1: those who were exposed to ibrutinib before enrollment and Cohort 2: those who were not exposed to Bruton's tyrosine kinase (BTK) inhibitor before enrollment. Participants were further allocated to Treatments A and B in each Cohort to receive parsaclisib.
Participants by arm
| Arm | Count |
|---|---|
| Cohort 1: Treatment A (Exposed to Ibrutinib) Participants received parsaclisib 20 milligrams (mg), orally, once daily (QD) for 8 weeks followed by 20 mg once weekly (QW), for up to 52 weeks. Participants who were exposed to ibrutinib before enrollment were included in this group. | 4 |
| Cohort 1: Treatment B (Exposed to Ibrutinib) Participants received parsaclisib 20 mg, orally, QD for 8 weeks followed by 2.5 mg QD, for up to 52 weeks. Participants who were exposed to ibrutinib before enrollment were included in this group. | 6 |
| Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve) Participants received parsaclisib 20 mg tablets, orally, QD for 8 weeks followed by 20 mg tablets QW, for up to 52 weeks. Participants who were not exposed to BTK inhibitor before enrollment were included in this group. | 28 |
| Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve) Participants received parsaclisib 20 mg tablets, orally, QD for 8 weeks followed by 2.5 mg tablets QD, for up to 52 weeks. Participants who were not exposed to BTK inhibitor before enrollment were included in this group. | 72 |
| Total | 110 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Changed Physicians | 0 | 0 | 0 | 1 |
| Overall Study | Death | 3 | 2 | 6 | 24 |
| Overall Study | Discharged from the Trust | 0 | 0 | 1 | 0 |
| Overall Study | Exclusion Criteria Met | 0 | 0 | 1 | 0 |
| Overall Study | Histological Criteria Not Met | 0 | 0 | 0 | 1 |
| Overall Study | Lost to Follow-up | 0 | 1 | 0 | 4 |
| Overall Study | Multifactorial Cognitive Decline | 0 | 0 | 0 | 1 |
| Overall Study | Participant Transferred to Rollover Study | 1 | 1 | 5 | 6 |
| Overall Study | Progression of Chronic Lymphocytic Leukemia | 0 | 0 | 0 | 1 |
| Overall Study | Removed for Safety | 0 | 0 | 0 | 1 |
| Overall Study | Site Closed | 0 | 0 | 0 | 1 |
| Overall Study | Withdrawal by Participant | 0 | 0 | 2 | 6 |
Baseline characteristics
| Characteristic | Cohort 1: Treatment A (Exposed to Ibrutinib) | Cohort 1: Treatment B (Exposed to Ibrutinib) | Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve) | Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve) | Total |
|---|---|---|---|---|---|
| Age, Continuous | 73.5 years | 72.2 years | 68.1 years | 69.8 years | 69.6 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 2 Participants | 3 Participants | 4 Participants | 9 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 3 Participants | 4 Participants | 19 Participants | 57 Participants | 83 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 6 Participants | 11 Participants | 18 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 1 Participants | 0 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 5 Participants | 10 Participants | 16 Participants |
| Race (NIH/OMB) White | 3 Participants | 5 Participants | 23 Participants | 60 Participants | 91 Participants |
| Sex: Female, Male Female | 2 Participants | 4 Participants | 16 Participants | 31 Participants | 53 Participants |
| Sex: Female, Male Male | 2 Participants | 2 Participants | 12 Participants | 41 Participants | 57 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 | 3 / 4 | 2 / 6 | 6 / 28 | 25 / 72 |
| other Total, other adverse events | 4 / 4 | 5 / 6 | 25 / 28 | 67 / 72 |
| serious Total, serious adverse events | 2 / 4 | 2 / 6 | 9 / 28 | 46 / 72 |
Outcome results
Objective Response Rate (ORR) Based on Lugano Classification Criteria
ORR=percentage of participants with complete response(CR) or partial response(PR) per revised response criteria for lymphomas,determined by independent review committee(IRC).Criteria for CR:1.Target nodes/nodal masses of lymph nodes,extralymphatic sites regressed to≤1.5cm in longest dimension transverse diameter of lesion(LDi);2.Absence of non-measured lesion;3.Organ enlargement regressed to normal;4.No new lesions;5.Normal bone marrow morphology;if indeterminate,immunohistochemistry negative.Criteria for PR:1.Lymph nodes,extralymphatic sites- ≥50%decrease in sum of product of perpendicular diameters for multiple lesions(SPD)of up to 6 target measurable nodes,extranodal sites;if lesion is too small to measure on computed tomography(CT),assign 5mm×5mm as default;if no longer visible,0×0mm.Node \>5mm×5mm but smaller than normal,use actual measurement.2.Absent/regressed non-measured lesions,no increase.3.Organ enlargement-Spleen regressed by \>50%in length beyond normal.4.No new lesions.
Time frame: Up to approximately 161 weeks
Population: Full Analysis Set: all participants enrolled in the study who received at least 1 dose of parsaclisib
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort 1: Treatment A (Exposed to Ibrutinib) | Objective Response Rate (ORR) Based on Lugano Classification Criteria | 50.0 percentage of participants |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Objective Response Rate (ORR) Based on Lugano Classification Criteria | 33.3 percentage of participants |
| Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve) | Objective Response Rate (ORR) Based on Lugano Classification Criteria | 57.1 percentage of participants |
| Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve) | Objective Response Rate (ORR) Based on Lugano Classification Criteria | 58.3 percentage of participants |
Best Percent Change From Baseline in Target Lesion Size
Target lesion size is measured by the sum of the product of diameters of all target lesion sizes and is determined by the IRC. The best percent change from Baseline is defined as the largest decrease, or smallest increase (if no decrease available), from Baseline in target lesion sizes on/before new (next-line) anti-lymphoma therapy during the study. Baseline is the last nonmissing measurement obtained before the first administration of study drug. A negative percent change from Baseline indicates improvement.
Time frame: Up to 1305 days
Population: Full Analysis Set: all participants enrolled in the study who received at least 1 dose of parsaclisib. The overall number of participants analyzed is the number of participants with splenomegaly and data available for analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cohort 1: Treatment A (Exposed to Ibrutinib) | Best Percent Change From Baseline in Target Lesion Size | -48.83 percent change in lesion size | Standard Deviation 21.193 |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Best Percent Change From Baseline in Target Lesion Size | -54.84 percent change in lesion size | Standard Deviation 21.454 |
| Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve) | Best Percent Change From Baseline in Target Lesion Size | -71.22 percent change in lesion size | Standard Deviation 18.566 |
| Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve) | Best Percent Change From Baseline in Target Lesion Size | -66.76 percent change in lesion size | Standard Deviation 19.971 |
Complete Response Rate (CRR) Based on Lugano Classification Criteria
CRR is defined as the percentage of participants with a CR as determined by an IRC. The criteria for CR included: 1.Target nodes/nodal masses of lymph nodes and extralymphatic sites must regress to ≤ 1.5 cm in LDi; 2. Absence of non-measured lesion; 3.Organ enlargement regressed to normal; 4.No new lesions; 5.Bone marrow must be normal by morphology; if indeterminate, immunohistochemistry negative.
Time frame: Up to 1305 days
Population: Full Analysis Set: all participants enrolled in the study who received at least 1 dose of parsaclisib
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort 1: Treatment A (Exposed to Ibrutinib) | Complete Response Rate (CRR) Based on Lugano Classification Criteria | 0.0 percentage of participants |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Complete Response Rate (CRR) Based on Lugano Classification Criteria | 0.0 percentage of participants |
| Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve) | Complete Response Rate (CRR) Based on Lugano Classification Criteria | 10.7 percentage of participants |
| Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve) | Complete Response Rate (CRR) Based on Lugano Classification Criteria | 4.2 percentage of participants |
Duration of Response (DOR)
DOR=time from first documented evidence of CR or PR until disease progression or death from any cause among participants who achieve an objective response as determined by IRC. Criteria for CR: 1.Target nodes/nodal masses of lymph nodes and extralymphatic sites must regress to ≤ 1.5 cm in LDi; 2. Absence of non-measured lesion; 3.Organ enlargement regressed to normal; 4.No new lesions; 5.Bone marrow must be normal by morphology; if indeterminate, immunohistochemistry negative. The criteria for PR included: 1.Lymph nodes and extralymphatic sites- a. ≥50% decrease in SPD of up to 6 target measurable nodes and extranodal sites; b. when a lesion is too small to measure on CT, assign 5 mm×5 mm as the default; c.when no longer visible, 0×0 mm. For a node \>5 mm×5 mm but smaller than normal, use actual measurement. 2.Non-measured lesions- Absent/regressed, but no increase. 3. Organ enlargement-Spleen must have regressed by \>50% in length beyond normal. 4.No new lesions.
Time frame: Up to 1305 days
Population: Full Analysis Set: all participants enrolled in the study who received at least 1 dose of parsaclisib. Only participants with objective response were analyzed.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1: Treatment A (Exposed to Ibrutinib) | Duration of Response (DOR) | NA months |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Duration of Response (DOR) | NA months |
| Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve) | Duration of Response (DOR) | 16.69 months |
| Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve) | Duration of Response (DOR) | 13.57 months |
Overall Survival (OS)
OS is defined as the time from the date of the first dose of study treatment until death from any cause.
Time frame: Up to 2354 days
Population: Full Analysis Set: all participants enrolled in the study who received at least 1 dose of parsaclisib
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1: Treatment A (Exposed to Ibrutinib) | Overall Survival (OS) | 18.94 months |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Overall Survival (OS) | NA months |
| Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve) | Overall Survival (OS) | NA months |
| Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve) | Overall Survival (OS) | 63.54 months |
Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)
An adverse event (AE) is any untoward medical occurrence associated with use of a drug in humans, whether or not considered drug related, that occurs after a participant provides informed consent. A TEAE is any AE either reported for the first time or worsening of a pre-existing event after first dose of study drug and within 30 days of the last administration of study drug regardless of starting new anti-lymphoma therapy. A SAE is any untoward medical occurrence that results in death, is life-threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, leads to a congenital anomaly/birth defect or is considered to be an important medical event that may not result in death, be immediately life-threatening, or require hospitalization but may be considered serious when, based on appropriate medical judgment, the event may jeopardize the participant or may require medical or surgical intervention.
Time frame: From first dose of study drug up to 1980 days
Population: Safety Population: all enrolled participants who received at least 1 dose of parsaclisib
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Cohort 1: Treatment A (Exposed to Ibrutinib) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | TEAEs | 100.0 percentage of participants |
| Cohort 1: Treatment A (Exposed to Ibrutinib) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | SAEs | 50.0 percentage of participants |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | SAEs | 33.3 percentage of participants |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | TEAEs | 83.3 percentage of participants |
| Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | TEAEs | 92.9 percentage of participants |
| Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | SAEs | 32.1 percentage of participants |
| Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | TEAEs | 97.2 percentage of participants |
| Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | SAEs | 63.9 percentage of participants |
Progression-Free Survival (PFS)
PFS is defined as the time from the date of the first dose of study treatment until the earliest date of disease progression, as determined by radiographic disease assessment provided by an IRC, or death from any cause.
Time frame: Up to 1305 days
Population: Full Analysis Set: all participants enrolled in the study who received at least 1 dose of parsaclisib
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1: Treatment A (Exposed to Ibrutinib) | Progression-Free Survival (PFS) | NA months |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Progression-Free Survival (PFS) | NA months |
| Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve) | Progression-Free Survival (PFS) | 19.42 months |
| Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve) | Progression-Free Survival (PFS) | 17.74 months |