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A Study of INCB050465 in Subjects With Relapsed or Refractory Marginal Zone Lymphoma (CITADEL-204)

A Phase 2, Open-Label, 2-Cohort Study of INCB050465, a PI3Kδ Inhibitor, in Subjects With Relapsed or Refractory Marginal Zone Lymphoma With or Without Prior Exposure to a BTK Inhibitor (CITADEL-204)

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03144674
Enrollment
110
Registered
2017-05-09
Start date
2017-12-18
Completion date
2024-05-29
Last updated
2025-07-11

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

Conditions

Lymphoma

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

DRUGParsaclisib

Parsaclisib at the protocol-defined dose.

Sponsors

Incyte Corporation
Lead SponsorINDUSTRY

Study design

Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

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

MeasureTime frameDescription
Objective Response Rate (ORR) Based on Lugano Classification CriteriaUp to approximately 161 weeksORR=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

MeasureTime frameDescription
Complete Response Rate (CRR) Based on Lugano Classification CriteriaUp to 1305 daysCRR 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 daysPFS 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 daysDOR=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 SizeUp to 1305 daysTarget 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 daysAn 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 daysOS 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

ArmCount
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
Total110

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003
Overall StudyChanged Physicians0001
Overall StudyDeath32624
Overall StudyDischarged from the Trust0010
Overall StudyExclusion Criteria Met0010
Overall StudyHistological Criteria Not Met0001
Overall StudyLost to Follow-up0104
Overall StudyMultifactorial Cognitive Decline0001
Overall StudyParticipant Transferred to Rollover Study1156
Overall StudyProgression of Chronic Lymphocytic Leukemia0001
Overall StudyRemoved for Safety0001
Overall StudySite Closed0001
Overall StudyWithdrawal by Participant0026

Baseline characteristics

CharacteristicCohort 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, Continuous73.5 years72.2 years68.1 years69.8 years69.6 years
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants2 Participants3 Participants4 Participants9 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
3 Participants4 Participants19 Participants57 Participants83 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
1 Participants0 Participants6 Participants11 Participants18 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants1 Participants1 Participants
Race (NIH/OMB)
Black or African American
0 Participants1 Participants0 Participants1 Participants2 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants0 Participants5 Participants10 Participants16 Participants
Race (NIH/OMB)
White
3 Participants5 Participants23 Participants60 Participants91 Participants
Sex: Female, Male
Female
2 Participants4 Participants16 Participants31 Participants53 Participants
Sex: Female, Male
Male
2 Participants2 Participants12 Participants41 Participants57 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
3 / 42 / 66 / 2825 / 72
other
Total, other adverse events
4 / 45 / 625 / 2867 / 72
serious
Total, serious adverse events
2 / 42 / 69 / 2846 / 72

Outcome results

Primary

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

ArmMeasureValue (NUMBER)
Cohort 1: Treatment A (Exposed to Ibrutinib)Objective Response Rate (ORR) Based on Lugano Classification Criteria50.0 percentage of participants
Cohort 1: Treatment B (Exposed to Ibrutinib)Objective Response Rate (ORR) Based on Lugano Classification Criteria33.3 percentage of participants
Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve)Objective Response Rate (ORR) Based on Lugano Classification Criteria57.1 percentage of participants
Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve)Objective Response Rate (ORR) Based on Lugano Classification Criteria58.3 percentage of participants
Secondary

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.

ArmMeasureValue (MEAN)Dispersion
Cohort 1: Treatment A (Exposed to Ibrutinib)Best Percent Change From Baseline in Target Lesion Size-48.83 percent change in lesion sizeStandard 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 sizeStandard 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 sizeStandard 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 sizeStandard Deviation 19.971
Secondary

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

ArmMeasureValue (NUMBER)
Cohort 1: Treatment A (Exposed to Ibrutinib)Complete Response Rate (CRR) Based on Lugano Classification Criteria0.0 percentage of participants
Cohort 1: Treatment B (Exposed to Ibrutinib)Complete Response Rate (CRR) Based on Lugano Classification Criteria0.0 percentage of participants
Cohort 2: Treatment A (Bruton's Tyrosine Kinase Inhibitor Naïve)Complete Response Rate (CRR) Based on Lugano Classification Criteria10.7 percentage of participants
Cohort 2: Treatment B (Bruton's Tyrosine Kinase Inhibitor Naïve)Complete Response Rate (CRR) Based on Lugano Classification Criteria4.2 percentage of participants
Secondary

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.

ArmMeasureValue (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
Secondary

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

ArmMeasureValue (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
Secondary

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

ArmMeasureGroupValue (NUMBER)
Cohort 1: Treatment A (Exposed to Ibrutinib)Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)TEAEs100.0 percentage of participants
Cohort 1: Treatment A (Exposed to Ibrutinib)Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)SAEs50.0 percentage of participants
Cohort 1: Treatment B (Exposed to Ibrutinib)Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)SAEs33.3 percentage of participants
Cohort 1: Treatment B (Exposed to Ibrutinib)Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)TEAEs83.3 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)TEAEs92.9 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)SAEs32.1 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)TEAEs97.2 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)SAEs63.9 percentage of participants
Secondary

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

ArmMeasureValue (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

Source: ClinicalTrials.gov · Data processed: Feb 27, 2026