Lymphoma
Conditions
Keywords
Mantle cell lymphoma, non-Hodgkin lymphoma, Bruton's tyrosine kinase (BTK), phosphatidylinositol 3-kinase (PI3K)
Brief summary
This is a Phase 2, open-label, 2-cohort study designed to evaluate the efficacy and safety of 2 parsaclisib treatment regimens in participants with relapsed or refractory mantle cell lymphoma (MCL) previously treated either with or without a Bruton's tyrosine kinase (BTK) inhibitor.
Interventions
Parsaclisib tablets administered orally with water and without regard to food.
Sponsors
Study design
Eligibility
Inclusion criteria
* Men and women, aged 18 years or older. * Documented failure to achieve at least partial response (PR) with, or documented disease progression after, the most recent treatment regimen. * Radiographically measurable lymphadenopathy or extranodal lymphoid malignancy. * Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2.
Exclusion criteria
* History of central nervous system lymphoma (either primary or metastatic). * Prior treatment with idelalisib, other selective phosphatidylinositol 3-kinase delta (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 first dose of study treatment. * Active graft-versus-host disease. * Liver disease: Participants positive for hepatitis B surface antigen or hepatitis B core antibody will be eligible if they are negative for hepatitis B virus-deoxyribonucleic acid (HBV-DNA). Participants positive for anti-hepatitis C virus (HCV) antibody will be eligible if they are negative for HCV-ribonucleic acid (RNA).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR) | Up to 1016 days | 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),assign5mm×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) | Up to 1016 days | CRR is defined as the percentage of participants with a CR as defined by response criteria for lymphomas, 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 1016 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 1016 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 1016 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 2045 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 2017 days | OS is defined as the time from the date of the first dose of study treatment until death from any cause. |
Countries
Belgium, Czechia, Denmark, France, Germany, Israel, Italy, Poland, Spain, United Kingdom, United States
Participant flow
Recruitment details
Participants took part in the study at 76 investigative sites in France, Spain, the United States, Italy, Poland, Czech Republic, Great Britain, Denmark, Belgium, Germany, and Israel.
Pre-assignment details
A total of 161 participants with relapsed or refractory mantle cell lymphoma who received 1-3 prior systemic therapies were enrolled into 2 Cohorts and treated. An additional participant was enrolled but not treated. Because this participant was not treated, he/she was not assigned to any treatment/cohort and was not included in the Full Analysis Set or Safety Population for analysis. Cohort 1 had previously received ibrutinib and Cohort 2 were Bruton's tyrosine kinase (BTK) inhibitor naive.
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. | 12 |
| 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 116 weeks. Participants who were exposed to ibrutinib before enrollment were included in this group. | 41 |
| Cohort 2: Treatment A (BTK Inhibitor Naïve) Participants received parsaclisib 20 mg, orally, QD for 8 weeks followed by 20 mg QW for up to approximately 145 weeks. Participants who were not exposed to BTK inhibitor before enrollment were included in this group. | 31 |
| Cohort 2: Treatment B (BTK Inhibitor Naïve) Participants received parsaclisib 20 mg, orally, QD for 8 weeks followed by 2.5 mg QD for up to approximately 136 weeks. Participants who were not exposed to BTK inhibitor before enrollment were included in this group. | 77 |
| Total | 161 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Death | 11 | 31 | 19 | 34 |
| Overall Study | Discomfort, Pain, and Radiographic Advancement | 0 | 0 | 0 | 1 |
| Overall Study | Disease Progression | 0 | 1 | 0 | 2 |
| Overall Study | Lost to Follow-up | 0 | 1 | 1 | 1 |
| Overall Study | Participant Transitioned to Rollover Protocol | 0 | 0 | 2 | 5 |
| Overall Study | Withdrawal by Subject | 0 | 3 | 1 | 5 |
Baseline characteristics
| Characteristic | Cohort 1: Treatment B (Exposed to Ibrutinib) | Cohort 1: Treatment A (Exposed to Ibrutinib) | Total | Cohort 2: Treatment B (BTK Inhibitor Naïve) | Cohort 2: Treatment A (BTK Inhibitor Naïve) |
|---|---|---|---|---|---|
| Age, Continuous | 69.8 years | 70.2 years | 70.9 years | 71.5 years | 72.2 years |
| Race/Ethnicity, Customized American-Indian/Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 0 Participants | 0 Participants | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Black or African American | 0 Participants | 0 Participants | 2 Participants | 2 Participants | 0 Participants |
| Race/Ethnicity, Customized Captured as Other in Database | 0 Participants | 1 Participants | 2 Participants | 2 Participants | 0 Participants |
| Race/Ethnicity, Customized Hispanic or Latino | 2 Participants | 3 Participants | 14 Participants | 5 Participants | 4 Participants |
| Race/Ethnicity, Customized Missing | 3 Participants | 0 Participants | 6 Participants | 7 Participants | 2 Participants |
| Race/Ethnicity, Customized Native Hawaiian/Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Not Hispanic or Latino | 28 Participants | 6 Participants | 112 Participants | 57 Participants | 21 Participants |
| Race/Ethnicity, Customized Not Reported | 5 Participants | 1 Participants | 20 Participants | 8 Participants | 6 Participants |
| Race/Ethnicity, Customized Unknown | 4 Participants | 2 Participants | 7 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 37 Participants | 11 Participants | 136 Participants | 64 Participants | 24 Participants |
| Sex: Female, Male Female | 11 Participants | 1 Participants | 34 Participants | 17 Participants | 5 Participants |
| Sex: Female, Male Male | 30 Participants | 11 Participants | 127 Participants | 60 Participants | 26 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 11 / 12 | 31 / 41 | 19 / 31 | 34 / 77 | 95 / 161 |
| other Total, other adverse events | 9 / 12 | 28 / 41 | 27 / 31 | 66 / 77 | 130 / 161 |
| serious Total, serious adverse events | 5 / 12 | 20 / 41 | 12 / 31 | 45 / 77 | 82 / 161 |
Outcome results
Objective Response Rate (ORR)
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),assign5mm×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 1016 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) | Objective Response Rate (ORR) | 8.3 percentage of participants |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Objective Response Rate (ORR) | 39.0 percentage of participants |
| Cohort 2: Treatment A (BTK Inhibitor Naïve) | Objective Response Rate (ORR) | 64.5 percentage of participants |
| Cohort 2: Treatment B (BTK Inhibitor Naïve) | Objective Response Rate (ORR) | 71.4 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 1016 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 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 | -19.82 percent change in lesion size | Standard Deviation 35.926 |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Best Percent Change From Baseline in Target Lesion Size | -9.51 percent change in lesion size | Standard Deviation 133.438 |
| Cohort 2: Treatment A (BTK Inhibitor Naïve) | Best Percent Change From Baseline in Target Lesion Size | -64.65 percent change in lesion size | Standard Deviation 53.36 |
| Cohort 2: Treatment B (BTK Inhibitor Naïve) | Best Percent Change From Baseline in Target Lesion Size | -67.54 percent change in lesion size | Standard Deviation 32.918 |
Complete Response Rate (CRR)
CRR is defined as the percentage of participants with a CR as defined by response criteria for lymphomas, 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 1016 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) | 0.0 percentage of participants |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Complete Response Rate (CRR) | 2.4 percentage of participants |
| Cohort 2: Treatment A (BTK Inhibitor Naïve) | Complete Response Rate (CRR) | 22.6 percentage of participants |
| Cohort 2: Treatment B (BTK Inhibitor Naïve) | Complete Response Rate (CRR) | 15.6 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 1016 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) | 3.20 months |
| Cohort 2: Treatment A (BTK Inhibitor Naïve) | Duration of Response (DOR) | 17.45 months |
| Cohort 2: Treatment B (BTK Inhibitor Naïve) | Duration of Response (DOR) | 13.01 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 2017 days
Population: Full Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1: Treatment A (Exposed to Ibrutinib) | Overall Survival (OS) | 10.91 months |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Overall Survival (OS) | 11.01 months |
| Cohort 2: Treatment A (BTK Inhibitor Naïve) | Overall Survival (OS) | 33.48 months |
| Cohort 2: Treatment B (BTK Inhibitor Naïve) | Overall Survival (OS) | 45.86 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 2045 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 | 83.3 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 | 41.7 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 | 48.8 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 | 90.2 percentage of participants |
| Cohort 2: Treatment A (BTK Inhibitor Naïve) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | TEAEs | 93.5 percentage of participants |
| Cohort 2: Treatment A (BTK Inhibitor Naïve) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | SAEs | 38.7 percentage of participants |
| Cohort 2: Treatment B (BTK Inhibitor Naïve) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | TEAEs | 92.2 percentage of participants |
| Cohort 2: Treatment B (BTK Inhibitor Naïve) | Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | SAEs | 58.4 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 1016 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) | 3.94 months |
| Cohort 1: Treatment B (Exposed to Ibrutinib) | Progression-Free Survival (PFS) | 3.68 months |
| Cohort 2: Treatment A (BTK Inhibitor Naïve) | Progression-Free Survival (PFS) | 8.11 months |
| Cohort 2: Treatment B (BTK Inhibitor Naïve) | Progression-Free Survival (PFS) | 13.83 months |