Aggressive Lymphoma, Chronic Lymphocytic Leukemia, Small Lymphocytic Lymphoma
Conditions
Brief summary
A Phase I/II Dose-Escalation and Expansion Study Of The Selective PKC-Β Inhibitor MS-553 In Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
Interventions
Oral, multiple dose levels
Oral
Oral
IV
IV
Sponsors
Study design
Intervention model description
a limited 3+3 phase 1 dose escalation study with expansion cohorts
Eligibility
Inclusion criteria
To be eligible for inclusion in the primary escalation and expansion cohort 1 in this study, patients must meet all of the following criteria: 1. Age 18 years or older 2. Diagnosis of chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL): 1. History of histologically documented CLL or SLL that meets IWCLL diagnostic criteria according to the 2008 guidelines, and 2. Indication for treatment as defined by the 2008 IWCLL guidelines, or the need for disease reduction prior to allogeneic transplantation
Exclusion criteria
Patients who meet any of the following criteria are not eligible for the primary escalation and expansion cohorts of this study: 1. Current or past transformation of CLL/SLL to prolymphocytic leukemia (PLL), non-Hodgkin lymphoma, or Hodgkin lymphoma aggressive lymphoma outlined in the inclusion criteria for the optional cohort. 2. Active and uncontrolled autoimmune cytopenia(s) 3. Any of the following prior therapies within 14 days prior to cycle 1, day 1: 1. Major surgery 2. Corticosteroids greater than 20 mg / day prednisone (or equivalent), unless used by inhalation or topical route, or unless necessary for premedication before iodinated contrast dye, or for autoimmune hemolytic anemia 3. Cytotoxic chemotherapy or biologic therapy, excepting BCR pathway kinase inhibitors for which no wash out is required (but must be stopped before cycle 1 day 1)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Assessments for DLT and TEAE will occur during Cycle 1 (28 days) for A1 Cohort and B1 Cohort and Cycles 1-4 (up to 112 days) for C1 Cohort. | DLT are defined as any of the following treatment-emergent events occurring during the DLT evaluation period. 1. Death 2. Hematologic toxicities: • Grade 4 neutropenia for ≥ 7 days • Grade 3 febrile neutropenia: absolute neutrophil count (ANC) 38.3°C (101°F) or a sustained temperature ≥38°C (100.4°F) for \> 1 hour • Grade 4 thrombocytopenia ≥ 14 days (patients with baseline platelet count of ≥ 50 x 109 /L) • Grade 4 thrombocytopenia ≥ 28 days (patients with baseline platelet count \< 50 x 10 9 /L) • ≥ Grade 3 thrombocytopenia associated with ≥ Grade 2 hemorrhage • New ≥ Grade 3 anemia requiring transfusion in a patient previously transfusion independent. 3. Nonhematologic toxicities: • Any other ≥ Grade 3 toxicity not reversed to any one of the following three conditions in 7 days with appropriate intervention: a) baseline; b) \< Grade 1; or c) a status considered to be controlled by the SRC. • Any TEAE requiring \>25% of doses of scheduled study drug to be withheld during the DLT period |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | Evaluation of the efficacy endpoints related to response will incorporate the data from the first 9 cycles (up to 252 days) of treatment. | This will be assessed according to the 2008 International Workshop on Chronic Lymphocytic Leukemia (IWCLL) Response Criteria with modifications for treatment-related lymphocytosis. Any patient who receives at least one cycle of study therapy is evaluable for response. |
Countries
United States
Participant flow
Recruitment details
Participants enrolled between May 2018 and Oct. 2023
Pre-assignment details
No participants were enrolled in Cohort B2, B3 or C2
Participants by arm
| Arm | Count |
|---|---|
| Phase I Dose Escalation Cohort A1 (MS-553: 100 mg BID) R/R CLL/SLL patients
MS-553 Monotherapy: Oral | 4 |
| Phase I Dose Escalation Cohort A1 (MS-553: 200 mg BID) R/R CLL/SLL patients
MS-553 Monotherapy: Oral | 3 |
| Phase I Dose Escalation Cohort A1 (MS-553: 250 mg BID) R/R CLL/SLL patients
MS-553 Monotherapy: Oral | 3 |
| Phase I Dose Escalation Cohort A1 (MS-553: 300 mg BID) R/R CLL/SLL patients
MS-553 Monotherapy: Oral | 4 |
| Phase I Dose Escalation Cohort A1 (MS-553: 350 mg BID) R/R CLL/SLL patients
MS-553 Monotherapy: Oral | 4 |
| Phase II Expansion Cohort A2 (MS-553 Monotherapy) R/R CLL/SLL patients
MS-553: Oral recommended phase 2 dose of MS-553 | 23 |
| Phase II Expansion Cohort A3 (MS-553 Monotherapy) patients with Richter's transformation or aggressive lymphoma
MS-553: Oral recommended phase 2 dose of MS-553 | 6 |
| Phase I Combination Dose Escalation Cohort B1 (MS-553: 150 mg BID) BTK inhibitor naïve CLL/SLL patients
MS-553: Oral
acalabrutinib: Oral | 3 |
| Phase I Combination Dose Escalation Cohort B1 (MS-553:200 mg BID) BTK inhibitor naïve CLL/SLL patients
MS-553: Oral
acalabrutinib: Oral | 3 |
| Phase I Combination Dose Escalation Cohort C1 (MS-553: 150 mg BID) Bcl-2 inhibitor naïve CLL/SLL patients
MS-553: Oral
venetoclax: Oral
Rituximab: IV
obinutuzumab: IV | 3 |
| Phase I Combination Dose Escalation Cohort C1 (MS-553: 200 mg BID) Bcl-2 inhibitor naïve CLL/SLL patients
MS-553: Oral
venetoclax: Oral
Rituximab: IV
obinutuzumab: IV | 4 |
| Total | 60 |
Baseline characteristics
| Characteristic | Total | Phase I Dose Escalation Cohort A1 (MS-553: 200 mg BID) | Phase I Dose Escalation Cohort A1 (MS-553: 250 mg BID) | Phase I Dose Escalation Cohort A1 (MS-553: 300 mg BID) | Phase I Dose Escalation Cohort A1 (MS-553: 350 mg BID) | Phase II Expansion Cohort A2 (MS-553 Monotherapy) | Phase II Expansion Cohort A3 (MS-553 Monotherapy) | Phase I Dose Escalation Cohort A1 (MS-553: 100 mg BID) | Phase I Combination Dose Escalation Cohort B1 (MS-553: 150 mg BID) | Phase I Combination Dose Escalation Cohort B1 (MS-553:200 mg BID) | Phase I Combination Dose Escalation Cohort C1 (MS-553: 150 mg BID) | Phase I Combination Dose Escalation Cohort C1 (MS-553: 200 mg BID) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 48 Participants | 2 Participants | 2 Participants | 3 Participants | 4 Participants | 21 Participants | 4 Participants | 3 Participants | 2 Participants | 3 Participants | 2 Participants | 2 Participants |
| Age, Categorical Between 18 and 65 years | 12 Participants | 1 Participants | 1 Participants | 1 Participants | 0 Participants | 2 Participants | 2 Participants | 1 Participants | 1 Participants | 0 Participants | 1 Participants | 2 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 3 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 1 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 56 Participants | 3 Participants | 2 Participants | 4 Participants | 4 Participants | 23 Participants | 6 Participants | 4 Participants | 3 Participants | 2 Participants | 2 Participants | 3 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 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 | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 57 Participants | 3 Participants | 2 Participants | 3 Participants | 4 Participants | 23 Participants | 6 Participants | 4 Participants | 3 Participants | 2 Participants | 3 Participants | 4 Participants |
| Region of Enrollment United States | 60 participants | 3 participants | 3 participants | 4 participants | 4 participants | 23 participants | 6 participants | 4 participants | 3 participants | 3 participants | 3 participants | 4 participants |
| Sex: Female, Male Female | 21 Participants | 1 Participants | 0 Participants | 1 Participants | 3 Participants | 8 Participants | 1 Participants | 2 Participants | 1 Participants | 2 Participants | 0 Participants | 2 Participants |
| Sex: Female, Male Male | 39 Participants | 2 Participants | 3 Participants | 3 Participants | 1 Participants | 15 Participants | 5 Participants | 2 Participants | 2 Participants | 1 Participants | 3 Participants | 2 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 | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk | EG008 affected / at risk | EG009 affected / at risk | EG010 affected / at risk |
|---|---|---|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 1 / 4 | 2 / 3 | 1 / 3 | 2 / 4 | 2 / 4 | 6 / 23 | 3 / 6 | 0 / 3 | 0 / 3 | 0 / 3 | 0 / 4 |
| other Total, other adverse events | 4 / 4 | 3 / 3 | 3 / 3 | 4 / 4 | 4 / 4 | 23 / 23 | 6 / 6 | 3 / 3 | 3 / 3 | 3 / 3 | 4 / 4 |
| serious Total, serious adverse events | 2 / 4 | 3 / 3 | 1 / 3 | 3 / 4 | 3 / 4 | 15 / 23 | 3 / 6 | 1 / 3 | 2 / 3 | 2 / 3 | 2 / 4 |
Outcome results
The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation
DLT are defined as any of the following treatment-emergent events occurring during the DLT evaluation period. 1. Death 2. Hematologic toxicities: • Grade 4 neutropenia for ≥ 7 days • Grade 3 febrile neutropenia: absolute neutrophil count (ANC) 38.3°C (101°F) or a sustained temperature ≥38°C (100.4°F) for \> 1 hour • Grade 4 thrombocytopenia ≥ 14 days (patients with baseline platelet count of ≥ 50 x 109 /L) • Grade 4 thrombocytopenia ≥ 28 days (patients with baseline platelet count \< 50 x 10 9 /L) • ≥ Grade 3 thrombocytopenia associated with ≥ Grade 2 hemorrhage • New ≥ Grade 3 anemia requiring transfusion in a patient previously transfusion independent. 3. Nonhematologic toxicities: • Any other ≥ Grade 3 toxicity not reversed to any one of the following three conditions in 7 days with appropriate intervention: a) baseline; b) \< Grade 1; or c) a status considered to be controlled by the SRC. • Any TEAE requiring \>25% of doses of scheduled study drug to be withheld during the DLT period
Time frame: Assessments for DLT and TEAE will occur during Cycle 1 (28 days) for A1 Cohort and B1 Cohort and Cycles 1-4 (up to 112 days) for C1 Cohort.
Population: DLT evaluable population (Phase 1 only) included all participants who had completed at least 75% of their planned doses during Cycle 1 or the DLT period, unless missed doses were due to adverse events.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Phase I Dose Escalation Cohort A1 (MS-553: 100mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with DLT | 0 Participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 100mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with TEAE | 0 Participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 200mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with DLT | 0 Participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 200mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with TEAE | 0 Participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 250mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with DLT | 0 Participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 250mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with TEAE | 0 Participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 300mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with DLT | 0 Participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 300mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with TEAE | 0 Participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 350mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with DLT | 1 Participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 350mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with TEAE | 1 Participants |
| Phase I Combination Dose Escalation Cohort B1 (MS-553: 150 mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with TEAE | 0 Participants |
| Phase I Combination Dose Escalation Cohort B1 (MS-553: 150 mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with DLT | 0 Participants |
| Phase I Combination Dose Escalation Cohort B1 (MS-553-200 mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with TEAE | 0 Participants |
| Phase I Combination Dose Escalation Cohort B1 (MS-553-200 mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with DLT | 0 Participants |
| Phase I Combination Dose Escalation Cohort C1 (MS-553: 150 mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with DLT | 0 Participants |
| Phase I Combination Dose Escalation Cohort C1 (MS-553: 150 mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with TEAE | 0 Participants |
| Phase I Combination Dose Escalation Cohort C1 (MS-553: 200 mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with DLT | 1 Participants |
| Phase I Combination Dose Escalation Cohort C1 (MS-553: 200 mg BID) | The Incidence Rate of DLT and TEAE Requiring Study Drug Discontinuation | Number of participants with TEAE | 1 Participants |
The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy
This will be assessed according to the 2008 International Workshop on Chronic Lymphocytic Leukemia (IWCLL) Response Criteria with modifications for treatment-related lymphocytosis. Any patient who receives at least one cycle of study therapy is evaluable for response.
Time frame: Evaluation of the efficacy endpoints related to response will incorporate the data from the first 9 cycles (up to 252 days) of treatment.
Population: Consisting of all patients who received at least one dose of study therapy of MS-553 and had at least one post-baseline efficacy evaluation.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Phase I Dose Escalation Cohort A1 (MS-553: 100mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 0 percentage of participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 200mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 33.3 percentage of participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 250mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 100 percentage of participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 300mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 66.7 percentage of participants |
| Phase I Dose Escalation Cohort A1 (MS-553: 350mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 33.3 percentage of participants |
| Phase I Combination Dose Escalation Cohort B1 (MS-553: 150 mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 42.10 percentage of participants |
| Phase I Combination Dose Escalation Cohort B1 (MS-553-200 mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 25 percentage of participants |
| Phase I Combination Dose Escalation Cohort C1 (MS-553: 150 mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 100 percentage of participants |
| Phase I Combination Dose Escalation Cohort C1 (MS-553: 200 mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 66.7 percentage of participants |
| Phase I Combination Dose Escalation Cohort C1 (MS-553: 150 mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 100 percentage of participants |
| Phase I Combination Dose Escalation Cohort C1 (MS-553: 200 mg BID) | The ORR of MS-553 in Patients With CLL/SLL Whose Disease Relapsed After or Was Refractory to at Least One Prior Therapy | 100 percentage of participants |