BTK Inhibitor BGB-3111 in Chinese Participants With Diffuse Large B-Cell Lymphoma (Non-GCB) and Indolent Lymphoma (FL and MZL)

A Phase 2 Study to Assess the Safety, Tolerability, and Activity of BGB-3111 in Combination With Rituximab in Chinese Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma (Non-GCB Subtype) and Relapsed/Refractory Indolent Lymphoma (Follicular Lymphoma and Marginal Zone Lymphoma)

Status

Completed

Phases

Phase 2

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT03520920

Enrollment

Registered

2018-05-11

Start date

2018-01-04

Completion date

2020-08-28

Last updated

2024-10-26

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

Conditions

Diffuse Large B-Cell Lymphoma, Follicular Lymphoma, Marginal Zone Lymphoma

Brief summary

This was a multicenter, open-label, phase 2 study to evaluate efficacy, safety, and tolerability of BGB-3111 (zanubrutinib) 160 milligrams (mg) twice daily (BID) in combination with rituximab in Chinese participants with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) (non-GCB \[non-germinal center B-cell-like\] subtype) and R/R indolent lymphoma (follicular lymphoma \[FL\] and marginal zone lymphoma \[MZL\]).

Interventions

DRUGZanubrutinib

Administered zanubrutinib 160 mg orally (PO) BID continuously

DRUGRituximab

Administered rituximab 375 mg/m\^2 intravenously on Cycle 1 Days 1, 8, 15, 22, and on Day 1 of Cycles 4, 6, 8, 10. Each cycle was 28 days long.

Study design

Allocation

NON_RANDOMIZED

Intervention model

SINGLE_GROUP

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

Key Inclusion Criteria: 1. ≥ Age 18 years at time of signing of informed consent. 2. Measurable disease by computed tomography (CT) or positron emission tomography/CT or magnetic resonance imaging, defined as ≥1 nodal lesion that was \>1.5 centimeters (cm) in the longest diameter, or ≥1 extra-nodal lesion (for example, hepatic nodules) that was \>1 cm in the longest diameter. 3. Availability of archival or fresh tumor tissue sample from an evaluable core or excisional biopsy. 4. Participants meet the following criteria: 1. Cohort 1: R/R non-GCB DLBCL i. Histologically confirmed non-GCB DLBCL per Hans criteria with non-transformed disease; additional methodologies for confirming non-GCB DLBCL may have been considered in consultation with the medical monitor. ii. Relapsed disease (disease progression after most recent therapy for DLBCL occurring more than 6 months after the completion of last therapy) or refractory disease (failure to achieve complete response \[CR\] or partial response \[PR\] to therapy for non-GCB DLBCL or disease progression within 6 months after completion of the most recent therapy for non-GCB DLBCL). iii. Must have received at least one standard anthracycline ± rituximab-based treatment (for example, rituximab plus cyclophosphamide, doxorubicin \[or epirubicin, hydroxydaunorubicin, or similar\], vincristine, and prednisone) or cyclophosphamide, vincristine, and prednisone +/- rituximab for DLBCL. 2. Cohort 2: R/R FL or R/R MZL i. Histologically confirmed CD20+ FL (Grade 1, 2, or 3a) or MZL. ii. Relapsed disease (disease progression after most recent therapy for FL or MZL occurring more than 6 months after the completion of last therapy) or refractory disease (failure to achieve complete response (CR) or partial response (PR) to most recent therapy for FL or MZL, or disease progression within 6 months after completion of the most recent therapy for FL or MZL). 5. Laboratory parameters as specified below: 1. Hematologic: Platelet count ≥75 x 10\^9/liter (L) independent of growth factor or transfusion within 7 days of study entry; absolute neutrophil count (ANC) ≥1 x 10\^9/L independent of growth factor within 7 days of study entry, hemoglobin \>8 grams/deciliter within 7 days of study entry. 2. Hepatic: Total bilirubin ≤ 2x upper limit of normal (ULN) unless documented Gilbert's syndrome; aspartate aminotransferase/serum glutamic-oxaloacetic transaminase and alanine transaminase/serum glutamic-pyruvic transaminase ≤3x ULN. 3. Renal: Creatinine clearance ≥30 milliliters/minute (as estimated by the Cockcroft-Gault equation based on ideal body weight or as measured by nuclear medicine scan or 24-hour urine collection). 4. International normalized ratio and activated partial thromboplastin time ≤1.5x ULN. Participants with anti-phospholipid syndrome, acquired von Willebrand disease, factor inhibitors or on vitamin K antagonist may have been enrolled after discussion with the Medical Monitor. 6. Left ventricular ejection fraction ≥50%. 7. Life expectancy ≥6 months. 8. Eastern Cooperative Oncology Group performance status of 0, 1, or 2. 9. Female participants of childbearing potential must have practiced highly effective methods of contraception initiated prior to first dose of study drug, for the duration of the study, and for ≥90 days after the last dose of zanubrutinib, or 12 months after the last dose of rituximab, whichever is longer. 10. Male participants were eligible if vasectomized or if they agreed to the use of barrier contraception in combination with other methods above during the study treatment period and for ≥90 days after the last dose of zanubrutinib. 11. Able to provide written informed consent and could understand and comply with the requirements of the study. Key

Exclusion criteria

1. Known central nervous system lymphoma or leukemia. 2. Histological confirmed gastric mucosa-associated lymphoid tissue type MZL. 3. Uncontrolled autoimmune hemolytic anemia or idiopathic thrombocytopenia purpura. 4. Clinically significant cardiovascular disease. 5. History of severe bleeding disorder such as hemophilia A, hemophilia B, von Willebrand disease, or history of spontaneous bleeding requiring blood transfusion or other medical intervention. 6. History of stroke or intracranial hemorrhage within 6 months before first dose of study drug. 7. Severe or debilitating pulmonary disease. 8. Hypersensitivity reaction to zanubrutinib or rituximab or any of the other ingredients of the study drugs. 9. Prior Bruton tyrosine kinase inhibitor treatment. 10. Required ongoing treatment with a strong cytochrome P450 protein inhibitor or inducer. 11. Vaccination with a live vaccine within 28 days of the first dose of study drug. 12. Hematopoietic stem cell transplantation within 6 months of first dose of study drug. 13. Receipt of the following treatment prior to first dose of study drug: 1. Corticosteroids at doses \>20 mg/day prednisone equivalent or steroids given with anti-neoplastic intent within 7 days prior to first dose of study drug. 2. Chemotherapy or radiotherapy within 4 weeks. 3. Monoclonal antibody within 4 weeks. 4. Investigational therapy within 4 weeks. 5. Chinese patent medicine with anti-neoplastic intent within 4 weeks. 14. Not recovered from toxicity of any prior anti-cancer therapy to ≤Grade 1, except for alopecia, ANC, hemoglobin (Hgb), and platelets. For ANC, Hgb and platelets, see inclusion criterion #5. 15. Prior malignancy within the past 3 years, except for curatively treated basal or squamous cell skin cancer, superficial bladder cancer, or carcinoma in situ of the cervix or breast. 16. Unable to swallow capsules or disease significantly affecting gastrointestinal function such as malabsorption syndrome, resection of the stomach or small bowel, symptomatic inflammatory bowel disease, history of bariatric surgery, or partial or complete bowel obstruction. 17. Major surgery within 4 weeks prior to first dose of study treatment. 18. Active fungal, bacterial and/or viral infection requiring systemic therapy. 19. Known infection with human immunodeficiency virus, or serologic status reflecting active hepatitis B or C infection as follows: 1. Presence of hepatitis B surface antigen (HBsAg) or anti-hepatitis B core antibody (anti-HBc). Participants with presence of anti-HBc, but absence of HBsAg, were eligible if hepatitis B virus (HBV) DNA was \<500 international units (IU)/mL, anti-viral therapy started before the first dose of study treatment, and if they were willing to undergo monthly monitoring for HBV reactivation. 2. Presence of hepatitis C virus (HCV) antibody. Participants with presence of HCV antibody were eligible if HCV RNA was undetectable (\<15 IU/mL). 20. Pregnant or lactating women. 21. Underlying medical conditions that, in the investigator's opinion, would have rendered the administration of study drug hazardous or obscure the interpretation of toxicity or adverse events. 22. Concurrent participation in another therapeutic clinical trial. Note: Other protocol defined Inclusion/

Design outcomes

Primary

Measure	Time frame	Description
Overall Response Rate (ORR) As Measured By The Investigator	Up to approximately 2.5 years	The percentage of participants whose best overall response met partial response (PR) or complete response (CR) criteria among all participants. The 95% confidence interval (CI) was calculated with the Clopper-Pearson method.

Secondary

Measure	Time frame	Description
Duration Of Response (DOR) As Determined By Investigator	Up to approximately 2.5 years	The DOR was defined as the time from the date that the response criteria were first met to the date that progressive disease (PD) was objectively documented or death, whichever occurred first. Medians were estimated by the Kaplan-Meier method with 95% CIs estimated using the Brookmeyer and Crowley method.
DOR: Event-free Rate	Up to approximately 2.5 years	The DOR was defined as the time from the date that the response criteria were first met to the date that progressive disease (PD) was objectively documented or death, whichever occurred first. The event-free rate was estimated by the Kaplan-Meier method with 95% CIs estimated using Greenwood's formula.
Progression-free Survival (PFS) As Determined By Investigator	Up to approximately 2.5 years	The PFS was defined as time from first dose of study treatment until first documentation of progression, assessed per the Lugano Classification, or death, whichever occurred first. Medians were estimated by the Kaplan-Meier method with 95% CIs estimated using the Brookmeyer and Crowley method.
PFS: Event-free Rate	Up to approximately 2.5 years	The PFS was defined as time from first dose of study treatment until first documentation of progression, assessed per the Lugano Classification, or death, whichever occurred first. The event-free rate was estimated by the Kaplan-Meier method with 95% CIs estimated using Greenwood's formula.
Overall Survival (OS)	Up to approximately 2.5 years	The OS was defined as the time from the date of first dose of study treatment to the date of death due to any cause. Medians were estimated by the Kaplan-Meier method with 95% CIs estimated using the method of Brookmeyer and Crowley.
OS: Survival Rate	Up to approximately 2.5 years	The OS was defined as the time from the date of first dose of study treatment to the date of death due to any cause. Survival rates were estimated by the Kaplan-Meier method with 95% CIs estimated using Greenwood's formula.
Time To Response (TTR) As Determined By The Investigator	Up to approximately 2.5 years	The TTR was defined as the time from the date of the first dose of study treatment to the date of the first qualifying response (partial response or better).
Median TTR	Up to approximately 2.5 years	The TTR was defined as the time from the date of the first dose of study treatment to the date of the first qualifying response (partial response or better).
Complete Response Rate As Determined By The Investigator	Up to approximately 2.5 years	The percentage of participants whose best overall response met complete response or complete metabolic response criteria among all participants are reported. The 95% CI was calculated with Clopper-Pearson method.
Number Of Participants Experiencing Treatment-emergent Adverse Events (TEAEs) And Serious TEAEs	Up to approximately 2.5 years	A treatment-emergent adverse event was defined as an adverse event with an onset or worsening (if present pretreatment) starting on or after the first dose of study drug up to 30 days after discontinuation of zanubrutinib or 90 days after discontinuation of rituximab, whichever occurred later; or initiation of new anticancer therapy if it occurred prior to the other 2 dates. Worsening of a treatment-emergent adverse event to Grade 5 beyond Day 30 after the last dose of zanubrutinib or Day 90 after the last dose rituximab was also considered a treatment-emergent adverse event if the event occurred prior to initiation of new anticancer therapy.

Countries

China

Participant flow

Recruitment details

This study was conducted at 4 study centers in China, all of which enrolled participants. The first enrolled participants received their first dose on 04 January 2018, and the last participant enrolled received their first dose on 20 December 2018. A total of 41 participants with non-Hodgkin lymphoma (NHL) were enrolled into the study, and all received ≥1 dose of study treatment.

Participants by arm

Arm	Count
Relapsed/Refractory Non-germinal Center B-cell-like Diffuse Large B-cell Lymphoma Participants with R/R non-GCB DLBCL received zanubrutinib plus rituximab for up to progressive disease or intolerance. Administered zanubrutinib 160 mg PO BID continuously and rituximab 375 mg/m\^2 IV on Cycle 1 Days 1, 8, 15, 22, and on Day 1 of Cycles 4, 6, 8, 10. Each cycle was 28 days long.	20
Relapsed/Refractory Follicular Lymphoma Participants with R/R FL received zanubrutinib plus rituximab for up to progressive disease or intolerance. Administered zanubrutinib 160 mg PO BID continuously and rituximab 375 mg/m\^2 IV on Cycle 1 Days 1, 8, 15, 22, and on Day 1 of Cycles 4, 6, 8, 10. Each cycle was 28 days long.	16
Relapsed/Refractory Marginal Zone Lymphoma Participants with R/R MZL received zanubrutinib plus rituximab for up to progressive disease or intolerance. Administered zanubrutinib 160 mg PO BID continuously and rituximab 375 mg/m\^2 IV on Cycle 1 Days 1, 8, 15, 22, and on Day 1 of Cycles 4, 6, 8, 10. Each cycle was 28 days long.	5
Total	41

Withdrawals & dropouts

Period	Reason	FG000	FG001	FG002
Overall Study	Death	13	1	0
Overall Study	Study Terminated by the Sponsor	5	14	5
Overall Study	Withdrawal by Subject	2	1	0

Baseline characteristics

Characteristic	Relapsed/Refractory Non-germinal Center B-cell-like Diffuse Large B-cell Lymphoma	Relapsed/Refractory Follicular Lymphoma	Relapsed/Refractory Marginal Zone Lymphoma	Total
Age, Continuous	55.2 years STANDARD_DEVIATION 15	47.6 years STANDARD_DEVIATION 12.36	61.2 years STANDARD_DEVIATION 8.87	53.0 years STANDARD_DEVIATION 13.94
Age, Customized <65 years	14 Participants	15 Participants	3 Participants	32 Participants
Age, Customized ≥65 years	6 Participants	1 Participants	2 Participants	9 Participants
Body Mass Index	23.43 kilogram/m^2 STANDARD_DEVIATION 2.652	25.04 kilogram/m^2 STANDARD_DEVIATION 5.079	24.33 kilogram/m^2 STANDARD_DEVIATION 4.813	24.17 kilogram/m^2 STANDARD_DEVIATION 3.989
Body Surface Area	1.72 m^2 STANDARD_DEVIATION 0.113	1.77 m^2 STANDARD_DEVIATION 0.295	1.69 m^2 STANDARD_DEVIATION 0.24	1.74 m^2 STANDARD_DEVIATION 0.213
Eastern Cooperative Oncology Group Performance (ECOG)Status Grade 0	13 Participants	11 Participants	3 Participants	27 Participants
Eastern Cooperative Oncology Group Performance (ECOG)Status Grade 1	5 Participants	4 Participants	2 Participants	11 Participants
Eastern Cooperative Oncology Group Performance (ECOG)Status Grade 2	2 Participants	1 Participants	0 Participants	3 Participants
Hepatitis B Core Antibody Missing	0 Participants	0 Participants	1 Participants	1 Participants
Hepatitis B Core Antibody Negative	14 Participants	13 Participants	2 Participants	29 Participants
Hepatitis B Core Antibody Positive	6 Participants	3 Participants	2 Participants	11 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Asian	20 Participants	16 Participants	5 Participants	41 Participants
Race (NIH/OMB) Black or African American	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) More than one race	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
Race (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) White	0 Participants	0 Participants	0 Participants	0 Participants
Sex: Female, Male Female	7 Participants	8 Participants	3 Participants	18 Participants
Sex: Female, Male Male	13 Participants	8 Participants	2 Participants	23 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk	EG002 affected / at risk
deaths Total, all-cause mortality	13 / 20	1 / 16	0 / 5
other Total, other adverse events	19 / 20	16 / 16	5 / 5
serious Total, serious adverse events	7 / 20	4 / 16	0 / 5

Outcome results

Primary

Overall Response Rate (ORR) As Measured By The Investigator

The percentage of participants whose best overall response met partial response (PR) or complete response (CR) criteria among all participants. The 95% confidence interval (CI) was calculated with the Clopper-Pearson method.