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A Study Evaluating the Efficacy of Venetoclax Plus Ibrutinib in Participants With T-cell Prolymphocytic Leukemia

A Prospective, Open-Label, Single-Arm, Phase 2, Multicenter Study Evaluating the Efficacy of Venetoclax Plus Ibrutinib in Subjects With T-Cell Prolymphocytic Leukemia

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03873493
Enrollment
14
Registered
2019-03-13
Start date
2020-01-14
Completion date
2021-11-04
Last updated
2022-12-19

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

Conditions

Cancer, Leukemia, T-cell Prolymphocytic Leukemia (T-PLL)

Keywords

T-cell Prolymphocytic Leukemia (T-PLL), Cancer, Venetoclax, Venclexta, Venclyxto, Ibrutinib, Imbruvica, Relapsed or Refractory T-lymphoid malignancy

Brief summary

The main objective of this study is to evaluate the efficacy of the combination of venetoclax plus ibrutinib for treating adults with T-cell prolymphocytic leukemia (T-PLL).

Detailed description

This study is planned as an adaptive 2-stage design as follows: Stage 1: Enroll 14 participants with relapsed or refractory (R/R) T-PLL and move to Stage 2 if 4 or more participants meet protocol-specified response criteria. Response assessment will be performed on a continued basis until all 14 participants have enrolled into Stage 1 and have completed the Week 24 disease assessment. Stage 2: Enroll up to an additional 23 participants. The study was stopped after Stage 1. Stage 2 was not conducted.

Interventions

DRUGVenetoclax

Venetoclax tablets taken orally once a day (QD). Initially, venetoclax was administered utilizing a 5-step dose ramp-up over 5 days. Subjects were hospitalized and closely monitored for 7 days. The venetoclax ramp-up was administered in a daily manner: 20 mg on Week 1 Day 1, 50 mg on Week 1 Day 2, 100 mg on Week 1 Day 3, 200 mg on Week 1 Day 4, and 400 mg on Week 1 Day 5 and thereafter, once daily, until the end-of-treatment. The dose of venetoclax may have been increased to 600 mg QD at Week 8 or thereafter.

DRUGIbrutinib

Ibrutinib capsules taken orally once a day, 420 mg/day until the end-of-treatment.

Sponsors

AbbVie
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

Inclusion criteria

* Adequate liver, kidney and hematology function per laboratory values as described in the protocol. * Diagnosis of T-cell prolymphocytic leukemia (T-PLL) that requires treatment. * Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 2. * Received prior alemtuzumab (unless unsuitable or unavailable). * Has no malignancies other than T-PLL that: * currently require systemic therapies; * were not previously treated with curative intention (unless the malignant disease is in a stable remission due to the discretion of the treating physician); or * developed signs of progression after curative treatment.

Exclusion criteria

* History of or current decompensated cirrhosis including Child-Pugh class B or C, ascites, hepatic encephalopathy, or variceal bleeding. * Has human T-cell lymphotropic virus, type 1. * Prior allogeneic stem cell transplant within 6 months of study drug administration and requirement for graft versus host therapy. * Has an uncontrolled or active infection including severe acute respiratory syndrome- coronavirus-2 (SARS-COV-2). * Previously treated with a B-cell lymphoma (BCL)-2 inhibitor. * Received a prohibited therapy within the specified time frame as described in the protocol.

Design outcomes

Primary

MeasureTime frameDescription
Overall Response Rate (ORR)Clinical response was assessed at Weeks 4, 8, 12, 16, and 24 for ORR assessmentORR is defined as the percentage of participants achieving complete remission (CR), CR with incomplete bone marrow recovery (CRi), or partial remission (PR) as their best response per investigator assessment based on the T-PLL consensus criteria 2019. CR: All of the following response criteria must be met: Group A: * all lymph nodes \< 1 cm; * spleen \< 13 cm; * no constitutional symptoms; * circulating lymphocyte count \< 4 × 10\^9/L; * bone marrow T-PLL cells \< 5% of mononuclear cells; * no other specific site involvement Group B: * platelets ≥ 100 × 10\^9 /L; * hemoglobin ≥ 11.0 g/dL; * neutrophils ≥ 1.5 × 10\^9 /L. CRi: All of the CR response criteria in Group A met; at least 1 parameter in Group B not achieved, unrelated to T-PLL, but related to drug toxicity. PR: At least 2 of the parameters in Group A and 1 parameter in Group B need to improve if previously abnormal. If only 1 parameter of both Groups A and B is abnormal prior to therapy, only 1 parameter needs to improve.

Secondary

MeasureTime frameDescription
Duration of Response (DOR)From first dose of study drug to end of study; median time on study was 30.1 weeks.Duration of response is defined for participants who achieved a best overall response of CR, CRi, or PR as the time from the date of first response (CR, CRi, or PR) to the earliest date of disease progression or death. DOR was calculated using Kaplan-Meier methods. Response was assessed by the investigator based on the T-PLL consensus criteria 2019. Progressive disease is defined as meeting at least one of the criteria of Group A or Group B below: Group A: * lymph nodes increase in \> 20% in SLD from nadir; * spleen increase ≥ 50% in vertical length beyond normal from baseline; * circulating lymphocyte count increase ≥ 50% from baseline; * appearance of a new lesion; Group B: * platelet count decrease of ≥ 50% from baseline due to T-PLL (not due to drug toxicity); * hemoglobin decrease of ≥ 2 g/dL from baseline due to T-PLL; * neutrophils decrease of ≥ 50% from baseline due to T-PLL.
Time to Progression (TTP)From first dose of study drug to end of study; median time on study was 30.1 weeks.Time to progression is defined as the time from the date of the participant's first dose of any study drug to the date of earliest disease progression. TTP was calculated using Kaplan-Meier methods. Clinical response (laboratory and physical examination assessments) was assessed by the investigator according to the T-PLL consensus criteria 2019. Progressive disease is defined as meeting at least one of the criteria of Group A or Group B below: Group A: * lymph nodes increase in \> 20% in SLD from nadir; * spleen increase ≥ 50% in vertical length beyond normal from baseline; * circulating lymphocyte count increase ≥ 50% from baseline; * appearance of a new lesion; Group B: * platelet count decrease of ≥ 50% from baseline due to T-PLL (not due to drug toxicity); * hemoglobin decrease of ≥ 2 g/dL from baseline due to T-PLL; * neutrophils decrease of ≥ 50% from baseline due to T-PLL.
Event-free Survival (EFS)From first dose of study drug to end of study; median time on study was 30.1 weeks.Event-free survival is defined as time from participant's first dose of any study drug to the date of earliest disease progression, death, or start of a new anti-T-PLL therapy. EFS was calculated using Kaplan-Meier methods. Clinical response (laboratory and physical examination assessments) was assessed by the investigator according to the T-PLL consensus criteria 2019. Progressive disease is defined as meeting at least one of the criteria of Group A or Group B below: Group A: * lymph nodes increase in \> 20% in SLD from nadir; * spleen increase ≥ 50% in vertical length beyond normal from baseline; * circulating lymphocyte count increase ≥ 50% from baseline; * appearance of a new lesion; Group B: * platelet count decrease of ≥ 50% from baseline due to T-PLL (not due to drug toxicity); * hemoglobin decrease of ≥ 2 g/dL from baseline due to T-PLL; * neutrophils decrease of ≥ 50% from baseline due to T-PLL.
Progression-Free Survival (PFS)From first dose of study drug to end of study; median time on study was 30.1 weeks.Progression-free survival is defined as the time from the date of first dose of any study drug to the date of earliest disease progression or death. PFS was calculated using Kaplan-Meier methods. Response was assessed by the investigator based on the T-PLL consensus criteria 2019. Progressive disease (PD) is defined as meeting at least one of the criteria of Group A or Group B below: Group A: * lymph nodes increase in \> 20% in sum of long-axis diameters of up to 3 target lesions (SLD) from nadir; * spleen increase ≥ 50% in vertical length beyond normal from baseline; * circulating lymphocyte count increase ≥ 50% from baseline; * appearance of a new lesion; Group B: * platelet count decrease of ≥ 50% from baseline due to T-PLL (not due to drug toxicity); * hemoglobin decrease of ≥ 2 g/dL from baseline due to T-PLL; * neutrophils decrease of ≥ 50% from baseline due to T-PLL.
Overall Survival (OS)From first dose of study drug to end of study; median time on study was 30.1 weeks.Overall survival is defined as the time from the date of the participant's first dose of any study drug to death from any cause. OS was calculated using Kaplan-Meier methods.
Number of Eligible Participants Reaching Autologous or Allogeneic TransplantationFrom first dose of study drug to end of study; median time on study was 30.1 weeks.Participants eligible for autologous or allogeneic transplantation were transplant-naïve participants who achieved CR.
Number of Participants With Treatment-emergent Adverse Events (TEAE)From first dose of study drug up to 30 days after last dose; median time on treatment was 13.86 weeks (range 1.0 to 44.4 weeks)An adverse event (AE) is any untoward medical occurrence in a clinical investigation participant administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. Treatment-emergent AEs are any event with onset after the first dose of study drug and no more than 30 days after the last dose of study drug. A serious AE was an event that resulted in death, was life-threatening, resulted in hospitalization or prolongation of hospitalization, persistent or significant disability/incapacity, or an important medical event requiring medical or surgical intervention to prevent a serious outcome. The Investigator rated the severity of each AE according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 5.0, where grade 1 = mild, grade 2 = moderate, grade 3 = severe, grade 4 = life-threatening and grade 5 = death. The Investigator assessed the relationship of the AE to the use of study drug.
Disease Control Rate (DCR)Clinical response was assessed at Weeks 4, 8, 12, 16, and 24 for DCR assessmentDCR is defined as the percentage of participants who achieved CR, CRi, PR, or stable disease (SD) as best overall response per investigator assessment based on the T-PLL consensus criteria 2019. Stable disease is defined as meeting all of the following criteria for at least 3 months: * lymph nodes change of -29% to +20% in SLD; * spleen change of -49% to +49% beyond normal from baseline; * circulating lymphocyte count \> 30 × 10\^9 /L or change of -49% to +49%; * platelet count change of -49% to +49%; * hemoglobin \< 11.0 g/dL or change \< 50% from baseline or change \< 2 g/dL; * neutrophils change of -49% to +49%.

Countries

Australia, Austria, Finland, France, Germany, Italy, Netherlands, United Kingdom, United States

Participant flow

Recruitment details

In total, 16 adults with relapsed or refractory T-cell prolymphocytic leukemia (R/R T-PLL) were screened, and 14 participants were enrolled across 10 sites in 7 countries (Australia, France, Germany, Italy, Netherlands, United Kingdom, and United States).

Pre-assignment details

This study was planned as an adaptive 2-stage design with Stage 1 to enroll 14 participants and Stage 2 to enroll up to an additional 23 participants based on the number of responders in Stage 1. Results from Stage 1 met the protocol-defined stopping rules, hence Stage 2 was not opened for enrollment. Stage 1 was completed as planned. For one participant study terminated by sponsor was entered as study discontinuation reason by mistake.

Participants by arm

ArmCount
Venetoclax + Ibrutinib
Participants received 400 mg venetoclax orally once a day after a 5-day ramp-up and 420 mg ibrutinib orally once a day for up to 2 years or until progressive disease, intolerability, or they became eligible for stem cell transplantation after achieving complete remission.
14
Total14

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyDeath9
Overall StudyLost to Follow-up1
Overall StudyOther2
Overall StudyStudy Terminated by Sponsor1
Overall StudyWithdrawal by Subject1

Baseline characteristics

CharacteristicVenetoclax + Ibrutinib
Age, Continuous66.8 years
STANDARD_DEVIATION 9.74
Age, Customized
40 - < 65 years
5 Participants
Age, Customized
< 40 years
0 Participants
Age, Customized
≥ 65 years
9 Participants
Disease Duration3.229 years
STANDARD_DEVIATION 3.2134
Eastern Cooperative Oncology Group (ECOG) Performance Status
0 (Fully active)
7 Participants
Eastern Cooperative Oncology Group (ECOG) Performance Status
1 (Restricted activity but ambulatory and able to work)
6 Participants
Eastern Cooperative Oncology Group (ECOG) Performance Status
2 (Ambulatory but unable to work)
1 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
14 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
0 Participants
Race (NIH/OMB)
Black or African American
0 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
Race (NIH/OMB)
White
14 Participants
Sex: Female, Male
Female
8 Participants
Sex: Female, Male
Male
6 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
10 / 14
other
Total, other adverse events
14 / 14
serious
Total, serious adverse events
8 / 14

Outcome results

Primary

Overall Response Rate (ORR)

ORR is defined as the percentage of participants achieving complete remission (CR), CR with incomplete bone marrow recovery (CRi), or partial remission (PR) as their best response per investigator assessment based on the T-PLL consensus criteria 2019. CR: All of the following response criteria must be met: Group A: * all lymph nodes \< 1 cm; * spleen \< 13 cm; * no constitutional symptoms; * circulating lymphocyte count \< 4 × 10\^9/L; * bone marrow T-PLL cells \< 5% of mononuclear cells; * no other specific site involvement Group B: * platelets ≥ 100 × 10\^9 /L; * hemoglobin ≥ 11.0 g/dL; * neutrophils ≥ 1.5 × 10\^9 /L. CRi: All of the CR response criteria in Group A met; at least 1 parameter in Group B not achieved, unrelated to T-PLL, but related to drug toxicity. PR: At least 2 of the parameters in Group A and 1 parameter in Group B need to improve if previously abnormal. If only 1 parameter of both Groups A and B is abnormal prior to therapy, only 1 parameter needs to improve.

Time frame: Clinical response was assessed at Weeks 4, 8, 12, 16, and 24 for ORR assessment

Population: The full analysis set includes all participants who received at least 1 dose of study drug (either venetoclax or ibrutinib).

ArmMeasureValue (NUMBER)
Venetoclax + IbrutinibOverall Response Rate (ORR)7.1 percentage of participants
Secondary

Disease Control Rate (DCR)

DCR is defined as the percentage of participants who achieved CR, CRi, PR, or stable disease (SD) as best overall response per investigator assessment based on the T-PLL consensus criteria 2019. Stable disease is defined as meeting all of the following criteria for at least 3 months: * lymph nodes change of -29% to +20% in SLD; * spleen change of -49% to +49% beyond normal from baseline; * circulating lymphocyte count \> 30 × 10\^9 /L or change of -49% to +49%; * platelet count change of -49% to +49%; * hemoglobin \< 11.0 g/dL or change \< 50% from baseline or change \< 2 g/dL; * neutrophils change of -49% to +49%.

Time frame: Clinical response was assessed at Weeks 4, 8, 12, 16, and 24 for DCR assessment

Population: Full analysis set

ArmMeasureValue (NUMBER)
Venetoclax + IbrutinibDisease Control Rate (DCR)28.6 percentage of participants
Secondary

Duration of Response (DOR)

Duration of response is defined for participants who achieved a best overall response of CR, CRi, or PR as the time from the date of first response (CR, CRi, or PR) to the earliest date of disease progression or death. DOR was calculated using Kaplan-Meier methods. Response was assessed by the investigator based on the T-PLL consensus criteria 2019. Progressive disease is defined as meeting at least one of the criteria of Group A or Group B below: Group A: * lymph nodes increase in \> 20% in SLD from nadir; * spleen increase ≥ 50% in vertical length beyond normal from baseline; * circulating lymphocyte count increase ≥ 50% from baseline; * appearance of a new lesion; Group B: * platelet count decrease of ≥ 50% from baseline due to T-PLL (not due to drug toxicity); * hemoglobin decrease of ≥ 2 g/dL from baseline due to T-PLL; * neutrophils decrease of ≥ 50% from baseline due to T-PLL.

Time frame: From first dose of study drug to end of study; median time on study was 30.1 weeks.

Population: Full analysis set participants with a best overall response of CR, CRi, or PR

ArmMeasureValue (MEDIAN)
Venetoclax + IbrutinibDuration of Response (DOR)4.6 months
Secondary

Event-free Survival (EFS)

Event-free survival is defined as time from participant's first dose of any study drug to the date of earliest disease progression, death, or start of a new anti-T-PLL therapy. EFS was calculated using Kaplan-Meier methods. Clinical response (laboratory and physical examination assessments) was assessed by the investigator according to the T-PLL consensus criteria 2019. Progressive disease is defined as meeting at least one of the criteria of Group A or Group B below: Group A: * lymph nodes increase in \> 20% in SLD from nadir; * spleen increase ≥ 50% in vertical length beyond normal from baseline; * circulating lymphocyte count increase ≥ 50% from baseline; * appearance of a new lesion; Group B: * platelet count decrease of ≥ 50% from baseline due to T-PLL (not due to drug toxicity); * hemoglobin decrease of ≥ 2 g/dL from baseline due to T-PLL; * neutrophils decrease of ≥ 50% from baseline due to T-PLL.

Time frame: From first dose of study drug to end of study; median time on study was 30.1 weeks.

Population: Full analysis set

ArmMeasureValue (MEDIAN)
Venetoclax + IbrutinibEvent-free Survival (EFS)2.6 months
Secondary

Number of Eligible Participants Reaching Autologous or Allogeneic Transplantation

Participants eligible for autologous or allogeneic transplantation were transplant-naïve participants who achieved CR.

Time frame: From first dose of study drug to end of study; median time on study was 30.1 weeks.

Population: Participants who were transplant-naive and achieved CR. No participants achieved a CR to be eligible for transplant.

Secondary

Number of Participants With Treatment-emergent Adverse Events (TEAE)

An adverse event (AE) is any untoward medical occurrence in a clinical investigation participant administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. Treatment-emergent AEs are any event with onset after the first dose of study drug and no more than 30 days after the last dose of study drug. A serious AE was an event that resulted in death, was life-threatening, resulted in hospitalization or prolongation of hospitalization, persistent or significant disability/incapacity, or an important medical event requiring medical or surgical intervention to prevent a serious outcome. The Investigator rated the severity of each AE according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 5.0, where grade 1 = mild, grade 2 = moderate, grade 3 = severe, grade 4 = life-threatening and grade 5 = death. The Investigator assessed the relationship of the AE to the use of study drug.

Time frame: From first dose of study drug up to 30 days after last dose; median time on treatment was 13.86 weeks (range 1.0 to 44.4 weeks)

Population: All participants who received at least 1 dose of study drug (either venetoclax or ibrutinib)

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)AE leading to ibrutinib discontinuation, incl PD11 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)AE with NCI-CTCAE toxicity Grade 3, 4, or 511 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)Serious adverse event8 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)AE leading to venetoclax discontinuation, incl PD11 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)AE leading to venetoclax interruption9 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)AE leading to venetoclax reduction2 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)AE with reasonable possibility related to venetoclax10 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)AE leading to ibrutinib interruption10 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)AE leading to ibrutinib reduction1 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)AE with reasonable possibility related to ibrutinib13 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)Serious AE with reasonable possibility related to venetoclax3 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)Serious AE with reasonable possibility related to ibrutinib4 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)AE leading to death5 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)All deaths10 Participants
Venetoclax + IbrutinibNumber of Participants With Treatment-emergent Adverse Events (TEAE)Any adverse event14 Participants
Secondary

Overall Survival (OS)

Overall survival is defined as the time from the date of the participant's first dose of any study drug to death from any cause. OS was calculated using Kaplan-Meier methods.

Time frame: From first dose of study drug to end of study; median time on study was 30.1 weeks.

Population: Full analysis set

ArmMeasureValue (MEDIAN)
Venetoclax + IbrutinibOverall Survival (OS)7.3 months
Secondary

Progression-Free Survival (PFS)

Progression-free survival is defined as the time from the date of first dose of any study drug to the date of earliest disease progression or death. PFS was calculated using Kaplan-Meier methods. Response was assessed by the investigator based on the T-PLL consensus criteria 2019. Progressive disease (PD) is defined as meeting at least one of the criteria of Group A or Group B below: Group A: * lymph nodes increase in \> 20% in sum of long-axis diameters of up to 3 target lesions (SLD) from nadir; * spleen increase ≥ 50% in vertical length beyond normal from baseline; * circulating lymphocyte count increase ≥ 50% from baseline; * appearance of a new lesion; Group B: * platelet count decrease of ≥ 50% from baseline due to T-PLL (not due to drug toxicity); * hemoglobin decrease of ≥ 2 g/dL from baseline due to T-PLL; * neutrophils decrease of ≥ 50% from baseline due to T-PLL.

Time frame: From first dose of study drug to end of study; median time on study was 30.1 weeks.

Population: Full analysis set

ArmMeasureValue (MEDIAN)
Venetoclax + IbrutinibProgression-Free Survival (PFS)2.7 months
Secondary

Time to Progression (TTP)

Time to progression is defined as the time from the date of the participant's first dose of any study drug to the date of earliest disease progression. TTP was calculated using Kaplan-Meier methods. Clinical response (laboratory and physical examination assessments) was assessed by the investigator according to the T-PLL consensus criteria 2019. Progressive disease is defined as meeting at least one of the criteria of Group A or Group B below: Group A: * lymph nodes increase in \> 20% in SLD from nadir; * spleen increase ≥ 50% in vertical length beyond normal from baseline; * circulating lymphocyte count increase ≥ 50% from baseline; * appearance of a new lesion; Group B: * platelet count decrease of ≥ 50% from baseline due to T-PLL (not due to drug toxicity); * hemoglobin decrease of ≥ 2 g/dL from baseline due to T-PLL; * neutrophils decrease of ≥ 50% from baseline due to T-PLL.

Time frame: From first dose of study drug to end of study; median time on study was 30.1 weeks.

Population: Full analysis set

ArmMeasureValue (MEDIAN)
Venetoclax + IbrutinibTime to Progression (TTP)2.7 months

Source: ClinicalTrials.gov · Data processed: Feb 15, 2026