Relapsed/Refractory Chronic Lymphocytic Leukemia, Richter's Syndrome, Small Lymphocytic Lymphoma, Treatment-naïve High Risk Chronic Lymphocytic Leukemia
Conditions
Keywords
DuoBody®, Bispecific antibodies, Anti-CD3, Anti-CD20
Brief summary
The study is a global, multi-center safety and efficacy trial of epcoritamab, an antibody also known as EPKINLY™ and GEN3013 (DuoBody®-CD3xCD20). Epcoritamab will be tested either in Relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL) as: * Monotherapy, or * Combination therapy: * epcoritamab + venetoclax * epcoritamab + pirtobrutinib In Non-United States (US) Participants Only: Treatment-naïve (TN) high risk (HR) (CLL): • epcoritamab + pirtobrutinib Combination therapy for Richter's Syndrome (RS): * epcoritamab + lenalidomide * epcoritamab + R-CHOP (i.e., rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine \[Oncovin®\] and prednisone). The study includes participants with R/R or TN HR CLL (non-US participants only)/small lymphocytic lymphoma (SLL) and participants with RS. The trial consists of two parts, a dose-escalation phase (phase Ib) and an expansion phase (phase II). Participants with RS are only included in the expansion phase. Epcoritamab will be injected subcutaneously (under the skin). Standard-of-care and combination treatments (venetoclax, pirtobrutinib, lenalidomide, and R-CHOP) will be given either orally (by mouth) or intravenously (in a vein). Study details include: * Study duration will be up to 5 years after the last participant's first treatment in the trial. * The treatment duration for each participant will be between 12 months (1 year) and 24 months (2 years), depending upon the treatment arm assigned. * The visit frequency will be either weekly, every other week, or monthly, depending upon the part of the study. All participants will receive active drug; no one will be given placebo.
Detailed description
The purpose of the dose-escalation phase of the trial is to determine the recommended phase 2 dose (RP2D) and the maximum tolerated dose (MTD; if reached) as well as establish the safety profile of epcoritamab monotherapy and epcoritamab + venetoclax in participants with R/R CLL. The purpose of the expansion phase is to assess and evaluate the preliminary efficacy, safety and tolerability profiles of epcoritamab monotherapy, epcoritamab + venetoclax and epcoritamab + pirtobrutinib at the RP2D for participants with R/R CLL, TN HR CLL (in non-US participants only) and SLL. Along with this, epcoritamab monotherapy, epcoritamab + lenalidomide and epcoritamab + R-CHOP will be evaluated in participants with RS to assess their efficacy, safety and tolerability profiles. The purpose of safety run-in phase for pirtobrutinib combination therapy is to evaluate the safety and tolerability profiles of pirtobrutinib in combination with epcoritamab.
Interventions
BIOLOGICALEpcoritamab
Epcoritamab will be administered subcutaneously in cycles of 28 days, (except Cycle 1 for high-dose cohorts = 35 days).
DRUGrituximab, cyclophosphamide, doxorubicin, vincristine and prednisone
R-CHOP will be administered intravenously (prednisone may be administered orally) in cycles of 21 days.
DRUGVenetoclax
Venetoclax tablets will be administered orally once daily during the 5-week ramp up period in cycles of 28 or 35 days each.
DRUGLenalidomide
Lenalidomide capsules will be administered once daily for 21 days in each cycle of 28 days.
DRUGPirtobrutinib
Pirtobrutinib tablets will be administered in cycles of 28 days.
Sponsors
Genmab
AbbVie
Eli Lilly and Company
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Key Inclusion Criteria 1. Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1 or 2. 2. Evidence of CD20 positivity in a sample representative of the disease at Screening. 3. Acceptable hematology parameters and organ function based on baseline bloodwork. 4. Life expectancy \>3 months on standard of care (SOC) for CLL, \>3 months for RS. 5. For R/R CLL arms - Must have active CLL/SLL disease requiring treatment per iwCLL 2018 criteria. 6. For R/R CLL monotherapy arms - Received at least 2 prior lines of systemic anti-neoplastic therapy including a Bruton's tyrosine kinase (BTK) inhibitor or at least 1 prior line of systemic antineoplastic therapy, including treatment with (or intolerance of) a covalent BTK inhibitor (cBTKi) and a B-cell lymphoma 2 (BCL-2) inhibitor. 7. For all RS arms - Have tumor biopsy-proven CD20+ Diffuse large B-cell Lymphoma (DLBCL) and a clinical history of CLL/SLL. 8. For all RS arms - Must have measurable disease by fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) or magnetic resonance imaging (MRI) scan. 9. For all RS arms - Must provide mandatory formalin-fixed, paraffin-embedded (FFPE) tumor biopsy sample. 10. For RS - monotherapy arm: Deemed as ineligible for chemoimmunotherapy at investigator's discretion or participant who refuses to receive intensive chemotherapy 11. For RS - lenalidomide combination therapy arm * Deemed as ineligible for chemoimmunotherapy at the investigator's discretion, or participant who refuses to receive intensive chemotherapy. * Eligible for treatment with lenalidomide. * Must be willing to use contraception and adhere to the Lenalidomide Pregnancy Risk Minimization Plan * A woman must agree not to breastfeed a child during treatment and for at least 28 days after discontinuation from study. 12. For RS - R-CHOP combination Therapy Arm - * Eligible for treatment with R-CHOP. * Females of childbearing potential must use highly effective contraceptive measures while taking R-CHOP and for 12 months after stopping treatment. * A woman must agree not to breastfeed a child during treatment or until 12 months after last treatment. 13. For R/R CLL - venetoclax combination Therapy arm - after receiving at least 1 prior line of systemic antineoplastic therapy. * Presence of measurable disease. * Must take prophylaxis for tumor lysis syndrome (TLS). 14. For R/R CLL pirtobrutinib combination Therapy arm: * Must have active CLL/SLL disease requiring treatment per iwCLL 2018 criteria. * Presence of measurable disease. * Previous treatment with at least one and a maximum 3 prior lines of therapy including a cBTKi. * Diagnosis of CLL/SLL that met published iwCLL criteria. 15. Non-US Participants Only - Participants with TN HR CLL - Pirtobrutinib Combination Therapy Expansion: * Diagnosis of CLL/SLL that met published iwCLL criteria 2018. * Must have active CLL/SLL disease that needs treatment per iwCLL * Must take prophylaxis for TLS based on their TLS risk evaluation upon initiation of trial drug. * Must have one or more high-risk features. * Presence of measurable disease. Key
Exclusion criteria
1. Received prior treatment with a CD3×CD20 bispecific antibody. 2. Received any prior allogeneic hematopoietic stem cell transplantation (HSCT) or solid organ transplantation. 3. Received chimeric antigen receptor (CAR) T-cell therapy within 100 days or an investigational drug within 4 weeks, prior to first dose of trial drug. 4. Autoimmune disease or other diseases that require permanent or high-dose immunosuppressive therapy. 5. Received vaccination with live vaccines within 28 days. 6. Clinically significant cardiac disease. 7. Known current malignancy other than inclusion diagnosis. 8. Has had major surgery within 4 weeks. 9. Known history of human immunodeficiency virus (HIV). 10. For R/R CLL arms - Any history of RS or evidence indicating a potential Richter's transformation. 11. For R/R CLL - Venetoclax Combination Therapy arm: received venetoclax within 24 months prior to beginning venetoclax ramp-up for this trial or has progressed on venetoclax treatment. 12. For all RS arms - Diagnosis of Richter's syndrome not of the DLBCL subtype such as Hodgkin's lymphoma, prolymphocytic leukemia. 13. RS - Lenalidomide Combination Therapy and RS Monotherapy Arms - received more than 2 prior lines of therapy for RS. 14. R/R CLL - Pirtobrutinib Combination Therapy Arm - Prior exposure to a non-covalent (reversible) BTK inhibitor or a BTK degrader. 15. Pirtobrutinib Combination Therapy Expansion Arms: * History of bleeding disorders or participants requiring therapeutic anticoagulation with warfarin or another vitamin K antagonist * Require continuous treatment with or have received strong cytochrome P450 (CYP) 3A inhibitors or strong/moderate CYP3A inducers within 4 to 5 half-lives or 14 days prior to the first dose of pirtobrutinib. NOTE: Other protocol defined Inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dose Escalation Phase: Number of Participants with Cytokine Release Syndrome (CRS), Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) and Clinical Tumor Lysis Syndrome (CTLS) | Up to 5 years | CRS and ICANS will be graded based on American Society for Transplantation and Cellular Therapy (ASTCT) criteria. CTLS will be graded according to Cairo-Bishop criteria. |
| Expansion Phase: Overall Response Rate (ORR) | Up to 5 years | R/R CLL participants will be assessed according to International Workshop on Chronic Lymphocytic Leukemia (iwCLL) criteria and the RS participants according to Lugano criteria. ORR based on the Lugano criteria is defined as the percentage of participants who achieve a response of PR or complete remission (CR), prior to initiation of subsequent therapy. The ORR based on the iwCLL criteria is defined as the percentage of participants who achieve a response of PR, CR with incomplete bone marrow recovery (CRi), or CR, prior to the initiation of subsequent therapy. |
| Dose Escalation Phase and Safety Run-in (R/R CLL arm): Number of Participants with Dose Limiting Toxicities (DLTs) | During the first cycle for low dose cohorts (Cycle length = 28 days) and for high dose cohorts (Cycle length = 35 days) | DLT events were defined as clinically significant adverse events (AEs) or abnormal laboratory values assessed as unrelated to disease progression, underlying disease, intercurrent illness, or concomitant medications as assessed per Common Terminology Criteria for Adverse Events (NCI-CTCAE) criteria version 5.0. |
| Dose Escalation Phase and Safety Run-in: Number of Participants with Treatment Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) | Up to 5 years | — |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Both Phases: Lymphoid Cells for Immunophenotyping | Up to 5 years | Evaluation of B cells, T cells and their activation |
| Expansion Phase: Number of Participants with CRS, ICANS and CTLS | Up to 5 years | CRS and ICANS will be graded based on ASTCT criteria. CTLS will be graded according to Cairo-Bishop criteria. |
| Expansion Phase and Safety Run-in : Percentage of Participants with Minimal Residual Disease (MRD) Negativity | Up to 5 years | MRD negativity rate, is defined as the proportion of participants with at least 1 undetectable MRD result according to the specific threshold, prior to initiation of subsequent therapy. |
| Both Phases and Safety Run-in: Number of Participants with Anti-drug Antibodies (ADA) to Epcoritamab | Up to 5 years | — |
| Expansion Phase: Number of Participants with PR | Up to 5 years | — |
| Both Phases and Safety Run-in: Duration of MRD Negativity | Up to 5 years | The time from first achieving MRD negativity after start of treatment to the MRD conversion to positive. |
| Expansion Phase: Number of Participants with TEAEs and SAEs | Up to 5 years | — |
| Dose Escalation Phase and Safety Run-in: ORR (for R/R CLL Participants) | Up to 5 years | The ORR is defined as the percentage of participants who achieve a response of PR, CRi, or CR, prior to the initiation of subsequent therapy as assessed by iwCLL criteria. |
| Both Phases and Safety Run-in: Duration of Response (DOR) | Up to 5 years | DOR is defined among responders, as the time from the initial documentation of response to the date of disease progression or death, whichever occurs earlier. |
| Both Phases and Safety Run-in: Number of Participants with CR/CRi | Up to 5 years | CR and CRi for R/R CLL participants will be assessed according to iwCLL criteria and CR for the RS participants, according to Lugano criteria. |
| Both Phases and Safety Run-in: Time to Response (TTR) | Up to 5 years | TTR is defined among responders, as the time between first dose of any study drug and the initial documentation of response. |
| Both Phases and Safety Run-in: Progression Free Survival (PFS) | Up to 5 years | PFS is defined as the time from the first dosing date of any study drug and the date of disease progression or death, whichever occurs earlier. |
| Both Phases and Safety Run-in: Overall Survival (OS) | Up to 5 years | OS is defined as the time from the first dosing date of any study drug and the date of death due to any cause. |
| Both Phase and Safety Run-in: Time to Next Systemic Anti-cancer Therapy (TTNT) | Up to 5 years | TTNT is defined as the time from the first dosing date of any study drug to the first documented administration of subsequent systemic anticancer therapy. |
| Both Phases and Safety Run-in: Area Under the Concentration-time Curve (AUC) in Epcoritamab | Predose and post dose at multiple timepoints at end of each cycle for low dose and high dose cohorts (Cycle length = 28 days, except Cycle 1 for high dose cohorts = 35 Days), up to 5 years | — |
| Both Phases: Pre-dose (Trough) Concentrations (Cthrough) in Epcoritamab | Predose and post dose at multiple timepoints at end of each cycle for low dose and high dose cohorts (Cycle length = 28 days, except Cycle 1 for high dose cohorts = 35 Days), up to 5 years | — |
| Both Phases and Safety Run-in: Maximum (Peak) Plasma Concentration (Cmax) in Epcoritamab | Predose and post dose at multiple timepoints at end of each cycle for low dose and high dose cohorts (Cycle length = 28 days, except Cycle 1 for high dose cohorts = 35 Days), up to 5 years | — |
| Both Phases and Safety Run-in: Time to Reach Cmax (Tmax) in Epcoritamab | Predose and post dose at multiple timepoints at end of each cycle for low dose and high dose cohorts (Cycle length = 28 days, except Cycle 1 for high dose cohorts = 35 Days), up to 5 years | — |
| Both Phases and Safety Run-in: Elimination Half-life (T1/2) in Epcoritamab | Predose and post dose at multiple timepoints at end of each cycle for low dose and high dose cohorts (Cycle length = 28 days, except Cycle 1 for high dose cohorts = 35 Days), up to 5 years | — |
| Both Phases and Safety Run-in: Total Body Clearance of Drug From Plasma (CL) in Epcoritamab | Predose and post dose at multiple timepoints at end of each cycle for low dose and high dose cohorts (Cycle length = 28 days, except Cycle 1 for high dose cohorts = 35 Days), up to 5 years | — |
Countries
Australia, Belgium, Czechia, Denmark, France, Germany, Israel, Italy, Netherlands, Poland, Spain, United States
Outcome results
None listed