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Clinical Trial 20743

Cancer Type: Malignant Hematology
Study Type: Treatment
NCT#: NCT03863184

Phase: Phase II
Principal Investigator: Shah, Bijal

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or 1-800-679-0775 Learn More

Overview

Study Title

A Multiple-center Phase 2 Study of Acalabrutinib-Lenalidomide-Rituximab in Patients with Previous Untreated Mantle Cell Lymphoma

Summary

This is a single-arm phase 2 study to evaluate the preliminary evidence of efficacy and safety of the combination of acalabrutinib, lenalidomide and rituximab (ALR) in previously untreated mantle cell lymphoma. The study includes an induction phase consisting of 12 cycles of ALR. Responding subjects will be eligible to enter a maintenance phase. Subjects will continue maintenance ALR until disease progression, development of unacceptable toxicity, or voluntary withdrawal. Subjects will be followed after completing study intervention every 6 months for alternate anti-cancer therapy and survival.

Objective

To determine the peripheral blood minimum residual disease (MRD)-negative complete response (CR) rate of the combination of ALR at the conclusion of 12 cycles of induction therapy. Secondary Objectives: Safety and tolerability of the combination Best overall response rate Complete response rate Progression free survival (time frame up to 2 years) Overall survival (time frame up to 2 years)

Treatments

Therapies

Chemotherapy (NOS); Therapy (NOS)

Medications

ACP-196 (Acalabrutinib); Acalabrutinib (); CC-5013 (Lenalidomide); Lenalidomide (Revlimid); Obinutuzumab (); Rituxan (rituximab); rituximab ()

Inclusion Criteria

Histologically confirmed diagnosis of mantle cell lymphoma

Age >18 years

No prior systemic therapy for lymphoma

Measurable disease defined by a tumor mass ≥ 1.5 cm in one dimension and measurable in two dimensions; measurable spleen disease is allowed

Treatment should be indicated according to the treating physician

ECOG performance status > Required initial laboratory parameters per protocol

Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (patients intolerant to ASA may use low molecular weight heparin).

All subjects must be registered into the mandatory Revlimid REMS® program, and be willing and able to comply with the requirements of Revlimid REMS®.

Patients of reproductive potential agree to use birth control throughout their participation in this study, and for 28 days following study termination.

Females of reproductive potential must adhere to the scheduled pregnancy testing as required in the Revlimid REMS® program. Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days and again within 24 hours prior to prescribing lenalidomide for Cycle 1 (prescriptions must be filled within 7 days). FCBP must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before and continue for at least 28 days after the last dose of lenalidomide (or 2 days after the last dose of acalabrutinib, whichever is longer). FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual activity with a FCBP through one week post last dose even if they have had a successful vasectomy. Men must also agree to refrain from sperm donation during the same timeframe. See Appendix: Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods.

Understand and voluntarily sign an ICF prior to any study related assessments and procedures are conducted.

Able to adhere to the study visit schedule and other protocol requirements.

Exclusion Criteria

Patients with blastoid histology

Patients with known or suspected CNS involvement

Viral infection with HIV or hepatitis type B or C. Seropositive HBV patients are eligible if they are negative for HBV DNA by PCR and receive concomitant antiviral therapy during treatment and for additional six months after coming off study.

Prior history of malignancies other than MCL unless the patient has been disease free for ≥ 5 years from the signing of the ICF. Exceptions include basal cell carcinoma or squamous cell carcinoma of the skin; carcinoma in situ of cervix; carcinoma in situ of breast, or localized prostate cancer

Active uncontrolled systemic fungal, bacterial or viral infection (defined as ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics, antiviral therapy and/or other treatment)

Clinically significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of screening, or any Class 3 or 4 cardiac disease as defined by the New York Heart Association Functional Classification.

Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel that is likely to affect absorption, symptomatic inflammatory bowel disease, partial or complete bowel obstruction, or gastric restrictions and bariatric surgery, such as gastric bypass.

Active bleeding or history of bleeding diathesis (e.g., hemophilia or von Willebrand disease).

Uncontrolled AIHA (autoimmune hemolytic anemia) or ITP (idiopathic thrombocytopenic purpura).

Requires treatment with a strong cytochrome P450 3A4 (CYP3A4) inhibitor/inducer. Patients on moderate CYP3A inhibitors can be considered for study after a washout period of at least 7 days.

Requires or receiving anticoagulation with warfarin or equivalent vitamin K antagonists (e.g., phenprocoumon) within 7 days of first dose of study drug. Prothrombin time (PT)/INR or aPTT (in the absence of lupus anticoagulant) >2x ULN.

Requires treatment with proton pump inhibitors (e.g., omeprazole, esomeprazole, lansoprazole, dexlansoprazole, rabeprazole, or pantoprazole). Subjects receiving proton pump inhibitors who switch to H2-receptor antagonists or antacids are eligible for enrollment to this study.

History of significant cerebrovascular disease/event, including stroke or intracranial hemorrhage, within 6 months before the first dose of study drug.

Major surgical procedure within 28 days of first dose of study drug. Note: If a subject had major surgery, they must have recovered adequately from any toxicity and/or complications from the intervention before the first dose of study drug.

Patients with a history of toxic epidermal necrolysis or Stevens-Johnson syndrome

Patients that are pregnant or breast feeding

Known hypersensitivity to any study drug or excipients

Patient on corticosteroids within two weeks prior to study entry, except for prednisone ≤ 20 mg/day or equivalent for purposes other than treating MCL

Use of any other experimental drug or therapy within 28 days of baseline

Patient at high risk for deep vein thrombosis not willing to take DVT prophylaxis

Any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study

Known prior exposure to BTK inhibitor

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