This study is to evaluate the safety and clinical activity of idelalisib alone and in combination with rituximab in patients with CLL or SLL. This Phase 2 study will be the first time that idelalisib is administered to previously untreated patients with hematologic malignancies. Idelalisib has demonstrated clinical activity as a single agent in relapsed or refractory CLL and SLL with acceptable toxicity, which supports its evaluation in previously untreated patients. The study population is limited to patients over 65 years of age because younger patients are generally appropriate for standard immunochemotherapy regimens that are highly active. Since the mechanism of action of idelalisib is distinct from rituximab, it is hypothesized that the combination will be more active than either agent alone. This study will establish initial safety and clinical activity of idelalisib in combination with rituximab in patients with CLL or SLL. Cohort 2 of this study will establish safety and clinical activity of idelalisib alone in subjects with untreated CLL or SLL.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
105
Idelalisib 150 mg tablets administered orally twice daily
Rituximab 375 mg/m\^2 administered intravenously once weekly x 8 weeks
University of California, San Diego, Moores Cancer Center
La Jolla, California, United States
Stanford University School of Medicine
Stanford, California, United States
Columbia University - Herbert Irving Pavilion
New York, New York, United States
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Sarah Cannon Research Institute
Nashville, Tennessee, United States
The Universtity of Texas MD Anderson Cancer Center
Houston, Texas, United States
Overall Response Rate (ORR)
ORR was assessed based on standardized International Workshop on Chronic Lymphocytic Leukemia (IWCLL) criteria as specifically modified for this study to reflect current recommendations which consider the mechanism of action of idelalisib and similar drugs, and was defined as the proportion of participants achieving a complete response (CR) or partial response (PR) as assessed by the investigator. Based on the CLL response definition in the protocol (modified Hallek 2008), the parameters of lymphadenopathy, liver and/or spleen size, constitutional symptoms, polymorphonuclear leukocytes, circulating clonal B-lymphocytes, platelet count, hemoglobin, and marrow were assessed. * CR: meeting all defined criteria * PR: meeting at least 2 of the criteria of circulating lymphocytes, lymphadenopathy, liver, spleen, or bone marrow (or only lymphadenopathy if liver and spleen normal at baseline) and at least 1 of the criteria for polymorphonuclear leukocytes, platelet count, or hemoglobin.
Time frame: Up to 28 Months
Overall Safety of Idelalisib
The overall safety of idelalisib was assessed as the percentage of participants experiencing treatment-emergent adverse events (AEs; Serious AEs, Grade ≥ 3 AEs, AEs related to idelalisib, and AEs leading to discontinuation of idelalisib).
Time frame: Up to 28 Months
Lymphadenopathy Response Rate
Lymphadenopathy response rate was defined as the percentage of participants with a ≥ 50% reduction from baseline in the sum of the perpendicular diameters of all measurable lesions while receiving study therapy.
Time frame: Baseline and up to 28 Months
Percent Change From Baseline in the Sum of the Product of the Greatest Perpendicular Diameters (SPD) of All Measurable Lesions
Time frame: Baseline; Weeks 8, 16, 24, 36, 48, 60, 72, 84, 96, 108, and 120
Duration of Response
Duration of response (DOR) was defined as the interval from the first documentation of CR or PR to the earlier of the first documentation of disease progression or death from any cause.
Time frame: Up to 28 Months
Progression-Free Survival
Progression-free survival (PFS) was defined as the interval from the first dose date of drug to the earlier of the first documentation of definitive disease progression or death from any cause. Progression was defined using the Standardized IWCLL criteria as specifically modified for this study to consider the mechanism of action of idelalisib and similar drugs. The occurrence of any of the following events indicated progression: 1. Evidence of any new disease 2. Evidence of worsening of index lesions, spleen or liver, or non-index disease 3. Decrease in platelet count or hemoglobin that is attributable to CLL and is confirmed by bone marrow biopsy
Time frame: Up to 28 Months
Idelalisib Plasma Concentrations (Cohort 1)
Time frame: Predose and 1.5 hours postdose at Weeks 0, 4, and 24
Idelalisib Plasma Concentrations (Cohort 2)
Time frame: Predose and 1.5 hours postdose at Weeks 0 and 4 and predose at Weeks 8 and 20
Changes in Potential Pharmacodynamic Markers of Drug Activity in Plasma and Whole Blood
Changes in potential pharmacodynamic markers of drug activity will include assessments of chemokine and cytokine concentrations, effects on the activity of PI3K and related pathways, and effect on cell migration and other functional outcomes. This endpoint will be assessed at the following time points: * Idelalisib+Rituximab (Cohort 1): Predose and 1.5 hour postdose on Day 1 and predose on Days 15, 29, 57, 113, and 169 * Idelalisib (Cohort 2): Predose on Days 1, 29, 57, 141
Time frame: Up to 169 days
Overall Survival
Overall survival (OS) is defined as the interval from the start of study treatment to death from any cause.
Time frame: Up to 28 Months
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