This is an open label, multicenter, dose escalation, phase Ib study to determine the recommended dose by assessing the maximum tolerated dose (MTD), safety and efficacy of ibrutinib in combination with R-DHAP (Group A/Abis) or R-DHAOx (Group B/Bbis) for patients with B-cell malignancies. This dose escalation will be followed by an exploratory expansion phase in 3 groups of 12 patients each (Group A/Abis, Group B/B bis and Group C). During Part 1 Dose Escalation, the "3+3" design will be applied. Three doses of ibrutinib (280, 420 and 560 mg) will be examined sequentially in each cohort by the Dose Escalation Committee. Dose escalation will begin at dose level 1 = 420 mg. The dose escalation will be performed for two types of associations in five separate groups : * Group A : ibrutinib D1-D21+ R-DHAP * Group B : ibrutinib D1-D21 R-DHAOx * Group Abis : ibrutinib D5-D18+ R-DHAP * Group Bbis : ibrutinib D5-D18 R-DHAOx This dose escalation will be followed by an exploratory expansion phase in the group Bbis plus a new group including only mantle cell lymphoma (MCL) in first line patients: group C. Patients included in the Group C will receive ibrutinib in combination with R-DHAP or R-DHAOx according to the choice of the local investigator at time of inclusion of each patient.
The primary objective of this study is to determine the recommended dose of ibrutinib when administered in combination with R-DHAP (rituximab + dexamethasone + cytarabine + cisplatin) or with R-DHAOx (rituximab + dexamethasone + cytarabine + oxaliplatin) in patients with relapsed or refractory B-cell malignancies eligible for autologous stem cell transplantation (ASCT) by assessing the maximum tolerated dose (MTD) observed during the dose escalation part of the study. Assessment of the MTD will be performed by the analysis of the dose-limiting toxicities (DLTs).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
85
Combination of immunochemotherapies (R-DHAP or R-DHAOx) and ibrutinib
Universite Catholique de Louvain Saint Luc
Brussels, Belgium
CHU de Liège
Liège, Belgium
CHU UCL Namur asbl
Yvoir, Belgium
Centre François Baclesse
Caen, France
Hôpital Henri Mondor
Créteil, France
CHU de Dijon - Hôpital le Bocage
Dijon, France
CHRU de Lille - Hôpital Claude Huriez
Lille, France
Centre Léon Bérard
Lyon, France
CHU Montpellier
Montpellier, France
CHU de Nantes
Nantes, France
...and 5 more locations
The primary endpoint is the incidence rate of DLTs at each dose level on cycle 1
Determine the recommended phase II dose (RP2D) of ibrutinib when administered in combination with R-DHAP (rituximab + dexamethasone + cytarabine + cisplatin) or with R-DHAOx (rituximab + dexamethasone + cytarabine + oxaliplatin) in patients with relapsed or refractory B-cell malignancies eligible for autologous stem cell transplantation (ASCT) by assessing the maximum tolerated dose (MTD) observed during the dose escalation part of the study. Assessment of the MTD will be performed by the analysis of the dose-limiting toxicities (DLTs).
Time frame: 21 days
Secondary safety endpoints
Study drug administration including treatment duration, average dose, dose reduction; Treatment discontinuation, study discontinuation; Adverse events, vital sign measurements, clinical laboratory measurements, and concomitant therapies.
Time frame: 84 days
Response Rate
Disease response evaluation at 3 cycles (or 4 cycles for patients with mantle cell lymphoma in first line in the expansion phase) will be used to determine the Response Rate. Response after 3 cycles (or 4 cycles) will be assessed at the end of completion of the cycles if patient received all cycles or at withdrawal
Time frame: 30 days after the last dose of study drug is administered
Duration of response (DoR)
Duration of response is defined as the time from first evidence of response (PR or better) to first documented disease progression, relapse or death from any cause. Patients alive and free of progression at data cut-off will be censored at the last adequate tumor assessment indicating no disease progression
Time frame: from first evidence of response to the date of first documented disease progression, relapse or death from any cause, assessed up to 52 months
Progression-Free Survival (PFS)
PFS is defined as the time from inclusion into the study to the first observation of documented disease progression or death due to any cause. If a patient has not progressed or died, PFS will be censored at the time of last visit with adequate assessment. Patients without documented event at the time of analysis will be censored at their last follow-up date.
Time frame: from the date of inclusion to the date of first observation of documented disease progression or death due to any cause, assessed up to 52 months
Time to Next Anti-Lymphoma Treatment (TTNLT)
TTNLT is defined as the time from the date of inclusion to the date of first documented administration of any new anti-lymphoma treatment (chemotherapy, radiotherapy, radio-immunotherapy, immunotherapy). Patients continuing in response or who are lost to follow-up will be censored on their last visit date. Patients who died (due to any cause) before having received a new anti-lymphoma treatment will be included in the statistical analysis with death being counted as an event.
Time frame: from the date of inclusion to the date of first documented administration of any new anti-lymphoma treatment, assessed up to 52 months
Overall Survival (OS)
Overall survival is defined as the time from the date of inclusion to the date of death from any cause. Patients who did not die will be censored at their last follow-up date.
Time frame: from the date of inclusion to the date of death from any cause, assessed up to 52 months
Pharmacokinetics profile of ibrutinib in Groups A bis and B bis
The objective is to assess the pharmacokinetic profile of ibrutinib in the presence of R-DHA(P/Ox) for groups A bis and B bis during the dose escalation part.
Time frame: During dose escalation part, on first day of ibrutinib administration (Day 5) and on Day 15 of cycle 1 and cycle 2
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