This phase Ib/II trial studies the best dose and safety of Bcl-2 inhibitor GDC-0199 in combination with obinutuzumab and ibrutinib and to see how well they work in treating patients with chronic lymphocytic leukemia that has returned (relapsed), does not respond to treatment (refractory), or is previously untreated. Bcl-2 inhibitor GDC-0199 and ibrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as obinutuzumab, may block cancer growth in different ways by targeting certain cells. Giving Bcl-2 inhibitor GDC-0199 together with obinutuzumab and ibrutinib may be a better treatment for chronic lymphocytic leukemia.
PRIMARY OBJECTIVES: I. To identify the dose of venetoclax (Bcl-2 inhibitor GDC-0199) that can be safely administered in combination with obinutuzumab and ibrutinib for the treatment of relapsed/refractory or previously untreated chronic lymphocytic leukemia (CLL). II. To evaluate the feasibility, safety, and tolerability of venetoclax in combination with obinutuzumab and ibrutinib in patients with relapsed/refractory or previously untreated CLL. III. To determine the minimal residual disease (MRD)-negative complete response (CR) rate after 12 cycles of treatment with venetoclax in combination with obinutuzumab and ibrutinib in patients with relapsed/refractory or previously untreated CLL. SECONDARY OBJECTIVES: I. To determine the overall response rate (ORR) and complete response rate (CR) of venetoclax in combination with obinutuzumab and ibrutinib in patients with relapsed/refractory or previously untreated patients with CLL. II. To estimate progression free survival (PFS) after treatment with venetoclax in combination with obinutuzumab and ibrutinib in patients with relapsed/refractory or previously untreated patients with CLL. III. To conduct pharmacokinetic and pharmacodynamic studies of venetoclax in combination with obinutuzumab and ibrutinib in patients with relapsed/refractory or previously untreated patients with CLL. IV. To examine pre-treatment and serial biomarkers associated with response and mechanisms of resistance to venetoclax, obinutuzumab and ibrutinib when given in combination for relapsed/refractory or previously untreated patients with CLL. OUTLINE: This is a phase Ib, dose-escalation study of Bcl-2 inhibitor GDC-0199 followed by a phase II study. Patients receive obinutuzumab intravenously (IV) on day 1 (days 1, 2, 8, and 15 for course 1 only) every 28 days for up to 8 courses. Beginning in course 2, patients receive ibrutinib orally (PO) once daily (QD) on days 1-28. Beginning in course 3, patients receive Bcl-2 inhibitor GDC-0199 PO QD on days 1-28. Treatment repeats every 28 days for up to 14 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 4 and 8 weeks, every 3 months for 2 years, and then every 6 months thereafter.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
87
Given PO
Given IV
Given PO
Correlative studies
Correlative studies
Ancillary studies
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, United States
Maximum Tolerated Dose of Bcl-2 Inhibitor GDC-0199 in Combination With Obinutuzumab and Ibrutinib (Phase Ib)
Time frame: 28 days (course 3)
Minimal Residual Disease (MRD)-Complete Response (CR) Defined by the International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 2008 Criteria (Phase II)
Assessments of MRD will be used in patients classified as CR to further evaluate their status as disease-free and if this further impacts their ability to remain progression-free and alive. MRD will be determined by high sensitivity 4 color flow cytometric analysis of the bone marrow using validated panels.
Time frame: Up to 8 weeks post-treatment
Number of Adverse Events Graded According to the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0
For all patients who receive at least one day of treatment, toxicities will be tabulated by type and grade and displayed in summary form. Serious adverse events are listed with "(SAE)" after the event name.
Time frame: Up to 4 years
Number of Courses Started/Completed
May be summarized.
Time frame: Up to 14 months
Number of Patients Who Reach the Target Dose of Bcl-2 Inhibitor GDC-0199
May be summarized.
Time frame: Up to 14 months
Number of Patients Requiring Dose Reductions
May be summarized.
Time frame: Up to 14 months
Reason for Going Off Treatment
May be summarized.
Time frame: Up to 14 months
Overall Response Rate
Overall response rate will be reported for all evaluable patients in the phase II setting, within and potentially across cohorts, assuming a binomial distribution.
Time frame: Up to 4 years
Progression-free Survival (PFS)
Will be summarized by the Kaplan-Meier method for each of the phase II cohorts.
Time frame: Time from first treatment date until the date of progression or death, whichever occurs first, assessed up to 8 years
Emotional Distress Assessment
Validated instruments will be administered serially to assess longitudinal changes in measures of health related quality of life using 36-Item Short Form Survey (SF-36) Mental Component Scale (MCS) T-scores for each time point with pairwise comparison p-values. Scores on the SF-36 scale range from 0 to 100, with higher scores indicating better mental health. Scores for the MCS are standardized using U.S. general population norms with summary scores set relative to a t-score mean of 50 and a standard deviation of 10.
Time frame: Cycle 1 day 1, cycle 2 day 1, cycle 3 day 1, cycle 6 day 1 and cycle 12 day 1
Health Related Quality of Life
Validated instruments will be administered serially to assess longitudinal changes in measures of health related quality of life using 36-Item Short Form Survey (SF-36) Physical Component Scale (PCS) T-scores for each time point with pairwise comparison p-values. Scores on the SF-36 scale range from 0 to 100, with higher scores indicating better physical health. Scores for the PCS are standardized using U.S. general population norms with summary scores set relative to a t-score mean of 50 and a standard deviation of 10.
Time frame: Cycle 1 Day 1, Cycle 2 Day 1, Cycle 3 Day 1, Cycle 6 Day 1, and Cycle 12 Day 1 (each cycle is 28 days)
Serial Assessment of Immune Effector Cell Number and Function.
Peripheral blood immunophenotyping will be used to enumerate immune effector cells (counts and percentages of T-, and Natural Killer (NK)-cell subsets).
Time frame: 4 weeks post-treatment
Baseline Prognostic Factors: Number of Prior Therapies
Relationships between baseline prognostic factors and response may be screened and analyzed quantitatively using logistic regression and adjusting for disease cohort, particularly if a sufficient number of patients respond to this combination therapy.
Time frame: Baseline
Baseline Prognostic Factors: Tumor Lysis Syndrome (TLS) Risk
Relationships between baseline prognostic factors and response may be screened and analyzed quantitatively using logistic regression and adjusting for disease cohort, particularly if a sufficient number of patients respond to this combination therapy.
Time frame: Baseline
Baseline Prognostic Factors: Hemoglobin
Time frame: Baseline
Baseline Prognostic Factors: Investigations
Absolute neutrophil count (ANC), Absolute lymphocyte count (ALC) and Platelets.
Time frame: Baseline
Baseline Prognostic Factor: Beta-2-microglobulin (B2M)
Beta-2-microglobulin (B2M)
Time frame: At baseline
Baseline Prognostic Factors: Lactate Dehydrogenase (LDH)
lactate dehydrogenase (LDH)
Time frame: At baseline
Baseline Prognostic Factors: Genetic Factors
Time frame: At baseline
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