This phase II trial studies the side effects of ibrutinib citrate when given with ixazomib, and determines how well they work in treating patients with Waldenstrom macroglobulinemia that is newly diagnosed, has come back (recurrent) or does not respond to treatment (refractory). Enzyme inhibitors, such as ibrutinib and ixazomib citrate, may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
PRIMARY OBJECTIVE: I. To determine the efficacy (as assessed by complete response \[CR\] rate) of the combination of ixazomib citrate (ixazomib) and ibrutinib in Waldenstrom macroglobulinemia (WM) patients. SECONDARY OBJECTIVES: I. To assess the overall response rate (ORR=partial response \[PR\] or better) in WM patients treated with ixazomib and ibrutinib. II. To assess the time to progression (TTP) in WM patients treated with ixazomib and ibrutinib. III. To further characterize the safety and toxicity of the combination of ibrutinib and ixazomib. IV. To assess the overall survival (OS) in WM patients treated with ixazomib and ibrutinib. CORRELATIVE RESEARCH OBJECTIVES: I. To determine the role of members of the BTK signalosome in achievement or lack thereof of response to ibrutinib and ixazomib. II. To explore biologic effects of ibrutinib and ixazomib on microenvironment in WM and correlate with response to treatment. OUTLINE: Patients receive ixazomib citrate orally (PO) on days 1, 8, and 15 and ibrutinib PO daily on days 1-28. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for up to 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
21
Given PO
Given PO
Correlative studies
Correlative studies
Correlative studies
Mayo Clinic in Florida
Jacksonville, Florida, United States
Mayo Clinic in Rochester
Rochester, Minnesota, United States
Complete Response Rate (CR)
Complete response rate to be defined as an objective status of CR at any time, where confirmation of the complete response status is required on two consecutive evaluations with a second immunofixation before calling the patient a CR. The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Categorized by Response Assessment Criteria as specified in Appendix III of the protocol.
Time frame: 4 years
Overall Response Rate
Overall response rate will be estimated by the total number of patients who achieve a CR, very good partial response (VGPR), or partial response (PR) divided by the total number of evaluable patients. All evaluable patients will be used for this analysis. Exact binomial 95% confidence intervals for the true overall response rate will be calculated. Response is categorized by Response Assessment Criteria as specified in Appendix III of the protocol.
Time frame: Up to 5 years
Progression-free Survival
The median time to progression will be estimated using the method of Kaplan-Meier. Categorized by Response Assessment Criteria as specified in Appendix III of the protocol.
Time frame: From study registration to the earliest date of documentation of disease progression, assessed up to 5 years
Overall Survival
Defined as the time from study enrollment until death due to any cause. The median overall survival will be estimated using the method of Kaplan-Meier.
Time frame: Up to 5 years
Number of Patients Experiencing Grade 3+ Adverse Effects (AE) Graded According to Common Terminology Criteria for Adverse Events (CTCAE) Version (v.) 4.0
The maximum grade for each type of AE will be recorded for each patient, and frequency tables will be reviewed to determine patterns. Additionally, the relationship of the AE(s) to the study treatment will be taken into consideration.
Time frame: Up to 5 years
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