This study evaluates the safety and efficacy of Ibrutinib combined with Venetoclax (IVEN) in the treatment of adults diagnosed with Waldenstrom's macroglobulinemia (WM) cancer with a specific MYD88 gene mutation. This research study involves an experimental drug combination of targeted therapies. The names of the study drugs involved in this study are: * Venetoclax * ibrutinib
* This research study is a Phase II clinical trial. Phase II clinical trials test the safety and effectiveness of an investigational drug to learn whether the drug works in treating a specific disease. "Investigational" means that the drug is being studied. * The names of the study drugs involved in this study are: * Venetoclax * ibrutinib * The research study procedures include screening for eligibility and study treatment including evaluations and follow up visits. * Participants will be on the research study for up to 2 years on combined venetoclax and ibrutinib and 4 years of follow-up . * It is expected that about 50 people will take part in this research study. * The U.S. Food and Drug Administration (FDA) has not approved venetoclax for your specific disease but it has been approved for other uses. \-- Venetoclax is a targeted therapy that blocks BCL-2, a protein that is important for the survival of WM cells. Laboratory studies and early clinical data have shown that the investigational new agent, venetoclax, may kill cancer cells and may cause tumors to shrink. * The U.S. Food and Drug Administration (FDA) has approved ibrutinib as a treatment option for this disease. --Ibrutinib is a targeted therapy that blocks BTK. It has been FDA approved in chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), mantle cell lymphoma (MCL), marginal zone lymphoma (MZL), chronic graft vs. host disease (cGVHD), and Waldenstrom's macroglobulinemia (WM). It is also used in research studies in participants with recurrent B-cell lymphoma), diffuse large B-cell lymphoma (DLBCL), and prolymphocytic leukemia. In a study of ibrutinib in relapsed/refractory WM patients, response rates were high and the treatment was well tolerated. * The U.S. Food and Drug Administration (FDA) has not approved the combination of ibrutinib and venetoclax as a treatment for any disease. * The U.S. Food and Drug Administration (FDA) has not approved the MYD88 test. This test is investigational.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
45
Ibrutinib Cycle 1-24 will be administered at a predetermined dose, once daily for 28 days
Venetoclax Cycle 2-24 will be administered daily for 28 days. Predetermined dosage ramp up schedule during cycle 2.
Massachusetts General Hospital
Boston, Massachusetts, United States
Dana Farber Cancer Institute
Boston, Massachusetts, United States
Number of Participants With Very Good Partial Response Within 24 Cycles of Therapy
Proportion of patients with VGPR to therapy within 24 cycles of therapy initiation. (VGPR is \>90% reduction in serum IgM from baseline)
Time frame: The primary objective of VGPR within 24 cycles of therapy was assessed starting at Cycle 3 Day 1 through the End of Treatment visit, range of 2 to 21 months after the initiation of therapy.
Number of Participants With Complete Response (CR) After 6 Cycles
Proportion of patients with a complete response after 6 cycles of therapy. A complete response (CR) is defined as having resolution of WM related symptoms, normalization of serum IgM levels with complete disappearance of IgM paraprotein by immunofixation, and resolution of any adenopathy or splenomegaly.
Time frame: 6 Cycles (28 day cycle)
Number of Participants With Complete Response (CR) After 12 Cycles
Proportion of patients with a complete response after 12 cycles of therapy. A complete response (CR) is defined as having resolution of WM related symptoms, normalization of serum IgM levels with complete disappearance of IgM paraprotein by immunofixation, and resolution of any adenopathy or splenomegaly.
Time frame: 12 Cycles (28 day cycle)
Number of Participants With Complete Response (CR) After 24 Cycles
Proportion of patients with a complete response after 24 cycles of therapy. A complete response (CR) is defined as having resolution of WM related symptoms, normalization of serum IgM levels with complete disappearance of IgM paraprotein by immunofixation, and resolution of any adenopathy or splenomegaly.
Time frame: Complete response to therapy was assessed starting at Cycle 3 Day 1 through the End of Treatment visit, range of 2 to 21 months after the initiation of therapy.
Overall Response
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Proportion of patients with minor response (MR) , partial response (PR), very good partial response (VGPR), or complete response (CR) to therapy.
Time frame: 72 months
Rate of VGPR at 30 Months
Proportion of patients with a VGPR at 30 months from beginning therapy.
Time frame: 30 Months
Median Time to Response
Time from treatment initiation until achievement of a minor response (reduction in serum IgM \>25%) or better.
Time frame: 24 months
Median Time to Major Response
Time from treatment initiation until partial response or better (\>50% reduction in serum IgM)
Time frame: 24 months
Progression Free Survival (PFS) at 24 Months
Time from initiation of therapy until disease progression (\>25% increase in serum IgM and 500 mg/dL absolute increase).
Time frame: 24 months
Progression Free Survival (PFS) at 36 Months
Time from initiation of therapy until disease progression (\>25% increase in serum IgM and 500 mg/dL absolute increase).
Time frame: 36 Months
Progression Free Survival (PFS) at 48 Months
Time from initiation of therapy until disease progression (\>25% increase in serum IgM and 500 mg/dL absolute increase).
Time frame: 48 Months
Progression Free Survival (PFS) at 60 Months
Time from initiation of therapy until disease progression (\>25% increase in serum IgM and 500 mg/dL absolute increase).
Time frame: 60 Months
Overall Survival
Time from initiation of therapy until death
Time frame: 72 months
Time to Next Treatment
Time from initiation of IVEN protocol therapy until initiation of new line of therapy.
Time frame: 72 months
Number of Participants With Treatment Related Adverse Events as Assessed (CTCAE) Version 5.0
CTCAE version 5.0
Time frame: 6 Months