This phase I/Ib trial studies the side effects and best dose of parsaclisib with or without polatuzumab-vedotin (Pola) plus the standard drug therapy (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone \[PaR-CHOP\]) and to see how well they work compared with R-CHOP alone in treating patients with newly diagnosed, high risk diffuse large B-cell lymphoma. Parsaclisib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Rituximab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Polatuzumab-vedotin is a monoclonal antibody, called polatuzumab, linked to a chemotherapy drug, called vedotin. Polatuzumab is a form of targeted therapy because it attaches to specific molecules (receptors) on the surface of cancer cells, known as anti-CD79b receptors, and delivers vedotin to kill them. Drugs used in chemotherapy, such as cyclophosphamide, doxorubicin hydrochloride, and vincristine sulfate, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Anti-inflammatory drugs, such as prednisone, lower the body's immune response and are used with other drugs in the treatment of some types of cancer. It is not yet known if giving parsaclisib and R-CHOP together works better than R-CHOP alone in treating patients with high risk diffuse large B-cell lymphoma.
PRIMARY OBJECTIVES: I. To establish the maximum tolerated dose (MTD) of parsaclisib in combination with R-CHOP in newly diagnosed diffuse large B-cell lymphoma (DLBCL). (Phase I) II. To assess the complete metabolic response rate by positron emission tomography (PET) (PET complete response \[CR\]) of combining parsaclisib and R-CHOP in patients with newly diagnosed DLBCL. (Dose Expansion) III. To assess significant toxicities of parsaclisib in combination with polatuzumab vedotin (pola) and R-CHP in newly diagnosed DLBCL. (Pola Safety Lead-in) SECONDARY OBJECTIVES: I. To describe the toxicities associated with parsaclisib in combination with R-CHOP. (Phase I) II. To assess the objective response rate (ORR) of parsaclisib in combination with R-CHOP. (Dose Expansion) III. To assess the duration of response (DOR), event-free survival (EFS), progression-free survival (PFS), and overall survival (OS) in patients treated with parsaclisib in combination with R-CHOP. (Dose Expansion) IV. To further describe the toxicities associated with parsaclisib in combination with R-CHOP. (Dose Expansion) V. To describe the toxicities associated with parsaclisib in combination with polatuzumab vedotin and R-CHP. (Pola Safety Lead-in) VI. To assess the PET CR rate and ORR of parsaclisib in combination with polatuzumab vedotin and R-CHP. (Pola Safety Lead-in) VII. To assess the duration of response (DOR), event-free survival (EFS), progression-free survival (PFS), and overall survival (OS) in patients treated with parsaclisib in combination with polatuzumab vedotin and R-CHP. (Pola Safety Lead-in) OUTLINE: This is a phase I, dose-escalation study of parsaclisib, and safety lead-in of pola. ARM I (PHASE I AND DOSE EXPANSION): Patients receive parsaclisib orally (PO) once daily (QD) on days 1-10 or 1-14, rituximab intravenously (IV) or biosimilar substitute, cyclophosphamide IV over 30 minutes, doxorubicin hydrochloride IV, and vincristine sulfate IV over 15 minutes on day 1. Patients also receive prednisone PO on days 1-5 and pegfilgrastim subcutaneously (SC) or biosimilar substitute on day 2. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. ARM II (PHASE I AND POLA SAFETY LEAD-IN): Patients receive parsaclisib PO once daily QD on days 1-10 or 1-14, polatuzumab vedotin IV over 90 minutes, rituximab IV or biosimilar substitute, cyclophosphamide IV over 30 minutes, doxorubicin hydrochloride IV, and vincristine sulfate IV over 15 minutes on day 1. Patients also receive prednisone PO on days 1-5 and pegfilgrastim SC or biosimilar substitute on day 2. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months during year 1 and every 4 months during year 2. Patients who experience disease progression before the end of year 2 are followed up every 6 months until 5 years after registration.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Given IV
Given IV
Given PO
Given SC
Given IV
Given PO
Given IV
Given IV
Mayo Clinic in Arizona
Scottsdale, Arizona, United States
Mayo Clinic in Florida
Jacksonville, Florida, United States
Mayo Clinic in Rochester
Rochester, Minnesota, United States
Maximum tolerated dose (MTD) of parsaclisib in combination with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) (Phase I)
The MTD will be defined as the dose level below the lowest dose that induces dose-limiting toxicity in in at least one-third of patients (at least 2 of a maximum of 6 patients).
Time frame: Up to 21 days
Complete metabolic response (CMR) rate (Dose Expansion)
Will be measured by positron emission tomography (PET). A success is defined as an objective status of CMR by the PET-computed tomography (CT) based response criteria at the end of treatment. The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Exact binomial 95% confidence intervals for the true rate of complete metabolic response will be calculated.
Time frame: Up to end of treatment (3-4 weeks after day 1 of cycle 6 [each cycle is 21 days])
Incidence of adverse events (AEs) (Phase I)
The number and severity (grade) of all treatment related AEs will be tabulated and summarized. Non-hematologic AEs will be evaluated via the ordinal Common Terminology Criteria for Adverse Events (CTCAE) version (v) 5.0 standard AE grading. Hematologic toxicity measures of thrombocytopenia, neutropenia, and leukopenia will be assessed using continuous variables as the outcome measures (primarily nadir) as well as categorization via CTCAE v 5.0 standard AE grading. Both all grade and grade 3 and above AEs will be described and summarized in a similar fashion. Overall AE incidences as well as AE profiles by dose level and patient will be explored and summarized. Frequency distributions, graphical techniques and other descriptive measures will form the basis of these analyses.
Time frame: Up to 2 years
Incidence of toxicity due to parsaclisib in combination with Pola-R-CHP (Pola Safety Lead-in)
Toxicity will be measured per NCI-CTCAE version 5. Significant toxicity is defined as an adverse event occurring during the first cycle of treatment that is possibly, probably, or definitely related to study treatment.
Time frame: Up to cycle 1 (21 days)
Objective response rate (Dose Expansion)
Will be estimated by the number of patients with an objective status of CMR or partial metabolic response (PMR) by the PET-CT based response criteria at the end of treatment 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 objective response rate will be calculated.
Time frame: Up to end of treatment (3-4 weeks after day 1 of cycle 6 [each cycle is 21 days])
Duration of response (Dose Expansion)
Defined as the date at which the patient's objective status is first noted to be either CMR or PMR to the earliest date progression is documented by CT or PET/CT \[progressive metabolic disease (PMD) or progressive disease (PD)\]
Time frame: Up to 2 years
Event-free survival (Dose Expansion)
Defined as the time from registration to disease progression or relapse (PMD or PD), initiation of subsequent anti-lymphoma therapy, or death due to any cause.
Time frame: Up to 5 years
Progression-free survival (Dose Expansion)
Defined as the time from registration to progression (PMD or PD) or death due to any cause
Time frame: Up to 5 years
Overall survival (Pola Safety Lead-in)
Defined as the time from registration until death due to any cause.
Time frame: Up to 5 years
Incidence of adverse events (Dose Expansion)
The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed to determine patterns. Additionally, the relationship of the adverse event(s) to the study treatment will be taken into consideration.
Time frame: Up to 2 years
Objective response rate (Pola Safety Lead-in)
Will be estimated by the number of patients with an objective status of CMR or PMR by the PET-CT based response criteria at the end of treatment 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 objective response rate will be calculated.
Time frame: Up to end of treatment [3-4 weeks after day 1 of cycle 6 (each cycle is 21 days)]
Duration of response (Pola Safety Lead-in)
Defined as the date at which the patient's objective status is first noted to be either CMR or PMR to the earliest date progression is documented by CT or PET/CT (PMD or PD)
Time frame: Up to 2 years
Event-free survival (Pola Safety Lead-in)
Defined as the time from registration to disease progression or relapse (PMD or PD), initiation of subsequent anti-lymphoma therapy, or death due to any cause
Time frame: Up to 5 years
Progression-free survival (Pola Safety Lead-in)
Defined as the time from registration to progression (PMD or PD) or death due to any cause
Time frame: Up to 5 years
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