BTK inhibition and checkpoint blockade are promising classes of therapy for central nervous system (CNS) lymphoma and have demonstrated efficacy with acceptable toxicity. A multidrug approach may carry a higher chance of durable efficacy in this aggressive disease that carries significant morbidity and mortality. Given the poor outcomes and limited options for patients who are not candidates for high-dose methotrexate, the investigators seek to evaluate the combination in this patient population. 08/30/2022: The study was originally designed for those with primary and secondary central nervous system (CNS) lymphoma. However, the first three patients who were enrolled all had secondary CNS lymphoma and most had germinal center phenotype disease with double hit phenotypes. In these three patients, two dose limiting toxicities were seen including 1 patient with grade 4 neutropenia at the time of disease progression and one with pneumonia in the setting of disease progression and worsening of existing heart disease. The third patient came off for clinical progression within cycle 1. Given the lack of response in patients with secondary CNS lymphomas, who do not exhibit the same biology as primary CNS lymphoma patients, Amendment 3 updates the study to only include patients with primary CNS lymphomas.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
25
Durvalumab will be administered over 60 minutes
Patients will take acalabrutinib orally every 12 hours (+/- 3 hours) daily.
Washington University School of Medicine
St Louis, Missouri, United States
The Ohio State University Hospital
Columbus, Ohio, United States
Tolerability as defined as tolerable dose
* Defined as Dose Level 2 if 0 or 1 dose limiting toxicities (DLTs) are seen in patients at that dose level, or Dose Level 1 if 2+ DLTs are seen in Dose Level 2 but only 0 or 1 DLTs are seen in patients at Dose Level 1. * A DLT is defined as the occurrence of an adverse event (AE) that is at least possibly related to the investigational product (IP) or investigational regimen (IR)
Time frame: Completion of first 12 weeks of treatment within phase I portion of study (estimated to be 14 months)
Safety as defined by frequency of toxicities assessed by CTCAE v 5.0
Time frame: From start of treatment through 90 days after treatment (estimated to be 9 months)
Overall response rate (complete response (CR) + partial response (PR))
* CR is defined as disappearance of all contrast-enhancing CNS (brain and spine if latter abnormal at baseline) disease, absence of any systemic corticosteroids prescribed to treat lymphoma (prophylactic steroid eye drops, topical steroids, corticosteroid antiemetics and steroids prescribed for non-disease reasons \[e.g. asthma exacerbation, dermatologic or rheumatologic conditions\] are allowed and not considered in the definition of CR), resolution of abnormal ocular findings on ophthalmological examination, negative CSF cytology/flow cytometry. * PR is defined as \>50% reduction in contrast-enhancing CNS (brain and spine if latter abnormal at baseline) disease either with minor abnormalities on ophthalmological examination or normal ophthalmological examination OR disappearance of all contrast-enhancing CNS (brain and spine if latter abnormal at baseline) but only reduction of vitreous cells or retinal infiltrates or residual suspicious or positive CSF cytology.
Time frame: Through completion of treatment (estimated to be 6 months)
Duration of response
-The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).
Time frame: Through 2 years post treatment (estimated to be 2 years and 6 months)
Time to response
-Time to response is measured from the start of treatment until the time measurement criteria are met for first objective tumor response (CR or PR, whichever is first recorded).
Time frame: Through completion of treatment (estimated to be 6 months)
Progression-free survival (PFS)
* PFS is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first. * Progressive disease is defined as \> 25% increase in contrast-enhancing CNS (brain and spine if latter abnormal at baseline) disease, appearance of any new, measurable (\>/= 10mm) contrast-enhancing disease or recurrent or new ocular or CSF disease. * Progression free survival will include all patients with at least one response assessment. Patients will be censored for progression free survival and duration of response if alive and without disease progression at completion of follow-up period.
Time frame: Through 2 years post treatment (estimated to be 2 years and 6 months)
Overall survival (OS)
* OS is defined as the duration of time from start of treatment to time of death. * All patients who receive treatment on study will be included in overall survival. Patients will be censored for overall survival is alive at last study data collection point (completion of follow-up).
Time frame: Through 2 years post treatment (estimated to be 2 years and 6 months)
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