This phase Ib trial seeks to find out the best dose and possible side effects and/or benefits of zanubrutinib in combination with the R-PolaCHP in treating patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). Zanubrutinib is designed to block a protein called Bruton Tyrosine Kinase in order to stop cancer growth. R-CHOP is the acronym for the combination of five drugs: rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone. It is the most widely used chemoimmunotherapy regimen for DLBCL and is considered the standard-of-care treatment for patients with DLBCL. Three of the drugs in R-CHOP (cyclophosphamide, doxorubicin and vincristine) are chemotherapy drugs. Rituximab is a type of immunotherapy and prednisone is a type of steroids.
PRIMARY OBJECTIVE: I. Determine the safety, toxicity profile and recommended phase 2 dose (RP2D) of zanubrutinib in combination with ZaR-PolaCHP (ZaR-PolaCHP) for patients with previously untreated diffuse large B-cell lymphoma (DLBCL). SECONDARY OBJECTIVES: I. Determine the objective response rate (ORR) (complete and partial responses), progression-free survival (PFS) and overall survival (OS) of ZaR-CHOP in patients treated at the RP2D. II. Provide descriptive data on treatment exposure to zanubrutinib and R-CHOP including treatment discontinuation rate and relative dose intensity. EXPLORATORY OBJECTIVES: I. Examine archival tumor samples attained before starting treatment on trial to determine the clinical outcomes of molecularly defined DLBCL subtypes in patients treated with ZaR-Pola-CHP or ZaR-CHOP. II. Measure circulating tumor deoxyribonucleic acid (DNA) (ctDNA) to correlate its presence with response by positron emission tomography (PET) imaging. OUTLINE: This is a dose de-escalation study of zanubrutinib and fixed-dose R-CHOP regimen followed by a dose-expansion study. Patients receive zanubrutinib orally (PO) once or twice daily on days 1-21, rituximab intravenously (IV) on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. 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 every 6 months for 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
38
Given IV
Given IV
Given PO
Given IV
Given IV
Given PO
Cleveland Clinic
Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, United States
MUSC
Charleston, South Carolina, United States
Incidence of adverse events
Measured by the Common Terminology Criteria for Adverse Events version 5.0.
Time frame: Up to 24 months
Objective response rate (ORR)
Defined as the proportion of patients achieving a complete or partial response. ORR will be reported with a 95% binomial confidence interval.
Time frame: Up to 5 years
Progression-free survival
Will be estimated using the method of Kaplan-Meier, where the estimates at time points of interest will be reported with 95% confidence intervals.
Time frame: From the start of treatment to time of progression or death, whichever occurs first, assessed up to 5 years
Overall survival (OS)
Will be estimated using the method of Kaplan-Meier, where the estimates at time points of interest will be reported with 95% confidence intervals.
Time frame: From start of treatment to death from any cause, assessed up to 5 years
Zanubrutinib duration of treatment
Time frame: Up to 6 cycles (each cycle is 21 days in length)
Zanubrutinib average daily dose
Time frame: Up to 6 cycles (each cycle is 21 days in length)
Zanubrutinib discontinuation rate
Time frame: Up to 6 cycles (each cycle is 21 days in length)
Zanubrutinib relative dose intensity
Defined as the ratio of the amount of a drug actually administered to the amount planned for a fixed time period.
Time frame: Up to 6 cycles (each cycle is 21 days in length)
Number of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP) cycles received
Time frame: Up to 6 cycles (each cycle is 21 days in length)
R-CHOP discontinuation rates
Time frame: Up to 6 cycles (each cycle is 21 days in length)
R-CHOP relative dose intensity
Defined as the ratio of the amount of a drug actually administered to the amount planned for a fixed time period.
Time frame: Up to 6 cycles (each cycle is 21 days in length)
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