This research study is evaluating the combination of three drugs - acalabrutinib, venetoclax, and obinutuzumab - as a possible treatment for relapsed or refractory and untreated mantle cell lymphoma (MCL). The names of the study drugs involved in this study are: * Acalabrutinib * Venetoclax * Obinutuzumab
This is an open-label, investigator-initiated, single-arm, multi-cohort phase 1/2 study to assess the safety and efficacy of the combination of acalabrutinib, venetoclax, and obinutuzumab (AVO) in relapsed/refractory (R/R) and untreated mantle cell lymphoma (MCL). The research study procedures include screening for eligibility and study treatment including evaluations and follow up visits. The names of the study drugs involved in this study are: * Acalabrutinib * Venetoclax * Obinutuzumab Participants will receive study treatment for as long as there are no serious side effects and the disease does not get worse. Participants will be followed for 5 years. It is expected that 72 people will take part in this research study. This is a Phase I/II clinical trial. Phase I clinical trials test the safety of investigational drugs and also tries to define the appropriate dose of investigational drugs to use for further studies. "Investigational" means that the drugs are being studied. * The U.S. Food and Drug Administration (FDA) has not approved venetoclax and obinutuzumab for this specific disease but it has been approved for other uses. * The U.S. Food and Drug Administration (FDA) has approved acalabrutinib as a treatment option for this disease.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
72
Each study drug is given according to a different schedule: Acalabrutinib: Oral, dosage per protocol, start cycle 1 and beyond according to schedule outlined in protocol
Venetoclax: oral. daily, dosage per protocol, start cycle 3 and beyond according to schedule outlined in protocol
Obinutuzumab: intravenous infusion, dosage per protocol, drug during cycles 2 and beyond according to schedule outlined in protocol
University of Chicago Medical Center
Chicago, Illinois, United States
RECRUITINGBeth Israel Deaconess Medical Center
Boston, Massachusetts, United States
RECRUITINGDana-Farber Cancer Institute
Boston, Massachusetts, United States
RECRUITINGRecommended Phase 2 Dose for acalabrutinib
The RP2D will be defined as the highest dose level for which there are no more than 1/6 DLTs observed.
Time frame: 5 months
Complete Remission Rate
Complete remission (CR) rate after 7 cycles of treatment with AVO in treatment naïve (TN) transplant ineligible MCL and TN transplant-eligible, TP53 mutated MCL, cohort B. CR rate after 7 cycles of treatment with AVO in TN TP53-mutated MCL, expansion cohort D. Complete remission (CR) is defined radiographically using 2014 Lugano criteria and a negative bone marrow biopsy by histology, immunohistochemistry, and flow cytometry, if bone marrow was initially involved by MCL at screening. CR, a primary endpoint measured after 7 cycles of AVO, does not incorporate minimal residual disease (MRD) testing
Time frame: 7 Months
MRD negative complete remission rate
Minimal residual disease (MRD) negative (\<1 in 106 cells) CR rate after 7 cycles of treatment with AVO in TN transplant-eligible, TP53 wild type MCL, cohort C
Time frame: 7 months
CR rate after 7 cycles of treatment with AVO in participants with TN TP53-mutated MCL in cohort B and expansion cohort D
Complete remission (CR) is defined radiographically using 2014 Lugano criteria and a negative bone marrow biopsy by histology, immunohistochemistry, and flow cytometry, if bone marrow was initially involved by MCL at screening. CR, a primary endpoint measured after 7 cycles of AVO, does not incorporate minimal residual disease (MRD) testing
Time frame: 7 cycles
Complete Remission (CR) rate after 7 cycles in the entire study population
Complete remission (CR) is defined radiographically using 2014 Lugano criteria and a negative bone marrow biopsy by histology, immunohistochemistry, and flow cytometry, if bone marrow was initially involved by MCL at screening. CR, a primary endpoint measured after 7 cycles of AVO, does not incorporate minimal residual disease (MRD) testing
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Time frame: 7 months
CR rate after 7 cycles cohort A and C
Complete remission (CR) is defined radiographically using 2014 Lugano criteria and a negative bone marrow biopsy by histology, immunohistochemistry, and flow cytometry, if bone marrow was initially involved by MCL at screening. CR, a primary endpoint measured after 7 cycles of AVO, does not incorporate minimal residual disease (MRD) testing
Time frame: 7 Months
Partial Response (PR) Rate after 7 cycles
2014 Lugano Criteria
Time frame: 7 months
Stable Disease Rate after 7 cycles
Stable disease is measured from the start of the treatment until the criteria for progression are met, taking as reference the smallest measurements recorded since the treatment started, including the baseline measurements.
Time frame: 7 months
Progressive Disease Rate after 7 Cycles
Lugano 2014 criteria
Time frame: 7 months
Progression Free Survival-Median
Kaplan Meier Progression-Free Survival (PFS) is defined as the time from randomization (or registration) to the earlier of progression or death due to any cause. Participants alive without disease progression are censored at date of last disease evaluation
Time frame: Up to 5 Years
Progression Free Survival
Kaplan Meier Progression-Free Survival (PFS) is defined as the time from randomization (or registration) to the earlier of progression or death due to any cause. Participants alive without disease progression are censored at date of last disease evaluation
Time frame: Up to 5 years
Overall Survival
Kaplan Meier- Overall Survival (OS) is defined as the time from randomization (or registration) to death due to any cause, or censored at date last known alive.
Time frame: Up to 5 years
Overall Survival-Median
Kaplan Meier Overall Survival (OS) is defined as the time from randomization (or registration) to death due to any cause, or censored at date last known alive.
Time frame: Up to 5 years
Rate of peripheral blood MRD-negativity after 7 cycles
Minimal residual disease (MRD) negativity is defined as 0 residual clonal cells per 1 x 106 nucleated cells in the peripheral blood assessed by the clonoSEQ® assay. The clonoSEQ assay uses next generation sequencing (NGS) to identify rearranged IgH (VDJ), IgH (DJ), IgK, and IgL receptor gene sequences, as well as translocated BCL1/IgH (J) sequences in a sample
Time frame: 7 months
Time to Minimal Residual Disease (MRD)-positive disease recurrence in the peripheral blood
Time to MRD-positive disease recurrence, in patients who have achieved MRD negativity
Time frame: Up to 8 months
Time to clinical disease progression
Time to Progression (TTP) is defined as the time from randomization (or registration) to progression, or censored at date of last disease evaluation for those without progression reported
Time frame: Up to 5 years
Rate of infusion related reactions
Some participants may develop hypersensitivity or other infusion-related reactions (IRRs) to obinutuzumab, pre-medication is recommended to reduce the risk of infusion reactions. Premedication will be given as outlined in protocol. Cycle numbers are specific to this trial
Time frame: Up to 5 years
Rate of tumor lysis syndrome
criteria of laboratory TLS or clinical TLS according to the Cairo-Bishop definition of TLS
Time frame: 7 Months
Rate of therapy discontinuation
descriptive analysis of rates of therapy discontinuation after 10 cycles will be performed, with subjects grouped by reasons for discontinuation (e.g. achievement of MRD-negative CR, progressive disease, or intolerability). Rates of discontinuation of individual components of the regimen will also be included in this analysis.
Time frame: 10 Months
Number of Participants with Treatment Related Adverse Events CTCAE 5.0 criteria
Grade 3 and higher toxicities, both regardless of attribution, and at least possibly attributed to the study treatment * Grade 2 or higher toxicity at least probably related to study treatment * Adverse events leading to discontinuation due to toxicity NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Time frame: up to 30 days after the last dose of study treatment or until resolution of toxicity to grade 1 or baseline, whichever occurs last up to 5 years