This phase I/II trial studies the side effects, best dose, and effectiveness of copanlisib and venetoclax in treating patients with mantle cell lymphoma that has come back (relapsed) or does not respond to treatment (refractory). Copanlisib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Venetoclax may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Giving copanlisib and venetoclax may help treat patients with mantle cell lymphoma.
PRIMARY OBJECTIVES: I. To assess the safety, tolerability, and the maximum tolerated dose (MTD) of copanlisib hydrochloride (copanlisib) and venetoclax in patients with relapsed/refractory (R/R) mantle cell lymphoma (MCL). (Phase 1) II. To estimate the efficacy (as measured by overall rate of response \[ORR\]) of copanlisib in combination with venetoclax in patients with R/R MCL. (Phase 2) SECONDARY OBJECTIVES: I. To characterize the safety profile of copanlisib in combination with venetoclax in patients with R/R MCL. (Phase 2) II. To evaluate duration of response (DOR) and progression-free survival (PFS) associated with combined administration of copanlisib/venetoclax. (Phase 2) III. To evaluate an overall survival (OS) associated with combined administration of copanlisib/venetoclax. (Phase 2) IV. To characterize the pharmacokinetics (PK) profile of copanlisib and venetoclax. (Phase 2) EXPLORATORY OBJECTIVES: I. Evaluate the emergence of resistant clones, as determined by the presence of novel mutations and expression of BCL2 family proteins. II. Characterize the T-cell population balance in patients treated with copanlisib/venetoclax. OUTLINE: This is a phase I, dose-escalation study of copanlisib hydrochloride, followed by a phase II study. Patients receive copanlisib hydrochloride intravenously (IV) over 1 hour on days 1, 8, and 15, and venetoclax orally (PO) once daily (QD) on days 1-28. Treatment repeats every 28 days for up to 26 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
8
Patients receive copanlisib hydrochloride IV over 1 hour on days 1, 8, and 15 for each cycle. Copanlisib will be given at 30mg, 45mg, or 60 mg depending on the assigned dose level.
Patients receive venetoclax PO QD on days 1-28 for each cycle. Venetoclax will have a weekly dose ramp up in cycle one from 20mg, 50mg, 100mg, 200mg, and then 400mg daily thereafter starting from cycle 2.
City of Hope Medical Center
Duarte, California, United States
Incidence of dose limiting toxicities (Phase I)
Toxicities will be assessed using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Time frame: Up to end of cycle 2 (1 cycle = 28 days)
Overall response rate (Phase II)
Defined as the proportion of response-evaluable participants that achieve a best response of either complete response (CR) or partial response (PR) during protocol therapy. Will be estimated along with the 2-sided 95% exact binomial confidence interval.
Time frame: Up to 2 years
Duration of response
Will be estimated using the Kaplan-Meier product-limit method along with the Greenwood estimator of standard error; 95% confidence interval for the survival timepoint estimates will be constructed based on the log-log transformation. Median survival time will be estimated when available.
Time frame: Time from the first achievement of PR or CR to time of progressive disease, start of non-protocol anti-lymphoma therapy, or death, whichever earlier, assessed up to 2 years
Progression-free survival
Will be estimated using the Kaplan-Meier product-limit method along with the Greenwood estimator of standard error; 95% confidence interval for the survival timepoint estimates will be constructed based on the log-log transformation. Median survival time will be estimated when available.
Time frame: From start of protocol treatment to time of disease relapse/progression, or death due to any cause, whichever occurs earlier, assessed up to 2 years
Overall survival
Will be estimated using the Kaplan-Meier product-limit method along with the Greenwood estimator of standard error; 95% confidence interval for the survival timepoint estimates will be constructed based on the log-log transformation. Median survival time will be estimated when available.
Time frame: From start of protocol treatment to time of death due to any cause, assessed up to 2 years
Incidence of adverse events
Toxicity and adverse events will be recorded using the NCI CTCAE 5.0 scale. Safety and tolerability of copanlisib in conjunction with venetoclax will be summarized for all patients (evaluable for toxicity) combined and by dose level (if patients were treated at both dose level \[DL\]1 and DL-1). Adverse events will be tabulated and summarized by major organ category, grade, and drug attribution. Severe adverse event specific incidence and exact 95% confidence interval will be provided where necessary/appropriate.
Time frame: Up to 90 days after completion of treatment
Plasma pharmacokinetics (PK) of copanlisib (Cmax)
Maximum plasma concentration (Cmax).
Time frame: From 30 minute before Copanlisib on cycle 2 day 15 through 24 hours after (Each cycle is 28 days)
Plasma pharmacokinetics (PK) of copanlisib (AUC)
Area under the Curve (AUC).
Time frame: From 30 minute before Copanlisib on cycle 2 day 15 through 24 hours after.(Each cycle is 28 days)
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