A Phase 2 study to evaluate the efficacy of nanatinostat in combination with valganciclovir in patients with relapsed/refractory EBV-positive lymphomas
Patients with EBV-associated lymphomas have inferior outcomes with standard-of-care therapies compared to those with EBV-negative disease. Nanatinostat is a selective class I HDAC inhibitor which induces EBV lytic phase protein generation, activating (val)ganciclovir to its cytotoxic form. This open-label, multicenter, multinational, single-arm, Phase 2 basket study employs a Simon's 2-stage design to allow termination of enrollment into cohorts where treatment appears futile, and will include the following cohorts of patients with EBV+ relapsed/refractory lymphomas: 1. Diffuse large B-cell lymphoma (DLBCL) 2. Extranodal natural killer/T-cell lymphoma (ENKTL) 3. Peripheral T-cell lymphoma (PTCL), including angioimmunoblastic T-cell lymphoma (AITL) and PTCL not otherwise specified (PTCL-NOS) 4. Hodgkin lymphoma (HL) 5. Post-transplant lymphoproliferative disorders (PTLD) 6. Human immunodeficiency virus (HIV)-associated lymphomas (HIV-L) 7. EBV+ lymphomas other than the above The study was terminated prematurely and did not reach its target enrollment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
102
Drug: Nanatinostat, 20 mg orally once daily, 4 days per week in 28 day cycles Drug: Valganciclovir, 900 mg orally once daily in 28 day cycles
The University of Alabama at Birmingham Comprehensive Cancer Center
Birmingham, Alabama, United States
City of Hope
Duarte, California, United States
David Geffen School of Medicine - UCLA
Los Angeles, California, United States
University of California Irvine
Orange, California, United States
Scripps MD Anderson Cancer Center
San Diego, California, United States
Objective Response Rate (ORR)
Number (percentage) of patients with a best overall complete response (CR) or partial response (PR) according to the 2007 International Working Group (IWG) criteria, where CR included complete disappearance of all detectable clinical evidence of disease and disease-related symptoms if present before therapy with all lymph nodes and nodal masses having regressed on computed tomography to normal size, and PR included at least a 50% decrease in sum of the product of the diameters (SPD) of up to six of the largest dominant nodes or nodal masses, no increase should have been observed in the size of other nodes, liver, or spleen, and splenic and hepatic nodules must have regressed by ≥ 50% in their SPD or, for single nodules, in the greatest transverse diameter.
Time frame: Up to approximately 2 years
Duration of Response (DOR)
Interval of time from date of first observed complete or partial response per 2007 International Working Group (IWG) criteria to the date of documented disease progression or death due to any cause, where disease progression is defined by 2007 IWG criteria as any new lesion or increase by ≥ 50% of previously involved sites from nadir. DOR was censored at the time of study withdrawal for hematopoietic stem cell transplant, or at the time of study termination, whichever was earlier, for patients whose disease was still in response.
Time frame: Up to approximately 2 years
Time to Next Anti-Lymphoma Treatment (TTNLT)
Interval of time from the start of study drug treatment to the date of next anti-lymphoma treatment (including chemotherapy, radiotherapy, radioimmunotherapy, or immunotherapy).
Time frame: Up to approximately 3 years
Time to Progression (TTP)
Interval of time from the start of study drug treatment to the date of disease progression, where disease progression is defined by 2007 IWG criteria as any new lesion or increase by ≥ 50% of previously involved sites from nadir. TTP was censored at the time of study withdrawal for hematopoietic stem cell transplant, at the time of study treatment withdrawal (or at the time of crossover from monotherapy to combination therapy), or at the time of study termination, whichever was earliest, for patients without reported disease progression.
Time frame: Up to approximately 3 years
Progression-Free Survival (PFS)
Interval of time from the start of study drug treatment to the date of first documented disease progression (defined by 2007 IWG criteria as any new lesion or increase by ≥ 50% of previously involved sites from nadir), initiation of new antineoplastic therapy, or death from any cause, whichever occurred first. PFS was censored at the time of study withdrawal for hematopoietic stem cell transplant, at the time of study treatment withdrawal (or at the time of crossover from monotherapy to combination therapy), or at the time of study termination, whichever was earliest, for patients without reported disease progression or death.
Time frame: Up to approximately 3 years
Overall Survival (OS)
Interval of time from the start of study drug treatment to the date of death for any reason. OS was censored at the time of study withdrawal or study termination, whichever was earlier, for patients without reported death.
Time frame: Up to approximately 3 years
Number (Percentage) of Participants With Adverse Events (AEs)
Number (percentage) of patients experiencing at least one treatment-emergent adverse event, defined as those untoward medical events with onset after the first dose of study drug or existing events that worsened after the first dose during the study
Time frame: Up to approximately 2 years
Pharmacokinetic (PK) Parameter - Time to Maximum Plasma Concentration [Tmax]
Defined as the time required to reach peak plasma concentration \[Cmax\] after study drug administration
Time frame: Cycle 1 Day 1 and Cycle 6 Day 1 at pre-dose and 1, 2, 4, and 6 hours post-dose (each cycle was 28 days)
Pharmacokinetic (PK) Parameter - Maximum Plasma Concentration [Cmax]
Defined as the peak plasma concentration \[Cmax\] after study drug administration
Time frame: Cycle 1 Day 1 and Cycle 6 Day 1 at pre-dose and 1, 2, 4, and 6 hours post-dose (each cycle was 28 days)
Pharmacokinetic Parameter - Area Under the Plasma Concentration-Time Curve [AUC0-t]
Defined as the area under the concentration-time curve from time 0 to the last measurable plasma concentration
Time frame: Cycle 1 Day 1 and Cycle 6 Day 1 at pre-dose and 1, 2, 4, and 6 hours post-dose (each cycle was 28 days)
Pharmacokinetic (PK) Parameter - Half-Life [t1/2]
Defined as the time required to reduce plasma concentration by 50% after study drug administration
Time frame: Cycle 1 Day 1 and Cycle 6 Day 1 at pre-dose and 1, 2, 4, and 6 hours post-dose (each cycle was 28 days)
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UCSF Hematology and Blood and Marrow Transplant
San Francisco, California, United States
University of Colorado Cancer Center
Aurora, Colorado, United States
University of Maryland Medical Center
Baltimore, Maryland, United States
John Theurer Cancer Center: Hackensack Univeristy
Hackensack, New Jersey, United States
Icahn School of Medicine at Mount Sinai
New York, New York, United States
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