The purpose of this study is to determine the correct dose and safety of combining two new cancer drugs, loncastuximab tesirine and venetoclax, as a treatment for relapsed or refractory B cell lymphoma.These drugs are used to treat some lymphomas, but have not yet been tested in combination for the treatment of lymphoma. The main goal of this study is to determine the safety of the combination.
This is a phase I trial designed to evaluate the safety and tolerability of loncastuximab tesirine given in combination with venetoclax for treatment of relapsed/refractory non - Hodgkin lymphoma. Loncastuximab tesirine is an investigational (experimental) drug that works by targeting a protein in cancer cells (called CD19) and delivering a small amount of chemotherapy directly to the cancer cells. Loncastuximab tesirine is experimental because it is not approved by the Food and Drug Administration (FDA). Venetoclax, is a targeted anti-cancer drug, which works by imitating a particular protein produced by the tumor and interrupting its normal processes, ultimately causing the tumor cells to die. Adding venetoclax to the loncastuximab tesirine regimen is believed to increase the chance of getting relapsed or refractory B cell lymphoma cancer in remission. Venetoclax is approved by the FDA for treatment in some types of cancer, but is not approved by the FDA for the treatment of lymphoma soit is considered experimental in this study. Up to 36 subjects will take in this phase I research study. The primary objective for this study: To determine the safety and tolerability of the combination of loncastuximab tesirine and venetoclax to identify the recommended phase 2 dose (RP2D) of these agents. Secondary objectives are: * To describe the adverse event profile of the combination of loncastuximab tesirine and venetoclax. * To describe the overall response rate (ORR) and complete response rate (CRR) of relapsed/refractory non-Hodgkin lymphoma treated with the combination of loncastuximab tesirine and venetoclax. * To describe the overall survival (OS) and progression free survival (PFS) of subjects with relapsed / refractory non-Hodgkin lymphoma treated with the combination of loncastuximab tesirine and venetoclax. * To describe the disease-free survival, the disease specific survival and time to treatment failure of subjects with relapsed/refractory non-Hodgkin lymphoma treated with the combination of loncastuximab tesirine and venetoclax.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
23
Loncastuximab tesirine 50 - 150 μg/kg will be administered as a 30 minutes IV infusion on Day 1 of each cycle for 6 cycles. On doses over 100 μg/kg, subsequent dosing (i.e. beyond 100 μg/kg) will be done at 50% of the dose that is administered on the first 2 cycles.
Participants will receive venetoclax at target doses of 400 - 800mg orally on days 1 - 5 of each (21 day) cycle. On cycle 1, venetoclax dose will be escalated to reach the target dose over the course of 5 days for target dose 400mg, 6 days for target dose 600mg and 7 days for target dose 800mg Venetoclax should preferably be given after a meal and on cycle 1 should be preceded by prophylaxis for tumor lysis syndrome (TLS).
Cleveland Clinic Taussig Cancer Center, Case Comprehensive Cancer Center
Cleveland, Ohio, United States
Dose limiting toxicities (DLTs) during cycle 1 of loncastuximab tesirine and venetoclax
Number of DLTs during cycle 1 (21 days) of loncastuximab tesirine and venetoclax
Time frame: Up to Day 21
Maximum tolerated dose (MTD) of loncastuximab tesirine and venetoclax
Number of MTDs of loncastuximab tesirine and venetoclax
Time frame: 6 weeks
Overall response rate (ORR) as measured by proportion of participants with Complete Response (CR) and Partial Response (PR)
ORR, described as proportion of participants with CR and PR. Response assessed via Revised Response Criteria for Malignant Lymphoma
Time frame: Day 5 of cycle 1 (each cycle is 21 days)
Overall response rate (ORR) as measured by proportion of participants with CR or PR
ORR, described as proportion of participants with CR and PR. Response assessed via Revised Response Criteria for Malignant Lymphoma
Time frame: Between cycle 3 and 4 (21-day cycles) +/- 7 days
Overall response rate (ORR) as measured by proportion of participants with CR or PR
ORR, described as proportion of participants with CR and PR. Response assessed via Revised Response Criteria for Malignant Lymphoma
Time frame: End of treatment, aproximately day 84 +/- 7 days
Overall response rate (ORR)
ORR, described as a proportion. Response assessed via Revised Response Criteria for Malignant Lymphoma
Time frame: Followup, every 3 months up to one year after end of treatment
Complete response rate (CRR) as measured by proportion of participants with CR
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ORR, described as a proportion. Response assessed via Revised Response Criteria for Malignant Lymphoma
Time frame: Day 5 of cycle 1 (each cycle is 21 days)
Complete response rate (CRR)
ORR, described as a proportion. Response assessed via Revised Response Criteria for Malignant Lymphoma
Time frame: Between cycle 3 and 4 (21-day cycles) +/- 7 days
Complete response rate (CRR)
ORR, described as a proportion. Response assessed via Revised Response Criteria for Malignant Lymphoma
Time frame: End of treatment, aproximately day 84 +/- 7 days
Complete response rate (CRR)
ORR, described as a proportion. Response assessed via Revised Response Criteria for Malignant Lymphoma
Time frame: Followup, every 3 months up to one year after end of treatment
Overall survival (OS)
OS is defined as the time from the date of study entry to the date of death, with censoring done on live patients at the time of last follow up. OS will be estimated using the Kaplan Meier method
Time frame: At end of follow-up (1 year)
Progression free survival (PFS)
PFS is defined as the time from entry onto study until lymphoma progression or death from any cause. PFS will be estimated using the Kaplan Meier method The precise date of progression is generally unknown. It may be defined as the first date of documentation of a new lesion or enlargement of a previous lesion, or the date of the scheduled clinic visit immediately after radiologic assessment has been completed. Where there is missing information, censoring of the data may be defined as the last date at which progression status was adequately assessed or the first date of unscheduled new anti-lymphoma treatment.
Time frame: At end of follow-up (1 year)
Median disease-free survival
Disease-free survival is measured from the time of occurrence of disease-free state (e.g. the adjuvant setting following surgery or radiation therapy) or attainment of a complete remission) to disease recurrence or death from lymphoma or acute toxicity of treatment.
Time frame: At end of follow-up (1 year)
Median disease-specific survival
Disease-specific survival is defined as death from lymphoma, or from toxicity from the drug. Death from unknown causes should be attributed to the drug
Time frame: At end of follow-up (1 year)
Time-to-treatment failure
Time to treatment failure (event-free survival) is measured from the time from study entry to any treatment failure including discontinuation of treatment for any reason, such as disease progression, toxicity, patient preference, initiation of new treatment without documented progression, or death.
Time frame: At end of follow-up (1 year)
Total number of adverse events during and after treatment
The objective is to describe the adverse event profile of the combination therapy by reporting number of adverse events during and after treatment, described as a proportion
Time frame: At end of treatment (21-day cycles until disease progression or toxicity, up to 6 cycles max)
Duration of response (DOR)
DOR, as measured by the median time in months of from first response (PR or CR) until relapse or death, using Kaplan Meier
Time frame: At end of follow-up (1 year)
Time to Progression (TTP)
TTP as measured by median time in months from treatment to death or relapse
Time frame: At end of follow-up (1 year)
Partial response rate (PRR)
PRR, as measured by proportion of patients with partial response
Time frame: At end of follow-up (1 year)