The Alternative-C Trial is a prospective, multicenter Phase 2 Study to evaluate the efficacy of the chemotherapy-free combination of copanlisib and obinutuzumab in patients with previously untreated follicular lymphoma (FL) and a high tumor burden. Additionally, the combination should be evaluated in terms of secondary efficacy endpoints, treatment compliance, safety and patient-reported symptoms. The study Population includes Patients \> 18 years of age with histologically confirmed follicular lymphoma grade 1, 2 or 3A with Ann Arbor Stage III/IV or stage II not suitable for radiotherapy and in need of therapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
98
Induction therapy will comprise 6 cycles of copanlisib, administered by intravenous Infusion at a dose of 60 mg on day 1,8,15 of cycles 1-6 to be given every 28 days. Consolidation therapy will comprise another 24 weeks of copanlisib in patients with clinical Remission 28 days after the last induction cycle. It will be administered by intravenous Infusion at a dose of 60 mg on days 1 and 15 of cycles 7 - 12 to be given every 28 days. Maintenance therapy will comprise another 72 weeks of copanlisib in patients with clinical remissions 28 days after the last consolidation cycle.
Induction therapy will comprise 6 cycles of obinutuzumab, administered by intravenous infusion at a dose of 1000 mg on days 1,8, 15 of cycle 1 and on day 1 of cycles 2 - 6 to be given every 28 days. Consolidation therapy will comprise of another 24 weeks of obinutuzumab in patients with clinical remission 28 days after the last induction cycle. Obinutuzumab will be applied at a dose of 1000 mg by intravenous infusion every 8 weeks. Maintenance therapy will comprise another 72 weeks in patients with clinical remission 28 days after the last consolidation cycle. Obinutuzumab will be applied at a dose of 1000 mg by intravenous infusion every 8 weeks.
LMU Klinikum
München, Bavaria, Germany
Gesundheitszentrum St. Marien GmbH
Amberg, Germany
HELIOS Klinikum Bad Saarow
Bad Saarow, Germany
Vivantes Netzwerk für Gesundheit GmbH - Vivantes Klinikum am Urban
Berlin, Germany
Charité Campus Benjamin Franklin
Berlin, Germany
Universitätsklinikum Bonn
One-year progression-free survival (PFS) probability from study registration
The rate of patients achieving a progression free survival of more than one year after registration (one-year PFS rate) will serve as early readout for efficacy.
Time frame: 1 year
Complete remission (CR) rates and overall response (CR or partial remission, PR) rates
Time frame: at end of induction (month 6), at end of consolidation (month 12), and at end of maintenance (month 30)
Progression free survival from registration
Time frame: continuous observation up to 78 months
Duration of response
Time frame: from end of induction to progression or death assessed up to 72 months
Cumulative incidence of progression
Time frame: from registration to end of study assessed up to 78 months
Failure-free survival
event defined by failure to achieve a CR/PR after 6 months or progression after CR or PR or death from any cause
Time frame: from start of therapy assessed up to 78 months
Time to next anti-lymphoma therapy and time to next chemotherapy based treatment
Time frame: from start of first-line therapy up to 78 months
Overall survival
Time frame: from registration up to 78 months
Treatment associated adverse events
Time frame: continuous observation up to 78 months
Percentage of MRD-negative patients
Time frame: therapy (month 12), and at end maintenance therapy (month 30)
Duration of molecular remission for MRD negative patients
Time frame: from end of induction therapy up to 72 months
Cumulative incidence of secondary transformations to aggressive lymphoma
Time frame: ongoing observation up to 78 months
Cumulative incidence of secondary malignancies
Time frame: ongoing observation up to 78 months
Percentage of patients with compliance to therapy
Time frame: after 6, 12, and 30 months
Frequency of patient-reported lymphoma symptoms and concerns (FACT-Lym)
Time frame: Baseline, End of Induction, End of Consolidation, End of Maintenance, and every 6 months during FU for at least 2 years until end of the whole study
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