This phase I/II trial tests the safety of tafasitamab, retifanlimab, and rituximab (TRR) as a prephase treatment and in combination with standard therapy consisting off cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or polatuzumab vedotin, cyclophosphamide, doxorubicin, and prednisone (PolaCHP) in patients with untreated diffuse large B-cell lymphoma. Tafasitamab, retifanlimab, and rituximab are monoclonal antibodies. Tafasitamab binds to a protein called CD19, which is found on B-cells (a type of white blood cell) and some types of cancer cells. Rituximab binds to a protein called CD20, which is also found on B-cells and some cancer cells. These monoclonal antibodies may help the immune system kill cancer cells. Immunotherapy with other monoclonal antibodies, such as retifanlimab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Chemotherapy drugs, such as CHOP and PolaCHP, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving TRR in combination with CHOP or PolaCHP may kill more cancer cells.
OUTLINE: PREPHASE THERAPY: Patients receive tafasitamab intravenously (IV) over 30 minutes on days 1, 8, and 15 of each cycle, rituximab and hyaluronidase human subcutaneously (SC) on day 1 of each cycle, and retifanlimab IV over 30 minutes on day 8 of each cycle. Treatment repeats every 21 days for 2 cycles in the absence of disease progression or unacceptable toxicity. COMBINATION THERAPY: After completion of prephase therapy or if patients progress during prephase therapy, patients receive tafasitamab IV over 30 minutes, retifanlimab IV over 30 minutes, rituximab and hyaluronidase human SC, cyclophosphamide IV, doxorubicin IV, and vincristine IV on day 1 of each cycle. Patients with an international prognostic index (IPI) score of 2-5 may receive polatuzumab vedotin IV in place of vincristine at investigator discretion. Patients also receive prednisone orally (PO) on days 1-5 of each cycle. Treatment repeats every 21 days for 4-6 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo optional bone marrow biopsy and aspiration and multi-gated acquisition (MUGA) scan at screening, and fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan and collection of blood and tissue samples throughout the trial. After completion of study treatment, patients are followed up at 4-6 weeks, 12 weeks and then per routine care for up to 5 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
35
Undergo bone marrow biopsy
Given IV
Given IV
Given PO
Given IV
Given SC
Given IV
Given vincristine
Undergo bone marrow aspiration
Undergo MUGA
Undergo FDG-PET/CT
Undergo FDG-PET
Undergo FDG-CT
Undergo collection of blood samples
Given IV
Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
RECRUITINGDose limiting toxicity rate
Statistical analysis will entail descriptive statistics of adverse event rates. Will build a Cox proportional hazard model for univariate analysis and multivariable analysis if applicable. Correlative studies may incorporate t-test and linear regression for continuous variables, Chi-squared test and logistic regression for categorical variables will be used, if applicable.
Time frame: From treatment start to end of cycle 3 (each cycle is 3 weeks)
Overall response rate
Will build a Cox proportional hazard model for univariate analysis and multivariable analysis if applicable. Correlative studies may incorporate t-test and linear regression for continuous variables, Chi-squared test and logistic regression for categorical variables will be used, if applicable.
Time frame: Up to 5 years
Progression-free survival
Time-to-event analyses for progression-free survival will be conducted using the Kaplan-Meier method and log-rank test. Will build a Cox proportional hazard model for univariate analysis and multivariable analysis if applicable. Correlative studies may incorporate t-test and linear regression for continuous variables, Chi-squared test and logistic regression for categorical variables will be used, if applicable.
Time frame: Time from start of trial therapy until relapse or progression, non-protocol re-treatment of lymphoma, or death as a result of any cause, assessed up to 5 years
Overall survival
Time-to-event analyses for overall survival will be conducted using the Kaplan-Meier method and log-rank test. Will build a Cox proportional hazard model for univariate analysis and multivariable analysis if applicable. Correlative studies may incorporate t-test and linear regression for continuous variables, Chi-squared test and logistic regression for categorical variables will be used, if applicable.
Time frame: From start of trial therapy to death from any cause, assessed up to 5 years
Proportion completing prephase
Will build a Cox proportional hazard model for univariate analysis and multivariable analysis if applicable. Correlative studies may incorporate t-test and linear regression for continuous variables, Chi-squared test and logistic regression for categorical variables will be used, if applicable.
Time frame: Up to 5 years
Relative dose intensity of doxorubicin and cylcophosphamide during combination therapy
Relative dose intensity for doxorubicin and cyclophosphamide will be calculated as follows: * Standard dose intensity (SDI): (Standard total dose, in mg/m2 )/(standard time to complete chemotherapy, in days * Delivered dose intensity (DDI): (Delivered total dose, in mg/m2)/(actual time to complete chemotherapy, in days) * Relative dose intensity: DDI/SDI x 100% Will build a Cox proportional hazard model for univariate analysis and multivariable analysis if applicable. Correlative studies may incorporate t-test and linear regression for continuous variables, Chi-squared test and logistic regression for categorical variables will be used, if applicable.
Time frame: Up to 5 years
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