The goal of this clinical trial is to learn about how a combination of tazemetostat and venetoclax in people with relapsed/refractory Non-Hodgkin Lymphoma (R/R NHL). The main questions that this trial aims to answer are what is the best dose of venetoclax to give with tazemetostat to people with R/R NHL; what types of side effects do people with R/R NHL get when taking venetoclax with tazemetostat; and what effects does this combination have on R/R NHL. Participants will need to take pills by mouth every day and regularly come to the clinic for blood work and imagining to monitor side effects and cancer progression. Participants may receive study drugs for up to 24 months.
This a phase 1, single arm, non-randomized trial of tazemetostat in combination with venetoclax in participants with two types of relapsed/refractory non-Hodgkin lymphoma. The purpose of this study is to evaluate the safety of the combination of tazemetostat and venetoclax in patients with relapsed/refractory (R/R) Follicular Lymphoma (FL) and Diffuse Large B-cell Lymphoma (DLBCL). This trial will be conducted in two parts. To evaluate the safety of the combination of tazemetostat and venetoclax in patients with relapsed/refractory (R/R) Follicular Lymphoma (FL) and Diffuse Large B-cell Lymphoma (DLBCL) we will conduct a phase I trial in two parts. In part one, we will perform a single-arm, open-label sequential dose escalation (3+3) of venetoclax in combination with tazemetostat, given at its recommended phase II dose (RP2D) of 800mg BID, to determine the maximum tolerated dose (MTD) of venetoclax. In part two, we will enroll two expansion cohorts (R/R DLBCL and R/R FL) to further characterize the safety and tolerability of the combination, and to estimate the preliminary efficacy. Up to 18 participants will be enrolled in part 1 and 20 participants will be enrolled in part 2.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
3
Participants will receive oral venetoclax taken once per day. The dose will be between 200 and 800 mg daily, with the exact dose determined by the protocol.
Tazemetostat 800mg taken orally, twice daily.
Weill Cornell Medicine/NewYork-Presberteryian Hospital
New York, New York, United States
Maximum-tolerated dose (MTD) determination (Part 1)
In part 1 of this study, participants will be assigned a dose of venetoclax following a (3+3) dose escalation design and monitored for dose-limiting toxicities (DLTs) during the first treatment cycle. Based on observed DLTs observed in each dose level cohort, the maximum-tolerated dose will be determined. The # of patients experiencing a DLT among the evaluable patients for each dose level in part 1 will be tabulated.
Time frame: Day 0 to 28
Number of participants who experience dose-limiting toxicities (DLTs)
In part 1 of this study, participants will be assigned a dose of venetoclax following a (3+3) dose escalation design and monitored for dose-limiting toxicities (DLTs) during the first treatment cycle. Dose limiting toxicity (DLT) will be assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0 (NCI CTCAE v5.0).
Time frame: Day 0 to 28
Number of participants who experience adverse events (AEs), from baseline to 30 days after the last dose of study drug, as assessed by CTCAE v5.0
The safety analysis population will consist of all enrolled patients who receive at least one dose of study drug. AEs and SAEs will be tabulated by type, grade, and attribution for all patients overall and by treatment group. For each patient, and within each type of toxicity, the patient will be counted only once at the highest grade of that toxicity. Participants will be evaluated for AEs/SAEs from the time they sign the informed consent form until 30 days after their last dose of study drug.
Time frame: Baseline through 25 months
Number of adverse events (AEs) by severity from baseline to 30 days, after the last dose of study drug as assessed, by CTCAE v5.0
The safety analysis population will consist of all enrolled patients who receive at least one dose of study drug. AEs and SAEs will be tabulated by type, grade, and attribution for all patients overall and by treatment group. For each patient, and within each type of toxicity, the patient will be counted only once at the highest grade of that toxicity. Participants will be evaluated for AEs/SAEs from the time they sign the informed consent form until 30 days after their last dose of study drug.
Time frame: Baseline through 25 months
Number of Participants who Achieve Complete Response (CR)
CR will be assessed for all evaluable patients in parts 1+2 according to Lugano response criteria.
Time frame: Day 0 through 24 months
Number of Participants who Achieve Partial Response (PR)
PR will be assessed for all evaluable patients in parts 1+2 according to Lugano response criteria.
Time frame: Day 0 through 24 months
Overall Response Rate (ORR)
The ORR response rate is the proportion of patients with a best overall response of either complete response (CR) or partial response (PR) among all evaluable patients. ORR, CR, and PR will be assessed for all evaluable patients in parts 1+2 according to Lugano response criteria. The best overall response is the best response recorded from the start of treatment until progressive disease.
Time frame: Day 0 through 24 months
Duration of Response (DoR)
The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or PD is objectively documented (taking as reference for PD the smallest measurements recorded since the treatment started). The duration of overall CR is measured from the time measurement criteria are first met for CR until the first date that recurrent disease is objectively documented. Duration of stable disease is measured from the start of the treatment until the criteria for progression are met, taking as reference the smallest measurements recorded since the treatment started.
Time frame: From date of treatment initiation until the date of first documented progression or date of death from any cause, whichever came first, as assessed at 5 years
Progression-Free Survival
PFS is defined as the duration of time from start of treatment to time of documentation of progression or death from any cause.
Time frame: From date of treatment initiation until the date of first documented progression or date of death from any cause, whichever came first, as assessed at 5 years
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Overall Survival (OS)
OS is defined as the duration of time from start of treatment to death from any cause.
Time frame: From date of treatment initiation until the date of death from any cause, as assessed at 5 years
Mean Change in Functional Assessment of Cancer Therapy - Lymphoma (FACT-Lym) Score from Baseline to End of Treatment
FACT-Lym is a 42 item questionnaire that includes questions on physical well-being, social/family well-being, emotional well-being, functional well-being, and lymphoma symptoms over the past 7 days. Each response is measured on a 5 point Likert-type scale. Scores can range from 0 to 168 with higher scores indicating better quality of life.
Time frame: Baseline; at the start of Cycle 4 (a cycle is 28 days); at the start of Cycle 7; and End of Treatment (treatment will continue until disease progression or unacceptable toxicity for a maximum of approximately 2 years)