This research is being done to evaluate Glofitamab by itself or in combination with Polatuzumab Vedotin, Pirtobrutinib, or Atezolizumab as possible treatments for Chronic Lymphocytic Leukemia (CLL) that has transformed into Richter's Transformation (RT). The names of the study drugs involved in this research study are: * Glofitamab (a T-cell bispecific humanized monoclonal antibody) * Obinutuzumab (a humanized glycoengineered type II anti-CD20 monoclonal antibody) * Polatuzumab vedotin (an antibody-drug conjugate) * Pirtobrutinib (a selective inhibitor of BTK) * Atezolizumab (a humanized immunoglobulin monoclonal antibody) * Tocilizumab (a recombinant, humanized, anti-human monoclonal antibody)
This is an open-label, multicenter phase II study to evaluate the efficacy and safety of glofitamab as monotherapy and in combination with polatuzumab vedotin, pirtobrutinib, or atezolizumab for participants with Richter's Transformation (RT) that has transformed from chronic lymphocytic leukemia (CLL). The U.S. Food and Drug Administration (FDA) has not approved glofitamab, obinutuzumab, polatuzumab vedotin, pirtobrutinib or atezolizumab for RT, but each drug has been approved for other uses. Glofitamab has been approved by the FDA for certain people with diffuse large B-cell lymphoma (DLBCL), which is similar to Richter's Transformation. Glofitamab has been studied as a single therapy and in combination with polatuzumab vedotin and atezolizumab in people with DLBCL. Polatuzumab vedotin is already an approved therapy for diffuse large B-cell lymphoma in combination with chemoimmunotherapy. Pirtobrutinib is an approved therapy for chronic lymphocytic leukemia, small lymphocytic lymphoma, and mantle cell lymphoma. Atezolizumab is an approved therapy for other cancers. Obinutuzumab is an approved therapy for chronic lymphocytic leukemia. Tocilizumab is approved for the treatment of an entity called cytokine release syndrome following another therapy called chimeric antigen receptor T-cell therapy; it will be used to treat cytokine release syndrome if a participant develops it in this study. Study procedures include screening for eligibility, clinic visits for study treatment, blood and urine tests, Positron Emission Tomography (PET) or Computed Topography (CT) scans, bone marrow biopsies, echocardiograms, and electrocardiograms (ECGs). Participants will receive study treatment for about 9 months and will be followed every 3-6 months for up to 10 years thereafter. It is expected that about 70 people will take part in this research study. Genentech, Inc./Loxo Oncology, Inc./Eli Lilly and Company are funding this research study by providing study drugs.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
70
"2:1" T-cell bispecific humanized monoclonal antibody, administered via intravenous infusion per protocol.
Humanized glycoengineered type II anti-CD20 monoclonal antibody, administered via intravenous infusion per protocol.
Antibody-drug conjugate, administered via intravenous infusion per protocol.
Humanized immunoglobulin monoclonal antibody, administered via intravenous infusion per protocol.
For the treatment of Cytokine Release Syndrome. Recombinant, humanized, anti-human monoclonal antibody, administered via intravenous infusion per protocol.
Selective inhibitor of BTK, 50 mg or 100 mg tablet, via oral administration per protocol.
Winship Cancer Institute at Emory University
Atlanta, Georgia, United States
RECRUITINGBrigham and Women's Hospital
Boston, Massachusetts, United States
RECRUITINGDana Farber Cancer Institute
Boston, Massachusetts, United States
RECRUITINGThe University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
RECRUITINGThe Ohio State University Comprehensive Cancer Center
Columbus, Ohio, United States
RECRUITINGBest Complete Response (CR) Rate
Best Complete Response (CR) rate is defined as the proportion of participants achieving CR at any of the 3 timepoints (after 4, 8 and 12 cycles). CR is defined per Lugano 2014 criteria.
Time frame: Disease evaluation will be performed at 12, 24 and 36 weeks
Best Overall Response Rate (ORR)
Best Overall response rate (ORR) is defined as the proportion of participants achieving complete response (CR) or partial response (PR) at any of the 3 timepoints (after 4, 8 and 12 cycles). CR and PR are defined per Lugano 2014 criteria.
Time frame: Disease evaluation will be performed at 12, 24 and 36 weeks
Best Partial Response (PR) Rate
Best Partial response (PR) rate is defined as the proportion of participants achieving partial response at any of the 3 timepoints (after 4, 8, 12 cycles). PR is defined per Lugano 2014 criteria.
Time frame: Disease evaluation will be performed at 12, 24 and 36 weeks
Overall Response Rate at 36 weeks
Overall response rate (ORR) at 36 weeks is defined as the proportion of participants who achieve complete response (CR) or partial response (PR) at the time of disease evaluation at 12 cycles (36 weeks). CR and PR are defined per Lugano 2014 criteria.
Time frame: 36 weeks
Partial Response (PR) Rate at 36 weeks
Partial Response (PR) rate at 36 weeks is defined as the proportion of participants achieving PR at the time of disease evaluation at 12 cycles (36 weeks). PR defined per Lugano 2014 criteria.
Time frame: 36 weeks
Complete Response (CR) Rate at 36 weeks
Complete Response (CR) rate at 36 weeks is defined as the proportion of participants achieving CR at the time of disease evaluation at 12 cycles (36 weeks). CR defined per Lugano 2014 criteria.
Time frame: 36 weeks
Duration of Response (DOR)
Duration of Response (DOR) is defined as the time from date of first documented confirmed objective response (CR + PR) to date of first documented progressive disease (PD) per Lugano 2014 criteria.
Time frame: Disease evaluation will be performed every 3 months, up to 2 years.
Duration of Complete Response (DOCR)
Duration of complete response (DOCR) is defined as the time from date of first documented complete response to date of first documented progressive disease (PD) per Lugano 2014 criteria.
Time frame: In long-term follow-up, participants were assessed every 6 months, up to 2 years
Progression Free Survival (PFS) at 2 years
PFS at 2 years is the percent probability estimate at 2 years based on the Kaplan-Meier method. PFS will be calculated as the time from start of treatment to the date of progressive disease (PD, defined per Lugano 2014 criteria), death, or last follow-up. Participants alive and progression-free at time of last follow-up will be censored.
Time frame: Participants will be followed up to 2 years.
Median Progression Free Survival (PFS)
PFS will be calculated as the time from start of treatment to the date of progressive disease (PD, defined per Lugano 2014 criteria), death, or last follow-up. Participants alive and progression-free at time of last follow-up will be censored.
Time frame: Participants will be followed up to 2 years.
Overall Survival (OS) at 2 years
OS at 2 years is the percent probability at 2 years based on Kaplan-Meier methodology. OS will be calculated as the time from the start of treatment to the date of death, or last follow-up. Participants alive at time of last follow-up will be censored.
Time frame: Participants will be followed up to 2 years.
Median Overall Survival
OS will be calculated as the time from the start of treatment to the date of death, or last follow-up. Participants alive at time of last follow-up will be censored.
Time frame: Participants will be followed up to 10 years.
Minimal Residual Disease (MRD) Negativity
MRD negativity is defined as the proportion of participants that achieve MRD negative, where it measured by multiparametric flow cytometry (Mayo Clinic Laboratories) or the clonoSEQ assay (Adaptive).
Time frame: MRD testing will be performed every 3 months, up to 2 years, then every 6 months, up to 3 years (5 years in total)
Rate and severity of Cytokine Release Syndrome (CRS), immune effector cell-associated Neurotoxicity Syndrome (ICANS), and Hemophagocytic Lymphohistiocyotis (HLH)
CRS, ICANS, and HLH rates and severity will be summarized based on American Society of Transplantation and Cellular Therapy (ASTCT) Consensus grading.
Time frame: Adverse events will be collected at each study visit plus 30 days post treatment end, up to 10 months.
Tocilizumab Usage Rate
Tocilizumab usage rate is defined as the proportion of participants requiring tocilizumab usage of management of CRS.
Time frame: Within the first year on study
Median Tocilizumab Usage
Median tocilizumab usage is defined as median number of doses of tocilizumab administered per participant
Time frame: Within the first year on study
Grade 3-5 Adverse Events Rate
Grade 3-5 AE rate is defined as the proportion of patients who experienced grade 3-5 adverse event based on the Common Toxicity Criteria for Adverse Events version 5.0 as reported on case report form.
Time frame: Adverse events will be collected at each study visit plus 30 days post treatment end
Treatment-related Adverse Events Rate
Treatment-related adverse event rate is defined as the proportion of participants who experienced treatment-related adverse event based on the Common Toxicity Criteria for Adverse Events version 5.0.
Time frame: Adverse events will be collected at each study visit plus 30 days post treatment end
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