This phase II trial tests the safety and effectiveness of glofitamab given in combination with pirtobrutinib in treating patients with mantle cell lymphoma that has come back after a period of improvement (relapsed) or that has not responded to previous treatment (refractory). Glofitamab and obinutuzumab are monoclonal antibodies that may interfere with the ability of cancer cells to grow and spread. Obinutuzumab may also reduce the risk of immune-related conditions from treatment. Pirtobrutinib is in a class of medications called kinase inhibitors. It works by blocking the action of the protein that signals cancer cells to multiply. Giving glofitamab in combination with pirtobrutinib may be safe, tolerable and/or effective in treating patients with relapsed or refractory mantle cell lymphoma.
PRIMARY OBJECTIVES: I. To characterize the safety and tolerability of the combination of glofitamab and pirtobrutinib in the first six participants enrolled. II. To evaluate the preliminary efficacy of glofitamab and pirtobrutinib in participants with relapsed or refractory mantle cell lymphoma (MCL) as measured by complete response rate. SECONDARY OBJECTIVES: I. To evaluate the preliminary efficacy of glofitamab and pirtobrutinib in participants with relapsed or refractory MCL as measured by progression-free survival and overall survival. II. To characterize the magnitude and duration of anti-tumor activity by objective response rate and duration of response. III. To characterize the safety and tolerability of the combination of glofitamab and pirtobrutinib. IV. To evaluate the preliminary efficacy of glofitamab and pirtobrutinib in participants with relapsed or refractory MCL as measured by complete response without measurable disease (CRMRD-) rate. V. To evaluate the time-to-complete response without measurable residual disease (CRMRD-). VI. To evaluate the treatment-free interval among participants who discontinue treatment following CRMRD- status. EXPLORATORY OBJECTIVES: I. To explore associations between baseline tumor characteristics including genetic (e.g. mutations in BTK) and immune profiles (e.g. expression of co-inhibitory receptors and T cell phenotypes) and outcomes in participants administered the combination of glofitamab and pirtobrutinib. II. To explore the effects of the combination of glofitamab and pirtobrutinib on pharmacodynamic markers relating to drug mechanism (e.g. emergence of clones with mutations conferring resistance to the study combination). III. To estimate the quality of life of participants during therapy with glofitamab and pirtobrutinib. IV. To explore time-to-CRMRD- during therapy with glofitamab and pirtobrutinib. OUTLINE: Participants receive study treatments until the absence of disease progression or unacceptable toxicity. Participants may also have a bone marrow biopsy and aspiration at cycle 13 and plasma and blood samples collected throughout study for correlative research. Additionally, participants may undergo a tissue biopsy at relapse or progression. Participants are followed for 30 days after treatment discontinuation for safety. Participants who discontinue treatment due to complete response (CR) with undetectable MRD will complete in-person visits through the end of study visit, 94 weeks from start of treatment. Participants who discontinue treatment for any reason other than CR will be followed every 3 months for up to 94 weeks from start of treatment, until death, loss to follow up, study termination, or participant withdrawal.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Given intravenously (IV)
Given IV
Given Orally (PO)
Undergo regular care imaging/scans
Blood and tissue samples
ClonoSEQ is an FDA-cleared, Clinical Laboratory Improvement Amendments of 1988 (CLIA)-validated measure used to determine minimal residual disease (MRD). This helps uncover how much, if any, cancer remains in your body during and after treatment.
Undergo bone marrow biopsy and aspiration.
University of California, Davis
Davis, California, United States
RECRUITINGUniversity of California, Los Angeles
Los Angeles, California, United States
RECRUITINGUniversity of California, San Francisco
San Francisco, California, United States
RECRUITINGPercentage of participants with high grade, treatment-emergent adverse events (AEs)
The severity of the toxicities will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0. AEs and clinically significant laboratory abnormalities meeting grade 3 4 or 5 will be summarized by maximum intensity and relationship to study drug for the first 6 participants from the initiation of the study drug combination (Cycle 2 Day 8 (C2D8)) through the end of cycle 2 (Cycle 2 Day 21 (C2D21)), approximately 14 days.
Time frame: Approximately 2 weeks
Proportion of participants with Complete Response (CR)
CR will be defined as the proportion of treated participants who experience a CR per Lugano criteria among evaluable participants. The Lugano classification recommends the Deauville five-point scale for reporting response by Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET)/Computerized tomography (CT): (1) no uptake or no residual uptake (when used interim) (2) slight uptake, but below blood pool (mediastinum) (3) uptake above mediastinal, but below or equal to uptake in the liver (4) uptake slightly to moderately higher than liver (5) markedly increased uptake or any new lesion (on response evaluation) from cycle 5 Day 1 through the follow-up period up to 94 weeks.
Time frame: Up to 94 weeks
Proportion of participants with reported Cytokine-release syndrome (CRS)
The proportion of participants with a diagnosed incident of CRS for the first 6 participants from the initiation of the study drug combination (Cycle 2 Day 8 (C2D8)) through the end of cycle 2 (Cycle 2 Day 21 (C2D21)), approximately 14 days, and graded according to the American Society of Transplantation and Cellular Therapy (ASTCT) criteria will be reported.
Time frame: Approximately 2 weeks
Proportion of participants with immune effector cell-associated neurotoxicity syndrome (ICANS)
The proportion of participants with a diagnosed incident of ICANS for the first 6 participants from the initiation of the study drug combination (Cycle 2 Day 8 (C2D8)) through the end of cycle 2 (Cycle 2 Day 21 (C2D21)), approximately 14 days, and graded according to the American Society of Transplantation and Cellular Therapy (ASTCT) criteria will be reported.
Time frame: Approximately 2 weeks
Proportion of participants with reported Hemophagocytic lymphohistiocytosis (HLH)
The proportion of participants with a diagnosed incident of HLH for the first 6 participants from the initiation of the study drug combination (Cycle 2 Day 8 (C2D8)) through the end of cycle 2 (Cycle 2 Day 21 (C2D21)), approximately 14 days, and graded according to the American Society of Transplantation and Cellular Therapy (ASTCT) criteria will be reported.
Time frame: Approximately 2 weeks
Median Progression-free survival (PFS)
PFS will be defined as the time that elapses between initiation of trial therapy and the earlier of the day of first documented disease progression or death from any cause. Progression is defined by Lugano criteria of (1) new or increased adenopathy; an individual node must be abnormal with: (a) longest transverse diameter (LDi) \>1.5 cm AND (2) splenic volume increase (3) new or larger non-measured lesions (4) recurrent previously resolved lesions (5) new extranodal lesion \>1 cm in any axis (new lesions \<1 cm in any axis are included if these are "unequivocally attributable" to lymphoma) (6) a new node \>1.5 cm in any axis . PFS will be summarized using Kaplan-Meier method.
Time frame: Up to 94 weeks
Median Overall Survival (OS)
OS will be defined as the time that elapses between the initiation of trial therapy and the date of death from any cause for all evaluable participants. OS will be summarized using Kaplan-Meier method.
Time frame: Up to 94 weeks
Objective Response Rate (ORR)
OR will be defined as the proportion of treated participants who experience an objective response (CR or partial response (PR) per Lugano criteria) among evaluable participants.
Time frame: Up to 94 weeks
Duration of response (DOR)
DOR will be defined as the time that elapses between the day of first documented response to trial therapy (CR or PR, whichever is first recorded) and subsequent disease progression.
Time frame: Up to 94 weeks
Proportion of participants with complete response without measurable disease (CRMRD)
CRMRD will be defined as the achievement of =\< 1 x 10-6 malignant cells in peripheral blood, as assessed by ClonoSEQ assay in a participant who meets all other criteria for CR.
Time frame: At cycle 13, day 1 (a cycle is 21 days)
Median Time to CRMRD
Time to CRMRD will calculate the time that elapses between the initiation of trial therapy and the day of first documented CRMRD and summarized using Kaplan-Meier method.
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Time frame: Up to 94 weeks
Median Treatment-free interval
Treatment-free interval will be defined as the time that elapses from CRMRD status to the time of recurrence and summarized using Kaplan-Meier method.
Time frame: Up to 94 weeks