This phase II trial tests the safety, side effects and effectiveness of epcoritamab and tazemetostat in treating patients with grade I-IIIa follicular lymphoma that has come back after a period of improvement (relapsed) or that has not responded to previous treatment (refractory). Epcoritamab is a bispecific monoclonal antibody that binds to two different antigens on the surface of cancer cells that may help the body's immune system attack the cancer and may interfere with the ability of the cancer cells to grow and spread. Tazemetostat, a EZH2 inhibitor, may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving epcoritamab and tazemetostat may be safe, tolerable and/or effective in treating patients with relapsed or refractory grade I-IIIa follicular lymphoma.
PRIMARY OBJECTIVES: I. To assess the safety/tolerability of epcoritamab in combination with tazemetostat in patients with relapsed/refractory follicular lymphoma (FL). (Safety lead-In) II. To evaluate the anti-tumor activity of epcoritamab in combination with tazemetostat in patients with relapsed/refractory FL by complete response rate. (Phase II) SECONDARY OBJECTIVES: I. To estimate overall response rate (ORR) duration of response (DOR) of the combination of epcoritamab and tazemetostat. II. To estimate progression-free survival, and overall survival of the combination of epcoritamab and tazemetostat. III. To assess the toxicities of the combination of epcoritamab and tazemetostat. EXPLORATORY OBJECTIVES: I. To characterize the T-cell population balance in patients treated with epcoritamab and tazemetostat in different compartments (peripheral blood, tumor). II. To explore correlation between response and presence of EZH2 mutations. III. To evaluate minimal residual disease (MRD) dynamics during treatment and explore the correlation of MRD kinetics with response. OUTLINE: Patients receive tazemetostat orally (PO) twice daily (BID) on days 1-28 of each cycle. Patients also receive epcoritamab subcutaneously (SC) on days 1, 8, 15, and 22 of cycles 2-4 then on day 1 of remaining cycles. Cycles repeat every 28 days for up to 13 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo collection of blood samples on study and undergo bone marrow biopsy and computed tomography (CT) or positron emission tomography (PET)/CT throughout the study. After completion of study treatment, patients are followed up at 30 and 60 days then for up to 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
33
Undergo blood sample collection
Undergo bone marrow biopsy
Undergo CT or PET/CT
Given SC
Undergo PET/CT
Given PO
City of Hope Medical Center
Duarte, California, United States
City of Hope at Irvine Lennar
Irvine, California, United States
Incidence of unacceptable adverse events (Safety lead-in)
Observed toxicities will be summarized by type, severity, and attribution. (each cycle is 28 days)
Time frame: up to first 2 cycles of study treatment
Complete response (CR) rate
CR rate will be defined as a best response of CR according to Lugano criteria before any documented disease progression or any subsequent non-Hodgkin lymphoma (NHL) treatment. CR rate will be estimated along with the 95% exact binomial confidence interval.
Time frame: Up to 3 years
Overall response rate (ORR)
ORR will be defined as a best response of CR or partial response (PR) according to Lugano 2016 guidelines on study before any documented disease progression or any subsequent NHL treatment. ORR will be estimated along with the 95% exact binomial confidence interval.
Time frame: Up to 3 years
Duration of response (DOR)
DOR will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error, and 95% confidence interval will be constructed based on log-log transformation. Median DOR will be estimated when possible.
Time frame: From CR or PR to disease progression/relapse or death, up to 3 years
Progression-free survival (PFS)
PFS will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error, and 95% confidence interval will be constructed based on log-log transformation. Median PFS will be estimated when possible.
Time frame: From start of protocol treatment to disease relapse/progression or death, up to 3 years
Overall survival (OS)
OS will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error, and 95% confidence interval will be constructed based on log-log transformation. Median OS will be estimated when possible.
Time frame: From start of protocol treatment to death, up to 3 years
Incidence of adverse events
Adverse events will be evaluated and graded using Common Terminology Criteria for Adverse Events version 5.0. Cytokine release syndrome and or immune effector cell associated neurotoxicity syndrome will be evaluated using American Society for Transplantation and Cellular Therapy Consensus grading criteria. Observed toxicities will be summarized by type, severity, and attribution.
Time frame: Up to 60 days after last dose of study drug
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