This Phase 1, open-label, multicenter study is evaluating the safety, tolerability, pharmacokinetics, pharmacodynamics, and preliminary antitumor activity of lonitoclax (ZE50-0134) in adults with relapsed or refractory chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), and select low-grade B-cell lymphomas. The study has two sequential parts. Part 1 uses dose escalation to determine the biologically effective dose and/or maximum tolerated dose of lonitoclax. Participants receive a 3-day step-up regimen followed by continuous once-daily or twice-daily oral dosing in 28-day cycles. Part 2 is a randomized dose-expansion comparison of two selected lonitoclax dose levels in venetoclax-naive participants with relapsed or refractory CLL/SLL. Treatment may continue for up to 12 cycles and, for participants deriving clinical benefit, for up to 24 cycles with approval from the Medical Monitor.
This is an open-label, multicenter Phase 1 study with two sequential parts. Part 1 is a non-randomized dose-escalation study in participants with relapsed or refractory CLL/SLL or select low-grade lymphomas. A standard 3+3 design is used to evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics, and preliminary antitumor activity of lonitoclax (ZE50-0134), and to identify a biologically effective dose and/or maximum tolerated dose. Planned dose levels include once-daily and twice-daily regimens. Dose Levels 6a and 6b may enroll concurrently. Dose-limiting toxicities are evaluated during Cycle 1. To reduce the risk of tumor lysis syndrome, participants receive intravenous hydration beginning on Day -1 and a 3-day step-up dosing regimen as inpatients. After step-up dosing, the assigned lonitoclax dose is administered orally once daily or twice daily in a fed state. Each treatment cycle is 28 days. Part 2 is a randomized dose-expansion portion in venetoclax-naive participants with relapsed or refractory CLL/SLL. Approximately 15 participants are assigned to each of two selected dose levels: the biologically effective dose or maximum tolerated dose and one lower dose level, provided activity is observed. Part 2 evaluates safety, tolerability, pharmacokinetics, pharmacodynamics, and preliminary antitumor activity to support selection of a recommended Phase 2 dose. Treatment is continuous for up to 12 cycles. Participants deriving clinical benefit may continue treatment for up to 24 cycles at the investigator's discretion with Medical Monitor approval. Participants are followed for safety after treatment and for disease progression, subsequent treatment, and survival.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
84
Lonitoclax is supplied as immediate-release white opaque soft gelatin capsules in 25 mg, 100 mg, and 250 mg strengths. Participants receive a 3-day step-up regimen followed by the assigned oral dose once daily (QD) or twice daily (BID) in a fed state, administered within 1 hour of food. Each cycle is 28 days. Treatment continues for up to 12 cycles and may continue for up to 24 cycles in participants deriving clinical benefit, at the investigator's discretion with Medical Monitor approval. Participants receive inpatient monitoring and tumor lysis syndrome prophylaxis during the initial step-up period.
Norton Cancer Institute, St. Matthews Campus
Louisville, Kentucky, United States
RECRUITINGUniversity of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
RECRUITINGUniversity of Cincinnati
Cincinnati, Ohio, United States
RECRUITINGThe Ohio State University
Columbus, Ohio, United States
RECRUITINGUT Southwestern Medical Center
Dallas, Texas, United States
NOT_YET_RECRUITINGIncidence and severity of treatment-emergent adverse events and serious adverse events
Number and percentage of participants with treatment-emergent adverse events, serious adverse events, clinically significant laboratory abnormalities, adverse events related to lonitoclax, and adverse events leading to treatment discontinuation. Adverse events are graded using NCI CTCAE Version 5.0.
Time frame: From first dose through 30 days after the last dose; treatment may continue for up to 24 cycles (28 days per cycle).
Incidence of dose-limiting toxicities in Part 1
Number and percentage of Part 1 participants experiencing a protocol-defined dose-limiting toxicity during the dose-limiting toxicity assessment period.
Time frame: Cycle 1 (Days 1-28).
Determination of the biologically effective dose and/or maximum tolerated dose
The selected dose is determined from the totality of safety, dose-limiting toxicity, pharmacokinetic, pharmacodynamic, and early response data across Part 1 dose cohorts according to the protocol-defined dose-escalation rules.
Time frame: After completion of Cycle 1 for evaluable participants in each Part 1 dose cohort.
Overall Response Rate (ORR)
Proportion of participants whose best overall response is partial response or better, as assessed by the investigator using iwCLL criteria for CLL, Lugano criteria for SLL and other applicable low-grade lymphomas, or Waldenstrom response criteria, as applicable.
Time frame: From first dose through end of treatment, up to 24 cycles (28 days per cycle).
Duration of response (DOR)
For participants with partial response or better, time from the first documented response until disease progression or death from any cause.
Time frame: From first documented response until progression, death, withdrawal, loss to follow-up, or sponsor termination; assessed during treatment and long-term follow-up.
Progression-free survival (PFS)
Time from first dose until disease progression by the applicable disease-specific response criteria or death from any cause.
Time frame: From first dose until progression, death, withdrawal, loss to follow-up, or sponsor termination; assessed during treatment and long-term follow-up.
Time to next treatment (TTNT)
Time from first dose of lonitoclax to initiation of a non-protocol anticancer treatment for CLL/SLL or death.
Time frame: From first dose until initiation of new anticancer treatment, death, withdrawal, loss to follow-up, or sponsor termination.
Maximum observed plasma concentration (Cmax) of lonitoclax
Maximum observed plasma concentration derived from serial plasma concentration measurements after lonitoclax administration.
Time frame: Cycle 1 Days 1-4, 8, 15, and 22; Cycle 2 Days 1-2; and end-of-treatment/early-termination sampling as applicable.
Area under the plasma concentration-time curve (AUC) of lonitoclax
AUC derived from serial plasma concentration measurements. For QD dosing, planned calculations include AUC0-8h or AUC0-6h and AUC0-24h. For BID dosing, planned calculations include AUC0-8h or AUC0-6h after the morning dose.
Time frame: Cycle 1 Days 1-3 and Cycle 2 Day 1, based on protocol-specified serial PK sampling.
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