The purpose of this clinical trial is to learn if the study drug Tazemetostat combined with Zanubrutinib and anti-CD20 monoclonal antibody is safe and effective in treating patients with relapsed or refractory indolent B-cell non-Hodgkin lymphoma.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
24
Tazemetostat will be self-administered BID as an oral treatment on a 28-day cycle.
Zanubrutinib will be self-administered BID as an oral treatment on a 28-day cycle.
Rituximab or a biosimilar will be administered intravenously per standard of care.
Huntsman Cancer Institute at University of Uta
Salt Lake City, Utah, United States
Maximum Tolerated Dose (MTD) of tazemetostat in combination with zanubrutinib and anti-CD20 mAb
To determine the MTD of tazemetostat in with zanubrutinib and anti-CD20 mAb. MTD is the highest dose where 0 of the first 3 or 1 of 6 patients had a dose-limiting Toxicity (DLT) during Cycle 1 of tazemetostat treatment. This will report the number of patients with DLTs at Dose Level (DL)-1, DL1, and DL2. A DLT is: A Grade ≥ 3 non-hematologic toxicity lasting \>3 days EXCEPT: * Alopecia * Grade 3 fatigue, asthenia, anorexia, constipation, nausea, vomiting, or diarrhea not requiring tube feeding, total parenteral nutrition, or hospitalization * Grade 3 or 4 tumor lysis syndrome (resolved ≥7 days) or electrolyte abnormalities (resolved to \< Grade 2 in \<72 hours) * Grade 3 alkaline phosphatase, gamma-glutamyl transferase, amylase, or lipase elevation \< 72 hours. Any of these hematologic toxicities: * Grade 4 neutropenia, febrile neutropenia, or thrombocytopenia * Grade 5 hematologic toxicity Dose delay due to toxicity \> 28 days
Time frame: 2 years
Overall response rate (ORR) rate at Cycle 7 Day 1 (C7D1)
To evaluate the ORR at C7D1. ORR is the proportion of patients who had a treatment outcome of Partial Response (PR), Very Good Partial Response (VGPR), or Complete Response (CR). CR is the absence of serum monoclonal Immunoglobulin M (IgM) protein by immunofixation, normal serum IgM level, resolution of extramedullary disease, and normal bone marrow aspirate and trephine biopsy. VGPR is detectable monoclonal IgM protein, ≥90% reduction in serum IgM level, complete resolution of extramedullary disease, and no new signs of active disease. PR is detectable Monoclonal IgM protein, ≥50% but \< 90% reduction in serum IgM, reduction in extramedullary disease, and no new sign of active disease. These are based on the response criteria for Waldenstrom Macroglobulinemia (WM) developed by the International Workshop on WM (IWWM), updated in the sixth IWWM. ORR indicates that treatment was effective. This outcome measure will report the proportion of patients who achieve ORR at C7D1.
Time frame: 8 months
Very Good Partial Response (VGPR) Rate at Cycle 7 Day 1 (C7D1)
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Obinutuzumab will be administered intravenously on days 1, 8, 15 of cycle 1 and then day 1 of cycles 2 to 12.
To evaluate the Very Good Partial Response (VGPR) rate at Cycle 7 Day 1 (C7D1). VGPR is a treatment outcome for t B-cell non-Hodgkin lymphomas characterized by detectable monoclonal IgM protein, ≥90% reduction in serum IgM level from baseline, a complete resolution of extramedullary disease (ie, lymphadenopathy/splenomegaly if present at baseline), and no new signs or symptoms of active disease. The response assessment will be based on the consensus-based uniform response criteria for Waldenstrom Macroglobulinemia (WM) developed by the International Workshop on Waldenstrom's Macroglobulinemia (IWWM), updated in the sixth IWWM. VGPR is used to indicate that the treatment has been highly effective, leading to substantial but not complete remission. This outcome measure will report the proportion of patients who achieve VGPR at C7D1.
Time frame: 8 months
Median Duration of Response (DOR)
To evaluate the Duration of Response (DOR) in participants who achieve response. DOR is defined as for patients who achieve response, the time from initial response to the time of death or progression, whichever occurs first. Participants who still respond at their last follow-up will be censored at that time. This outcome measure will report the median DOR and corresponding 95% confidence interval.
Time frame: 7 years
Median Progression-Free Survival (PFS)
To evaluate median Progression-Free Survival (PFS) from treatment initiation. PFS is defined as the time from treatment initiation to the time of disease progression or death. Patients who are alive and progression-free will be censored at their last follow-up time. Patients who start a subsequent anticancer therapy will be censored at their last follow-up prior to the start of anticancer therapy. This outcome measure will report the median PFS with the corresponding 95% confidence interval.
Time frame: 2 years
Progression-Free Survival (PFS) at two years after treatment initiation.
To evaluate Progression-Free Survival (PFS) at two years after treatment initiation. PFS is defined as the time from treatment initiation to the time of disease progression or death. Patients who are alive and progression-free will be censored at their last follow-up time. Patients who start a subsequent anticancer therapy will be censored at their last follow-up prior to the start of anticancer therapy. This outcome will report the proportion of patients who remain free from disease progression two years after starting treatment.
Time frame: 2 years
Median Overall Survival (OS)
To evaluate median overall survival (OS) from treatment initiation. OS is defined as the time from treatment initiation to the time of death, with participants who are alive at their last follow-up time being censored at that time. This outcome measure will report the median OS with the corresponding 95% confidence interval.
Time frame: 2 years
Overall Survival (OS) at two years after treatment initiation.
To evaluate Overall Survival (OS) at two years after treatment initiation. OS is defined as the time from treatment initiation to the time of death, with participants who are alive at their last follow-up time being censored at that time. This outcome will report the proportion of participants who are still alive two years following the start of their treatment.
Time frame: 2 years