This phase I trial tests zanubrutinib in combination with sonrotoclax for treating underrepresented ethnic and racial minorities with B-cell non-Hodgkin lymphoma that has come back after a period of improvement (relapsed) or that has not responded to previous treatment (refractory). Many racial and ethnic minorities face additional treatment challenges which may lead to poorer outcomes, however, there are fewer racial and ethnic minorities participating in clinical trials. Zanubrutinib, a type of tyrosine kinase inhibitor, blocks a protein called Bruton tyrosine kinase (BTK), which may help keep cancer cells from growing. Sonrotoclax works by blocking a protein called B-cell lymphoma-2 (Bcl-2). This protein helps certain types of blood cancer cells to survive and grow. When sonrotoclax blocks Bcl-2, it slows down or stops the growth of cancer cells and causes them to die. Zanubrutinib and sonrotoclax have been shown to be an effective treatment for B-cell cancers. Giving zanubrutinib in combination with sonrotoclax may be effective in treating ethnic and racial minorities with relapsed or refractory B-cell non-Hodgkin lymphoma.
PRIMARY OBJECTIVES: I. Assess the feasibility of completing zanubrutinib lead-in and sonrotoclax ramp up in underrepresented minorities with relapsed/refractory (r/r) B cell non-Hodgkin lymphoma (B-NHL). II. Assess the feasibility of patient retention through 2 cycles of combination therapy at a steady dose in underrepresented minorities with r/r B-NHL. SECONDARY OBJECTIVES: I. Assess safety and tolerability. II. Estimate overall response rate (ORR). III. Estimate complete response (CR) rate. IV. Estimate time to response. V. Estimate progression free survival (PFS). VI. Estimate overall survival (OS). EXPLORATORY OBJECTIVES: I. Assess demographics potentially related to health care disparities including the highest level of education within the home, primary language spoken by patient, distance from patient's home to treating institution, time from diagnosis of r/r B-NHL until seen at trial center and socioeconomic status by zip code of participant. II. Estimate minimum residual disease (MRD) rate for patients with chronic lymphocytic leukemia (CLL)/small cell leukemia (SLL) only. III. For the first 7 patients only: assess feasibility of using mobile phlebotomy for blood sample collection. IV. Evaluate the relationship between three-factor risk estimate scale (Tres) comorbidity score and survival outcomes. V. Assess patient-reported quality-of-life outcomes. VI. Assess patient-reported perceptions of clinical trial participation and barriers. OUTLINE: Patients receive zanubrutinib orally (PO) once daily (QD) on days 1-28 of each cycle. Starting with cycle 3, patients also receive sonrotoclax PO QD on days 1-28 of each cycle. Cycles repeat every 28 days for up to 28 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo urine and blood sample collection, and computed tomography (CT) or magnetic resonance imaging (MRI) throughout the study. Additionally, patients may undergo biopsy at progression and bone marrow aspiration and biopsy throughout the study. After completion of study treatment, patients are followed up at 30 days then every 3 months for up to 3 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
37
Undergo biopsy
Undergo urine and blood sample collection
Undergo bone marrow aspiration and biopsy
Undergo bone marrow aspiration and biopsy
Undergo CT
Undergo MRI
Ancillary studies
Given PO
Given PO
City of Hope Medical Center
Duarte, California, United States
RECRUITINGFeasibility of completing zanubrutinib lead-in (cycle 1 and cycle 2) and sonrotoclax ramp up (cycle 3)
Will be estimated as a binary proportion along with the 95% exact binomial confidence interval.
Time frame: From start of cycle 1 through end of cycle 3 (cycle length = 28 days)
Feasibility of patient retention through 2 cycles of the combination therapy at a steady dose
Will be estimated as a binary proportion along with the 95% exact binomial confidence interval.
Time frame: From start of cycle 4 though end of cycle 5 (cycle length = 28 days)
Incidence of adverse events (AEs)
Will be coded and graded by National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. For chronic lymphocytic leukemia/small lymphocytic leukemia, hematologic AEs will be coded and graded by International Workshop on Chronic Lymphocytic Leukemia.
Time frame: Up to 30 days after last dose of study treatment
Overall response rate
Will be defined as achieving a best response of complete response (CR) or partial response (PR). Will be calculated as the proportion of response-evaluable participants achieving an overall response. Will be estimated as a binary proportion along with the 95% exact binomial confidence interval.
Time frame: After the start of protocol therapy and prior to disease progression and/or start of other anti-lymphoma therapy, assessed up to 3 years
CR rate
Will be defined as achieving a best response of CR. CR rate will be calculated as the proportion of response-evaluable participants achieving CR. Will be estimated as a binary proportion along with the 95% exact binomial confidence interval.
Time frame: After the start of protocol therapy and prior to disease progression and/or start of other anti-lymphoma therapy, assessed up to 3 years
Time to response
Will be summarized by descriptive statistics.
Time frame: From start of protocol treatment to the time CR or PR is first achieved, assessed 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. The 95% confidence interval will be constructed based on log-log transformation. Media PFS will be estimated when available. Analysis will be performed in aggregate as well as separately for the two cohorts.
Time frame: From start of protocol treatment to time of disease relapse/progression or death due to any cause, whichever occurs earlier, assessed 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. The 95% confidence interval will be constructed based on log-log transformation. Media OS will be estimated when available. Analysis will be performed in aggregate as well as separately for the two cohorts.
Time frame: From start of protocol treatment to time of death due to any cause, assessed up to 3 years
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