This phase Ib trial tests the safety and side effects of glofitamab after pre-treatment with obinutuzumab and how well they work in treating patients with central nervous system (CNS) lymphoma. Glofitamab is a bispecific antibody that can bind to two different antigens (substances that cause the body to make a specific immune response) at the same time. Glofitamab binds to CD20 on lymphoma cells, and CD3 on T-cells (a type of white blood cell) and may interfere with the ability of cancer cells to grow and spread. Obinutuzumab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. A monoclonal antibody is a type of protein that can bind to certain targets in the body, such as molecules that cause the body to make an immune response (antigens). Obinutuzumab can also be administered as a pre-treatment to make glofitamab safer and more tolerable. Giving glofitamab with obinutuzumab pre-treatment may be safe, tolerable, and/or effective in treating patients with CNS lymphoma.
PRIMARY OBJECTIVE: I. To evaluate the safety of glofitamab with obinutuzumab pre-treatment in patients with primary and secondary CNS lymphoma. SECONDARY OBJECTIVES: I. To estimate the overall response rate of glofitamab with obinutuzumab pre-treatment in primary and secondary CNS lymphoma. II. To estimate the complete response rate, duration of response, duration of complete response, progression-free survival, event-free survival, and overall survival of glofitamab with obinutuzumab pre-treatment in primary and secondary CNS lymphoma. EXPLORATORY OBJECTIVES: I. To evaluate the degree to which glofitamab crosses the blood brain barrier (BBB) in CNS lymphoma and define biomarkers of response and toxicity to treatment. II. To assess the utility of tocilizumab to address cytokine release syndrome in CNS lymphoma subjects treated with glofitamab. III. To assess the utility of corticosteroids to address immune effector cell-associated neurotoxicity syndrome in CNS lymphoma subjects treated with glofitamab. OUTLINE: Patients receive obinutuzumab intravenously (IV) on day 1 of cycle 1 and glofitamab IV over 2-4 hours on days 8 and 15 of cycle 1 and on day 1 of subsequent cycles. Cycles repeat every 21 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo computed tomography (CT) or positron emission tomography (PET)/CT at screening and cerebrospinal fluid (CSF) and blood sample collection, brain magnetic resonance imaging (MRI) throughout the study. Patients with secondary CNS lymphoma also undergo CT or PET/CT throughout the study. Additionally, patients with baseline CSF involvement, may undergo lumbar puncture throughout the study. After completion of study treatment, patients are followed up at 30 days and at 3, 6, 9, 12, 18, and 24 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Undergo CSF and blood sample collection
Undergo CT or PET/CT
Given IV
Undergo lumbar puncture
Undergo brain MRI
Given IV
Undergo PET/CT
City of Hope Medical Center
Duarte, California, United States
Incidence of grade 3 or higher non-hematologic toxicity that does not resolve to grade 1 or better within 7 days
For continuous variables, descriptive statistics such as number, mean, standard deviation, standard error, median (range) etc. will be provided. For categorical variables, counts and percentages will be provided. Observed toxicities will be summarized by type, severity, and attribution.
Time frame: During first 2 cycles of treatment (cycle length = 21 days)
Incidence of grade 3 or 4 thrombocytopenia associated with grade >= 3 bleeding
For continuous variables, descriptive statistics such as number, mean, standard deviation, standard error, median (range) etc. will be provided. For categorical variables, counts and percentages will be provided. Observed toxicities will be summarized by type, severity, and attribution.
Time frame: During first 2 cycles of treatment (cycle length = 21 days)
Incidence of grade 4 neutropenia or grade 4 thrombocytopenia (without clinically significant bleeding) that lasts > 14 days
For continuous variables, descriptive statistics such as number, mean, standard deviation, standard error, median (range) etc. will be provided. For categorical variables, counts and percentages will be provided. Observed toxicities will be summarized by type, severity, and attribution.
Time frame: During first 2 cycles of treatment (cycle length = 21 days)
Incidence of grade >= 3 cytokine release syndrome (CRS) not resolving to grade 1 or better within 7 days
For continuous variables, descriptive statistics such as number, mean, standard deviation, standard error, median (range) etc. will be provided. For categorical variables, counts and percentages will be provided. Observed toxicities will be summarized by type, severity, and attribution.
Time frame: During first 2 cycles of treatment (cycle length = 21 days)
Incidence of grade 4 CRS
For continuous variables, descriptive statistics such as number, mean, standard deviation, standard error, median (range) etc. will be provided. For categorical variables, counts and percentages will be provided. Observed toxicities will be summarized by type, severity, and attribution.
Time frame: During first 2 cycles of treatment (cycle length = 21 days)
Incidence of any emergent grade 3 neurologic toxicity
For continuous variables, descriptive statistics such as number, mean, standard deviation, standard error, median (range) etc. will be provided. For categorical variables, counts and percentages will be provided. Observed toxicities will be summarized by type, severity, and attribution.
Time frame: During first 2 cycles of treatment (cycle length = 21 days)
Incidence of emergent grade 4 neurologic toxicity
For continuous variables, descriptive statistics such as number, mean, standard deviation, standard error, median (range) etc. will be provided. For categorical variables, counts and percentages will be provided. Observed toxicities will be summarized by type, severity, and attribution.
Time frame: During first 2 cycles of treatment (cycle length = 21 days)
Incidence of any grade 5 toxicity
For continuous variables, descriptive statistics such as number, mean, standard deviation, standard error, median (range) etc. will be provided. For categorical variables, counts and percentages will be provided. Observed toxicities will be summarized by type, severity, and attribution.
Time frame: During first 2 cycles of treatment (cycle length = 21 days)
Overall response rate (ORR)
Will be defined as achieving a best response of complete response (CR) or partial response (PR). Will be tabulated by the response categories. ORR will be estimated as a percentage along with the 95% exact binomial confidence interval.
Time frame: From start of protocol therapy to disease progression and/or start of other anti-lymphoma therapy, assessed up to 24 months
CR rate
Will be tabulated by the response categories. CR rate will be estimated as a percentage along with the 95% exact binomial confidence interval.
Time frame: From start of protocol therapy to disease progression and/or start of other anti-lymphoma therapy, assessed up to 24 months
Duration of response (DOR)
Will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error; 95% confidence interval will be constructed based on log-log transformation. Median DOR will be estimated when available.
Time frame: From first achievement of PR or CR to time of progression, relapse, or death, whichever is earlier, assessed up to 24 months
Duration of CR (DOCR)
Will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error; 95% confidence interval will be constructed based on log-log transformation. Median DOCR will be estimated when available.
Time frame: From first achievement of CR to time of progression, relapse or death, whichever is earlier, assessed up to 24 months
Progression-free survival (PFS)
Will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error; 95% confidence interval will be constructed based on log-log transformation. Median PFS will be estimated when available.
Time frame: From start of protocol treatment to time of progression, relapse, or death due to any cause, whichever occurs earlier, assessed up to 24 months
Event-free survival (EFS)
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Will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error; 95% confidence interval will be constructed based on log-log transformation. Median EFS will be estimated when available.
Time frame: From the start of protocol treatment to time of progression, relapse, start of any new anti-lymphoma therapy, or death due to any cause, whichever occurs earlier, assessed up to 24 months
Overall survival (OS)
Will be estimated using the product-limit method of Kaplan and Meier along with the Greenwood estimator of standard error; 95% confidence interval will be constructed based on log-log transformation. Median OS will be estimated when available.
Time frame: From start of protocol treatment to time of death due to any cause, assessed up to 24 months