This phase II trial tests the effect of venetoclax and obinutuzumab followed by epcoritamab in treating patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) that have not previously received treatment. Venetoclax is in a class of medications called B-cell lymphoma-2 (BCL-2) inhibitors. It may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. 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). Epcoritamab, a bispecific monoclonal antibody, binds to a protein called CD3, which is found on T cells (a type of white blood cell). It also binds to a protein called CD20, which is found on B cells (another type of white blood cell) and some lymphoma cells. This may help the immune system kill cancer cells. The combination of venetoclax and obinutuzumab is a standard treatment for CLL/SLL and has been found to be safe and effective. Adding epcoritamab to standard treatment with venetoclax and obinutuzumab may lead to deeper and longer-lasting responses in patients with untreated CLL/SLL.
PRIMARY OBJECTIVE: I. Evaluate the efficacy of venetoclax and obinutuzumab followed by venetoclax and epcoritamab in patients with newly diagnosed CLL/SLL, as assessed by the minimal residual disease (MRD)-negative complete response (CR) rate at 12 cycles of therapy. SECONDARY OBJECTIVES: I. Evaluate the safety and tolerability of venetoclax and obinutuzumab followed by venetoclax and epcoritamab in patients with newly diagnosed CLL/SLL. II. Evaluate the overall response rate (ORR), progression-free survival (PFS), duration of response (DOR) and overall survival (OS) in patients with newly diagnosed CLL/SLL who received venetoclax and obinutuzumab followed by venetoclax and epcoritamab. EXPLORATORY OBJECTIVES: I. Examine T cell and natural killer (NK) cell immune function in patients with newly diagnosed CLL/SLL treated with venetoclax and obinutuzumab followed by venetoclax and epcoritamab. II. Examine the association between established biomarkers (chromosomal abnormalities, immunoglobulin heavy chain \[IGHV\] mutational status, TP53 mutational status) and clinical outcomes (ORR, PFS). OUTLINE: Patients receive obinutuzumab intravenously (IV) on days 1, 2, 8 and 15 of cycle 1 and on day 1 of cycles 2-6, venetoclax orally (PO) once daily (QD) on days 22-28 of cycle 1 and on days 1-28 of cycles thereafter, as well as epcoritamab subcutaneously (SC) on days 1, 8, 15, and 22 of cycles 7-9 and on day 1 of cycles thereafter. Cycles repeat every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity. After completion of 12 cycles, patients who are MRD positive and have CR, partial response (PR), or stable disease (SD) continue receiving epcoritamab SC on day 1 of each cycle. Cycles of epcoritamab repeat every 28 days for 6 cycles in the absence of disease progression or unacceptable toxicity. All patients also undergo blood sample collection and computed tomography (CT) or magnetic resonance imaging (MRI) throughout the study. Additionally, patients may undergo bone marrow aspiration and biopsy throughout the study. After completion of study treatment, patients are followed up at 30 and 60 days, then every 6 months (for patients who have not experienced disease progression) and 12 months (after disease progression) for up to 5 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
33
Undergo blood sample collection
Undergo bone marrow aspiration and biopsy
Undergo bone marrow aspiration and biopsy
Undergo CT
Ancillary studies
Given SC
Undergo MRI
Given IV
Given PO
City of Hope Medical Center
Duarte, California, United States
RECRUITINGCity of Hope at Irvine Lennar
Irvine, California, United States
RECRUITINGCity of Hope at Long Beach Elm
Long Beach, California, United States
RECRUITINGUniversity of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, United States
NOT_YET_RECRUITINGCity of Hope Atlanta Cancer Center
Newnan, Georgia, United States
RECRUITINGLaura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York, United States
NOT_YET_RECRUITINGMedical College of Wisconsin
Milwaukee, Wisconsin, United States
NOT_YET_RECRUITINGMinimal residual disease (MRD) negative complete response (CR)
MRD status will be assessed using ClonoSEQ® (Adaptive Biotechnologies™) on the blood (sensitivity at 10\^-4 and 10\^-6). The determination of MRD status (i.e. positive versus negative) will be defined as the presence or absence of measurable clonotypes, respectively, at a sensitivity of 10\^-6. Will be estimated along with the 95% exact binomial confidence interval.
Time frame: At beginning of cycle 12 (cycle length = 28 days)
Overall response rate
Will be defined as achieving a best response of either CR or partial response (PR) in a response-evaluable participant. Will be estimated 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 5 years
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 for survival at specific timepoints will be constructed based on log-log transformation. Median PFS will be estimated when possible.
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 5 years
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 for survival at specific timepoints will be constructed based on log-log transformation. Median DOR will be estimated when possible.
Time frame: From the first achievement of PR or CR to time of disease relapse/progression or death, whichever earlier, assessed up to 5 years
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 for survival at specific timepoints will be constructed based on log-log transformation. Median OS will be estimated when possible.
Time frame: From start of protocol treatment to death due to any cause, assessed up to 5 years
Incidence of adverse events
Will be graded by National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Hematologic toxicities will be graded according to International Workshop on Chronic Lymphocytic Leukemia. Cytokine release syndrome and immune effector cell associated neurotoxicity syndrome will be graded according to the American Society for Transplantation and Cellular Therapy Cytokine Release Syndrome Consensus Grading criteria. Observed toxicities will be summarized by type, severity, and attribution.
Time frame: Up to 60 days after last dose of study treatment
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