This phase I trial studies the safety and side effects of glofitamab plus a chemoimmunotherapy regimen called R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) in treating patients newly-diagnosed with HIV-associated large B-cell lymphoma. Glofitamab is a bispecific monoclonal antibody, which can bind to two different antigens that are expressed by cancer cells (CD3 and CD20) at the same time. This may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Rituximab is a monoclonal antibody. It binds to a protein called CD20, which is found on B cells (a type of white blood cell) and some types of cancer cells. This may help the immune system kill cancer cells. Cyclophosphamide is in a class of medications called alkylating agents. It works by damaging the cell's deoxyribonucleic acid (DNA) and may kill cancer cells. It may also lower the body's immune response. Doxorubicin is in a class of medications called anthracyclines. Doxorubicin damages the cell's DNA and may kill cancer cells. It also blocks a certain enzyme needed for cell division and DNA repair. Vincristine is in a class of medications called vinca alkaloids. It works by stopping cancer cells from growing and dividing and may kill them. Prednisone is in a class of medications called corticosteroids. It is used to reduce inflammation and lower the body's immune response to help lessen the side effects of chemotherapy drugs. Giving glofitamab in combination with the R-CHOP regimen may be a safe treatment for patients with newly-diagnosed with HIV-associated large B-cell lymphoma.
PRIMARY OBJECTIVE: I. To establish the feasibility and safety of the regimen glofitamab plus rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (Glofit-RCHOP) in people with newly diagnosed Human Immunodeficiency Virus (HIV)-associated large B-cell lymphoma (LBCL). SECONDARY OBJECTIVES: I. To evaluate the toxicity of Glofit-RCHOP when utilized in combination with antiretroviral therapy (ART) as assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. II. To evaluate the overall response rate (ORR) and complete response rate (CRR) for Glofit-RCHOP in newly diagnosed HIV-associated LBCL using Lugano criteria. III. To evaluate progression-free survival (PFS), duration of response (DoR), and overall survival (OS) for Glofit-RCHOP in newly diagnosed HIV-associated LBCL. EXPLORATORY OBJECTIVES: I. To prospectively assess if circulating tumor deoxyribonucleic acid (ctDNA) levels at baseline and ctDNA dynamics (e.g., changes in ctDNA levels after 3 cycles and at end of treatment) can predict outcomes of therapy (PFS and OS). II. To characterize the genetic subtypes of newly diagnosed HIV-associated LBCL based on commonly occurring genetic alterations. III. To assess dynamic changes in cluster of differentiation 4 (CD4) and cluster of differentiation 8 (CD8) counts during treatment with Glofit-RCHOP. IV. To assess the relationship between T-cell subsets, serum levels of cytokines, and inflammation-associated/microbial-translocation molecular profiles with clinical response in HIV-associated aggressive B-cell lymphomas treated with Glofit-RCHOP. V. To assess the impact of Glofit-RCHOP on quality of life (QoL). VI. To assess the prognostic significance of myelocytomatosis oncogene (MYC) overexpression (defined as MYC immunohistochemistry \[IHC\] ≥ 40%). VII. To assess the association of HIV viral load prior to starting glofitamab on frequency and severity of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). OUTLINE: Patients receive RCHOP consisting of: rituximab intravenously (IV) over 90-360 minutes, cyclophosphamide IV over 1 hour, doxorubicin IV over 3-10 minutes, and vincristine IV over 3-10 minutes on day 1 of each cycle, and prednisone orally (PO) once daily (QD) on days 1-5 of each cycle. Patients also receive glofitamab IV over 4 hours on days 8 and 15 of cycle 2 and on day 8 of cycles thereafter. Cycles of RCHOP repeat every 21 days for 6 cycles, and cycles of glofitamab repeat every 21 days for 8 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo echocardiogram (ECHO), bone marrow biopsy or aspiration, positron emission tomography/computed tomography (PET/CT), and blood sample collection throughout the study. Patients may also undergo tumor tissue biopsy during screening. After completion of study treatment, patients are followed every 3 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
15
Undergo tumor tissue biopsy
Undergo blood sample collection
Undergo bone marrow biopsy or aspiration
Undergo bone marrow biopsy or aspiration
Undergo PET/CT
Given IV
Given IV
Undergo ECHO
Given IV
Undergo PET/CT
Given PO
Ancillary studies
Given IV
Given IV
Ability to deliver at least 4 full cycles of glofitamab-rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (Glofit-RCHOP) (Feasibility)
Feasibility status is defined by the ability to deliver at least 4 cycles of Glofit-RCHOP (i.e. study cycles 1-4). The proportion of the participants who completed at least 4 cycles of Glofit-RCHOP treatment (i.e. cycles 1-4) will be estimated. Will report 95% confidence interval of the above proportion. For the regimen Glofit-RCHOP to be declared feasible, at least 12 out of 15 evaluable participants must complete at least 4 full cycles of Glofit-RCHOP.
Time frame: Up to cycle 4 (Cycles = 21 days)
Incidence and severity of adverse events (AEs) and serious AEs
Will be assessed by National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome will be graded using the American Society for Transplantation and Cellular Therapy Cytokine Release Syndrome criteria. All reported toxicities, regardless of attribution, by toxicity type and maximum grade will be summarized, and sorted by number of participants experiencing the toxicity. Safety data will be based mainly on the frequency and attribution of AEs, the frequency of discontinuation of treatment due to toxicity during study treatment, and the proportion of participants experiencing grade 3 or higher AEs related to the treatment components. AEs will be summarized by presenting the number and percentage of participants having any AE.
Time frame: Up to 2 years after completion of study treatment
Complete response rates (CRR)
Defined as the proportion of participants who achieve complete response (CR) among evaluable participants until end of treatment. CRR will be estimated using proportion and corresponding 95% confidence intervals using the Clopper-Pearson method.
Time frame: Up to 8 cycles (Cycles = 21 days)
Overall response rate (ORR)
Defined as the proportion of participants who achieve CR or partial response among evaluable participants. ORR will be estimated using proportion and corresponding 95% confidence intervals using the Clopper-Pearson method.
Time frame: Up to 8 cycles (Cycles = 21 days)
Progression-free survival (PFS)
Point estimates (e.g. median and 12 months PFS) with 95% confidence intervals will be calculated using the Kaplan-Meier product limit method to summarize the results. Differences in PFS by groups will be tested using the log-rank test. The association between baseline covariates and PFS will be assessed using a Cox proportional hazards regression model.
Time frame: From treatment initiation and date of documented progression or date of death from any cause, assessed up to 2 years after completion of study treatment
Overall survival (OS)
Point estimates (e.g. median and 12 months OS) with 95% confidence intervals will be calculated using the Kaplan-Meier product limit method to summarize the results. Differences in OS by groups will be tested using the log-rank test. The association between baseline covariates and OS will be assessed using a Cox proportional hazards regression model.
Time frame: From treatment initiation and date of death from any cause, assessed up to 2 years after completion of study treatment
Duration of response (DoR)
For DoR, responders who do not exhibit any disease progression or death during the follow-up will be censored at the last day of follow-up.
Time frame: From the date of first documented response and disease progression or death from any cause, assessed up to 2 years after completion of study treatment
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.