This phase II trial studies how well epcoritamab works in combination with the chemotherapy regimen dose adjusted etoposide, prednisone, Oncovin (vincristine), cyclophosphamide, hydroxydaunorubicin-rituximab (DA-EPOCH-R) in treating patients with high risk Burkitt lymphoma. Epcoritamab 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. Epcoritamab is a type of bispecific T-cell engager. Etoposide is in a class of medications known as podophyllotoxin derivatives. It blocks a certain enzyme needed for cell division and DNA repair and may kill cancer cells. Vincristine is in a class of medications called vinca alkaloids. It works by stopping cancer cells from growing and dividing and may kill them. Cyclophosphamide is in a class of medications called alkylating agents. It works by damaging the cell's 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. 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 epcoritamab in combination with the DA-EPOCH-R regimen may be an effective treatment for patients with high risk Burkitt lymphoma.
PRIMARY OBJECTIVES: I. To demonstrate the feasibility of adding epcoritamab to dose adjusted etoposide, prednisone, Oncovin (vincristine), cyclophosphamide, hydroxydaunorubicin-rituximab (DA-EPOCH-R) in the first line treatment of high-risk Burkitt lymphoma (BL) patients with at least one adverse risk factor. (Cohort 1) II. To compare one-year overall survival (OS) of DA-EPOCH-R with or without epcoritamab in newly diagnosed high-risk BL with at least one additional high-risk feature. (Cohort 2) SECONDARY OBJECTIVES: I. To assess response rates and two-year OS. (Cohort 1 and 2) II. To assess one-year progression-free survival (PFS) and event-free survival (EFS) of risk adapted DA-EPOCH-R with or without epcoritamab in newly diagnosed high-risk BL with at least one additional high-risk feature. (Cohort 1 and 2) III. To assess the safety profile and tolerability of proposed treatments including tumor lysis syndrome, infection, cytokine release syndrome (CRS), and immune effector cell associated neurotoxicity syndrome (ICANS). (Cohort 1 and 2) IV. To assess overall response rate (ORR) and duration of response (DoR) of DA-EPOCH-R with or without epcoritamab in newly diagnosed high-risk BL with at least one additional high-risk feature. (Cohort 1 and 2) V. To assess any influence of human immunodeficiency virus (HIV) including HIV viral load and CD4 counts on the outcomes including toxicities. (Cohort 1 and 2) EXPLORATORY OBJECTIVES: I. To assess the predictability of circulating tumor deoxyribonucleic acid (ctDNA) to predict outcomes in this setting. II. To assess the predictability of cell free deoxyribonucleic acid (cfDNA) in the cerebrospinal fluid (CSF) to predict outcomes in this setting. OUTLINE: Patients are assigned to 1 of 2 cohorts. COHORT 1: Patients receive epcoritamab subcutaneously (SC) on days 1, 8, and 15 OR days 2, 9, and 16 OR days 3, 10, and 17 OR days 8 and 15 of cycle 1 at the determination of the investigators. Patients then receive epcoritamab SC on days 1, 8, and 15 of each cycle thereafter. Patients also receive DA-EPOCH-R consisting of etoposide, doxorubicin, and vincristine IV over 96 hours on days 1-4, prednisone or equivalent orally (PO) twice daily (BID) on days 1-5, cyclophosphamide IV over 1 hour on day 5, and rituximab IV on day 1 or days 1-2 of each cycle. Cycles repeat every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. NOTE: Patients who have received one cycle of DA-EPOCH or CHOP-like therapy off study receive only cycles 1-5). COHORT 2: Patients are randomized to 1 of 2 arms. ARM I: Patients receive DA-EPOCH-R as in Cohort 1 above. ARM II: Patients receive epcoritamab and DA-EPOCH-R as in Cohort 1 above. All patients also undergo multi-gated acquisition scan (MUGA) or echocardiogram (ECHO) during screening, as well as positron emission tomography (PET)/computed tomography (CT), and collection of blood and CSF throughout the study. Patients may also undergo bone marrow biopsy/aspiration during screening and magnetic resonance imaging (MRI) as clinically indicated. After completion of study treatment, patients are followed every 4 months for 2 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
43
Undergo collection of blood and CSF
Undergo bone marrow biopsy/aspiration
Undergo bone marrow biopsy/aspiration
Undergo PET/CT
Given IV
Given IV
Undergo ECHO
Given SC
Given IV
Undergo MRI
Undergo MUGA
Undergo PET/CT
Given PO
Given IV
Given IV
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Proportion of participants who complete at least Cycle 3 among 10 participants (Feasibility)
A cycle with at least one dose of epcoritamab 48 mg will be considered complete.
Time frame: Up to 3 cycles (one cycles = 21 days)
Overall survival
Kaplan-Meier method will be used to estimate survival rates for pre-specified time points along with 95% confidence intervals (CI).
Time frame: From date of study registration and the date of death from any cause, assessed up to 2 years after completion of study treatment
Progression-free survival
Kaplan-Meier method will be used to estimate survival rates for pre-specified time points along with 95% CI.
Time frame: From date of study registration and the date of progression or the date of death from any cause, assessed up to 2 years after completion of study treatment
Incidence of dose-limiting toxicities
Will be based on National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Safety analysis will include detailed tabulations of adverse events (AEs) by type, grade, and treatment attribution.
Time frame: Up to 6 cycles (one cycles = 21 days)
Incidence of treatment-emergent adverse events
Will be based on NCI CTCAE version 5.0. Safety analysis will include detailed tabulations of AEs by type, grade, and treatment attribution.
Time frame: Up to 2 years after completion of study treatment
Overall response rate
Defined as proportion of participants with complete response (CR) or partial response (PR). Responses will be assessed by Lugano criteria. Will be estimated along with corresponding 95% CI using Fisher's exact method.
Time frame: Up to 2 years after completion of study treatment
Duration of response
Medians and quartiles will be estimated using Kaplan-Meier method for responders. Swimmer's plot will be used for visualization.
Time frame: From the date of documented response (CR or PR) and the date of progression or the date of death from any cause, assessed up to 2 years after completion of study treatment
Incidence and severity of tumor lysis syndrome
Safety analysis will include detailed tabulations of AEs by type, grade, and treatment attribution.
Time frame: Up to 2 years after completion of study treatment
Incidence and severity of infection
Safety analysis will include detailed tabulations of AEs by type, grade, and treatment attribution.
Time frame: Up to 2 years after completion of study treatment
Incidence and severity of cytokine release syndrome
Will be defined by the 2019 American Society for Transplantation and Cellular Therapy (ASTCT) harmonized system. Safety analysis will include detailed tabulations of AEs by type, grade, and treatment attribution.
Time frame: Up to 2 years after completion of study treatment
Incidence and severity of immune effector cell associated neurotoxicity syndrome
Will be defined by the 2019 ASTCT harmonized system. Safety analysis will include detailed tabulations of AEs by type, grade, and treatment attribution.
Time frame: Up to 2 years after completion of study treatment
Patterns of HIV viral load and CD4 and CD19 recovery
Descriptive statistics will be used for summarizing endpoints and linear regression, logistic regression, and Cox proportional hazards regression models will be used to examine association between outcome and biomarkers.
Time frame: Up to 2 years after completion of study treatment
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