Patients with diffuse large B-cell lymphoma (DLBCL) who are primary refractory to first-line R-CHOP therapy or relapse within 12 months after R-CHOP have a poor prognosis and limited treatment options. Conventional salvage chemotherapy has limited efficacy, and CAR-T cell therapy may be limited by manufacturing time, accessibility, and patient condition. Therefore, an immediately available, chemotherapy-free treatment strategy that may reduce the cumulative toxicity of conventional cytotoxic chemotherapy is needed. Polatuzumab vedotin is a CD79b-targeted antibody-drug conjugate that delivers a cytotoxic agent to malignant B cells, and glofitamab is a CD20×CD3 bispecific antibody that activates T cells and induces immune-mediated antitumor activity. The combination of these two agents may provide complementary antitumor effects through direct tumor cell killing and T-cell-mediated immune response. This single-arm, open-label, phase 2 study will evaluate the efficacy and safety of polatuzumab vedotin in combination with glofitamab in patients with DLBCL who are primary refractory to or relapse within 12 months after first-line R-CHOP therapy. Approximately 47 participants will be enrolled. The primary endpoint is the complete response rate at the end of treatment, as assessed by the investigator according to Lugano 2014 criteria.
This is a multicenter, single-arm, open-label, phase 2 study designed to evaluate the efficacy and safety of polatuzumab vedotin in combination with glofitamab in patients with diffuse large B-cell lymphoma (DLBCL) who are primary refractory to first-line R-CHOP therapy or relapse within 12 months after R-CHOP therapy. Approximately 47 participants will be enrolled at approximately seven study sites in Korea, allowing for an approximately 10% dropout rate to secure 42 efficacy-evaluable participants. The planned enrollment period is approximately 24 months. Participants will be followed for at least 12 months after the end of treatment, and the total study duration is expected to be approximately 4 years. Treatment will be administered for a fixed duration of up to 12 cycles, with each cycle defined as 21 days. The treatment period consists of two parts. Part A includes Cycles 1 through 6, during which participants will receive obinutuzumab pretreatment followed by combination therapy with polatuzumab vedotin and glofitamab. Obinutuzumab 1000 mg will be administered once by intravenous infusion on Cycle 1 Day 1. Polatuzumab vedotin 1.8 mg/kg will be administered by intravenous infusion on Cycle 1 Day 2 and then on Day 1 of each cycle from Cycle 2 through Cycle 6 at 21-day intervals. Glofitamab will be administered using step-up dosing: 2.5 mg by intravenous infusion on Cycle 1 Day 8, 10 mg by intravenous infusion on Cycle 1 Day 15, and 30 mg by intravenous infusion on Day 1 of each cycle from Cycle 2 through Cycle 6. Part B includes Cycles 7 through 12, during which participants will receive glofitamab monotherapy. Glofitamab 30 mg will be administered by intravenous infusion on Day 1 of each 21-day cycle. Disease response will be assessed using PET-CT, or contrast-enhanced CT if PET-CT cannot be performed, at Week 9, Week 18, Week 36, and at the end of treatment, based on Cycle 1 Day 1. Response will be evaluated according to Lugano 2014 criteria. The primary endpoint is the complete response rate at the end of treatment, as assessed by the investigator according to Lugano 2014 criteria. Secondary endpoints include overall response rate, duration of response, progression-free survival, overall survival, duration of complete response, time to first objective response, and safety. Exploratory analyses will evaluate ctDNA-based minimal residual disease and immune cell profiling in relation to clinical response and long-term outcomes. To reduce the risk of cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, risk mitigation measures including obinutuzumab pretreatment, step-up dosing of glofitamab, and premedication will be implemented according to the protocol.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
47
Participants will receive fixed-duration treatment with polatuzumab vedotin in combination with glofitamab. Obinutuzumab 1000 mg will be administered once by intravenous infusion on Cycle 1 Day 1 as pretreatment before glofitamab administration. Polatuzumab vedotin 1.8 mg/kg will be administered by intravenous infusion on Cycle 1 Day 2 and then on Day 1 of each cycle from Cycle 2 through Cycle 6. Glofitamab will be administered by intravenous infusion using step-up dosing: 2.5 mg on Cycle 1 Day 8, 10 mg on Cycle 1 Day 15, and 30 mg on Day 1 of each cycle from Cycle 2 through Cycle 12. Each cycle is 21 days.
Complete response rate at the end of treatment
Complete response rate is defined as the proportion of participants who achieve complete response at the end of treatment, as assessed by the investigator according to Lugano 2014 criteria based on PET-CT.
Time frame: At the end of treatment (EOT), up to approximately 36 weeks after the first dose.
Overall response rate
EOT ORR is defined as the proportion of participants achieving CR or PR at EOT.
Time frame: From the first dose through the end of treatment (EOT), up to approximately 36 weeks.
Duration of response
DOR is defined as the time from the first documented objective response to disease progression or death from any cause.
Time frame: From the first documented objective response until disease progression or death from any cause, assessed when all enrolled participants have completed at least 12 months of follow-up after EOT.
Progression-free survival
PFS is defined as the time from the first dose to disease progression or death from any cause.
Time frame: From the first dose until disease progression or death from any cause, whichever occurs first, assessed when all enrolled participants have completed at least 12 months of follow-up after EOT.
Overall survival
OS is defined as the time from the first dose to death from any cause.
Time frame: From the first dose until death from any cause, assessed when all enrolled participants have completed at least 12 months of follow-up after EOT.
Duration of complete response
DOCR is defined as the time from the first documented complete response to disease progression or death from any cause.
Time frame: From the first documented complete response until disease progression or death from any cause, assessed when all enrolled participants have completed at least 12 months of follow-up after EOT.
Time to first objective response
TFOR is defined as the time from the first dose to the first documented objective response.
Time frame: From the first dose until the first documented objective response, up to approximately 36 weeks.
Safety
Safety will be assessed based on the incidence, nature, frequency, severity, and timing of adverse events (AEs) and serious adverse events (SAEs), graded according to NCI CTCAE v5.0.
Time frame: From the first dose through 30 days after the last dose of study treatment.
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