LOC-R01 Study of Lenalidomide and Ibrutinib in Association With Rituximab-Methotrexate Procarbazine Vincristin (R-MPV)

Phase 1

Active, not recruiting

• Conditions: Lymphoma, Large B-Cell, Diffuse; Central Nervous System Neoplasms, Primary
• Interventions: Drug: Lenalidomide; Drug: Ibrutinib

• Registration Number: NCT04446962
• Lead Sponsor: Institut Curie

Brief Summary

This study is to improve the first-line induction chemotherapy, by combining either Ibrutinib, or Lenalidomide, to a conventional immuno- chemotherapy of R-MPV type (Rituximab-Methotrexate-Procarbazine-Vincristine). This is a randomized Phase II trial, preceded by a dose escalation phase Ib. The objective of the phase Ib is to rule out any limiting toxicity of the new treatment associations, and to determine the recommended dose of Lenalidomide and Ibrutinib to be used in the phase II. In the phase II study, patients will receive 4 cycles of R-MPV + Lenalidomide or 4 cycles of R-MPV + Ibrutinib. The therapeutic response will be evaluated after the 2nd and the 4th cycle. Patients in good therapeutic response will proceed to the consolidation phase with Autologous Stem Cell Transplantation (ASCT).

Detailed Description

The objective of this proposal is to test the feasibility and efficacy of two targeted induction chemotherapies obtained by adding either Lenalidomide or Ibrutinib to a standard Rituximab-High Dose (HD) Methotrexate (MTX) based induction chemotherapy regimen. The R-MPV regimen is chosen as the backbone chemotherapy because of its wide use with robust reproducible results and a good and manageable toxicity profile

Study Timeline

• Study First Submitted: 2020-06-22
• Study First Submitted QC: 2020-06-22
• Study First Posted: 2020-06-25
• Study Start: 2020-10-30
• Status Verified: 2025-04
• Last Update Submitted: 2025-04-08
• Last Update Posted: 2025-04-10
• Primary Completion: 2025-08-30
• Study Completion: 2035-08-30

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 118

Inclusion Criteria

1. Newly diagnosed Primary Central Nervous System Lymphoma (PCNSL).

2. a) Aged between 18 and 60 (>18 and < 60) - phase IB b) Aged between 18 and 65 (≥ 18 and ≤ 65) - phase II.

3. Histological confirmed diagnosis of Primary central nervous system lymphoma of Diffuse Large B-Cell Lymphomas (DLBCL) type OR patients with a measurable typical cerebral lesion on MRI with a diagnosis made by cytology and/or by flow cytometry on the vitreous or on the cerebral spinal fluid.

4. Measurable lesion on MRI with gadolinium enhancement.

5. Adequate hematological, renal and hepatic function (Laboratory Parameters realized within 14 days before inclusion):

   1. Absolute neutrophil count (ANC) >1000/mm3
   2. Platelets > 100,000/mm3 independent of transfusion support
   3. Alanine aminotransferase and aspartate aminotransferase ≤ 3 x Upper Limit of Normal (ULN)
   4. Total bilirubin ≤ 1.5 x ULN unless bilirubin rise is due to Gilbert's syndrome or of non-hepatic origin
   5. Estimated Glomerular Filtration Rate ≥ 60 mL/min/1.73m2.

6. Able to swallow capsules.

7. Karnofsky performance status: 40-100% for the phase IB and no restriction on the KPS for the phase II.

8. Able to understand teratogenic risks of the Lenalidomide and Ibrutinib. Patient must be able to understand and fulfill the Lenalidomide Pregnancy Prevention Plan requirements. This plan may be accepted by the person of confidence in case of impaired cognitive status of the patient.

9. Women of childbearing potential (WCBP)* and men who are sexually active must be practicing a highly effective method** of birth control. Women should avoid a pregnancy while taking treatment by Lenalidomide or Ibrutinib and for up to 1 month after ending treatment. Men must agree to not to father a child or donate sperm during treatment by Lenalidomide or Ibrutinib and up to 3 months after the last dose of study drug.

10. Women of childbearing potential (WCBP)* must have a negative serum (beta-human chorionic gonadotropin [B-hCG]) or urine pregnancy test at inclusion.

11. Signed informed consent, which could be signed by a person on confidence in case the neurologic status of the patient does not allow him to understand and/or to sign.

Exclusion Criteria

1. Histology other than DLBCL.
2. Positive HIV serology.
3. Active viral infection with Hepatitis B or C virus.
4. Preexisting immunodeficiency and/or organ transplant recipient.
5. Isolated Central Nervous System (CNS) relapse of systemic Non-Hodgkin's Lymphoma.
6. Prior treatment for PCNSL (except corticosteroids).
7. Isolated primary vitreo-retinal lymphoma.
8. Major surgery, within 4 weeks prior to the first dose of study drug. Stereotactic biopsy and vitrectomy are not considered major surgery.
9. History of stroke or intracranial hemorrhage (except minor post biopsy hemorrhage) within 6 months prior to inclusion.
10. Requires anticoagulation with warfarin or equivalent vitamin K antagonists.
11. Requires treatment with strong CYP3A4 inhibitors.
12. Pregnancy or lactation.
13. Clinically significant cardiovascular disease.
14. Any other active malignancy, except basocellular carcinoma and non-invasive cervix cancer.
15. Inclusion in another experimental anti-cancer drug therapy.
16. No social security affiliation.
17. Persons under legal protection.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm A: R-MPV with Lenalidomide	Lenalidomide	Lenalidomide in association with R-MPV as a targeted induction treatment
Arm B: R-MPV with Ibrutinib	Ibrutinib	Ibrutinib in association with R-MPV as a targeted induction treatment

Primary Outcome Measures

Name	Time	Method
Complete Response (CR) rate including unconfirmed Complete Response (uCR) at the end of the 4 cycles of induction therapy	4 months	The primary endpoint for the phase II part of the study is the Complete Response (CR) rate including unconfirmed CR (CR+uCR) at the end of the 4 cycles of induction therapy. Assessment of response will be based on the International Primary Central Nervous System Lymphoma Collaborative Group (IPCG)
Dose Limiting Toxicity (DLT) during the first cycle of treatment for each treatment arm.	1 month	Occurrence of a Dose Limiting Toxicity (DLT) during the first cycle of treatment for each treatment arm. The phase Ib is a 3+3 dose escalation design

Secondary Outcome Measures

Name	Time	Method
Progression-Free Survival (PFS)	142 months	Progression-Free Survival (PFS) will be calculated from the date of randomization to the date of progression or death (if the patient does not progress). Patients alive without progression at the date of last contact will be censored at this date
Patients who will receive ASCT	7 months	The percentage of patients who will receive ASCT will be presented
Response rates (CR + uCR) after 2 cycles of induction treatment	2 months	Assessment of response will be based on the International Primary Central Nervous System Lymphoma Collaborative Group (IPCG)
Overall Survival (OS)	142 months	Overall Survival (OS) will be calculated from the date of randomization to the date of death, whatever the cause. Patients alive at the date of last contact will be censored at this date.
Overall response (CR + uCR + Partial Response(PR)), stable disease (SD), and primary refractory patients (PD) after 2 cycles of induction treatment	2 months	Assessment of response will be based on the International Primary Central Nervous System Lymphoma Collaborative Group (IPCG)
Overall response (CR + uCR + Partial Response(PR)), stable disease (SD), and primary refractory patients (PD) after 4 cycles of induction treatment	4 months	Assessment of response will be based on the International Primary Central Nervous System Lymphoma Collaborative Group (IPCG)
The severity of the toxicity of treatment induction or ASCT	7 months	Toxicity of treatment induction or ASCT will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE 5.0) whenever possible and described by system organ class, preferred term

Trial Locations

Locations (28)

CHU Amiens; 🇫🇷 Amiens, France

CHU Besançon; 🇫🇷 Besançon, France

CH Colmar; 🇫🇷 Colmar, France

CHU Créteil; 🇫🇷 Créteil, France

CHU Dijon; 🇫🇷 Dijon, France

CHU Grenoble; 🇫🇷 Grenoble, France

CHU Lyon; 🇫🇷 Lyon, France

CHU Angers; 🇫🇷 Angers, France

CHU Clermont-Ferrand; 🇫🇷 Clermont-Ferrand, France

CH côte Basque; 🇫🇷 Bayonne, France

CHU La Timone Marseille; 🇫🇷 Marseille, France

CHU Nancy; 🇫🇷 Nancy, France

Centre Lacassagne; 🇫🇷 Nice, France

CHU Pitié-Salpêtrière; 🇫🇷 Paris, France

CHU Poitiers; 🇫🇷 Poitiers, France

Institut Bergonié; 🇫🇷 Bordeaux, France

CHU Caen; 🇫🇷 Caen, France

CHRU Lille; 🇫🇷 Lille, France

CHU Limoges; 🇫🇷 Limoges, France

CHU Nantes; 🇫🇷 Nantes, France

CHU Nîmes - Carémeau; 🇫🇷 Nîmes, France

institut de Cancérologie de Strasbourg; 🇫🇷 Strasbourg, France

Institut Curie; 🇫🇷 Paris, France

Hôpital Cochin; 🇫🇷 Paris, France

CHU Rennes; 🇫🇷 Rennes, France

Centre Henri Becquerel; 🇫🇷 Rouen, France

IUCT -Oncopole; 🇫🇷 Toulouse, France

CHU Tours; 🇫🇷 Tours, France