FILOCLL14 - STAIR : "Open-label, phase 2 study investigating the STop and restart Acalabrutinib In fRrail patients with previously untreated CLL (STAIR)"

Phase 2

Active, not recruiting

• Conditions: elderly patients (> 70 years) with CLL or SLL

• Registration Number: 2024-513936-80-00
• Lead Sponsor: French Innovative Leukemia Organization

Brief Summary

To determine whether discontinuating ACA after 18 months in treatment-naïve CLL patients affects progression-free survival (PFS) at one year after treatment interruption.

Detailed Description

Not available

Study Timeline

• Study First Posted: 2024-10-28
• Last Update Posted: 2025-05-19

Recruitment & Eligibility

• Status: Ongoing, recruitment ended
• Sex: Not specified
• Target Recruitment: 160

Inclusion Criteria

Age > 70 years or older

Adequate hematology values: absolute neutrophil count ≥ 0.75 x 109/L, platelet count ≥ 50 x 109/L (accordance to the coordinator if linked to the disease)

Adequate liver function as indicated by a total bilirubin < 1.5, aspartate transaminase and alanine transaminase ≤ 3 the institutional upper limits of normal values, unless directly attributable to CLL, unless directly attributable to Gilbert’s syndrome

Signed (or their legally-acceptable representatives must sign) an informed consent document indicating that they understand the purpose of and procedures required for the study, including specify biology analysis, and are willing to participate in the study.

ECOG performance status ≤ 2

Previously untreated CLL or SLL

CLL or SLL requiring treatment according to the iwCLL 2018 criteria

Total CIRS score > 6 and / or 30 < CrCl < 69 mL/min

Both patients with or without TP53 disruption 17p deletion and/or TP53 mutations) can be included

Patients can be included whatever their IGHV mutational status

Patients with therapy-controlled cardiovascular comorbidities and/or anticoagulation (novel oral anticoagulant alone, aspirin alone, heparin alone) can be included (patients treated by vitamin K antagonist or dual anti-platelet therapy cannot be included)

Life expectancy > 6 months

Exclusion Criteria

Hypersensitivity to the active substance

Fertile male patients who cannot or do not wish to use an effective method of contraception, during and for 12 months after the final treatment used for the purposes of the study

No affiliation to social security

Patient under psychiatric care

Patient unable to express consent

Patients who are not vaccinated against COVID (2nd dose 15 days before inclusion)

Known HIV seropositivity

Evidence of other clinically significant uncontrolled condition(s) including, but not limited to: 1). Uncontrolled and/or active systemic infection (viral, bacterial or fungal). 2). Known history of human immunodeficiency virus, serologic status reflecting active hepatitis B virus or hepatitis C virus infection, any uncontrolled active systemic infection along with subjects who are on ongoing anti-infective treatment and subjects who have received vaccination with a live attenuated vaccine within 4 weeks before the first dose of study treatment 2a). Subjects who are hepatitis B core antibody (anti-HBc) positive and who are hepatitis B surface antibody (anti-HBs) negative will need to have a negative hepatitis B virus PCR result before enrollment. Those who are hepatitis B surface antigen (HBsAg) positive or hepatitis B virus PCR positive will be excluded. 2b). Subjects who are hepatitis C virus antibody positive will need to have a negative hepatitis C virus PCR result before enrollment. Those who are hepatitis C virus PCR positive will be excluded. 3). Active and uncontrolled autoimmune cytopenia, including autoimmune hemolytic anemia (AIHA) (isolated positive DAT is not an exclusion criteria) and idiopathic thrombocytopenic purpura (ITP). 4). Uncontrolled autoimmune hemolytic anemia or idiopathic thrombocytopenic purpura.

Patients treated by vitamin K antagonist or dual anti-platelet therapy

History of bleeding diathesis (e.g. hemophilia or von Willebrand disease)

History of confirmed progressive multifocal leukoencephalopathy (PML).

Concurrent severe diseases which exclude the administration of therapy: 1). Heart insufficiency NYHA grade III/IV, LEVF < 50% and or RF < 30%, myocardial infarction within the past 6 months prior to study. 2). Significant cardiovascular disease such as symptomatic arrhythmias (including atrial fibrillation), congestive heart failure, or myocardial infarction within 6 months of Screening, or any Class 3 or 4 cardiac disease as defined by the New York Heart Association Functional (Subjects with controlled, asymptomatic atrial fibrillation are allowed to enroll on study). 3). Severe chronic obstructive lung disease with hypoxemia. 4). History of stroke or intra-cranial hemorrhage within the last 6 months. 5). Severe diabetes mellitus. 6).Uncontrolled hypertension 7). Impaired renal function with creatinine clearance < 30 ml/min according the formula of Cockroft and Gault. 8). Patient who requires treatment with proton-pump inhibitors (e.g., omeprazole, esomeprazole, lansoprazole, dexlansoprazole, rabeprazole, or pantoprazole) unless of separate dosing of acalabrutinib capsules with antacids by at least 2 hours. Acalabrutinib capsules should be taken 2 hours before an H2-receptor antagonist. Avoid co-administration of acalabrutinib capsules with proton pump inhibitors. 9). Disease significantly affecting gastrointestinal function (malabsorption syndrome, stomach or small bowel resection). 10). Evidence for Richter syndrome. 11). Treatment with any of the following within 7 days prior to the first dose of study drug : steroid therapy for anti-neoplastic intent. 12). A significant history of renal, neurologic, psychiatric, endocrine, metabolic, immunologic, cardiovascular, or hepatic disease that, in the opinion of the investigator, would adversely affect the patient’s participation in this study or interpretation of study outcomes. 13). Major surgery within 30 days prior to the first dose of study treatment. 14). History of prior other malignancy that could affect compliance with the protocol or interpretation of results, with the exception of the following: - curatively treated basal cell carcinoma or squamous cell carcinoma of the skin or carcinoma in situ of the cervix at any time prior to study; - other cancers not specified above that have been curatively treated by surgery and/or radiation therapy from which patient is disease-free for ≥ 5 years without further treatment

Adult under law-control

Study & Design

• Study Type: Interventional clinical trial of medicinal product
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
PFS at 1 year post-ACA discontinuation is defined as the time from randomization to progression (needing therapy or not) or death from any cause. Patients alive and progression-free will be censored at the last disease assessment or at initiation of next treatment. Progression will be evaluated using iwCLL 2018 criteria		PFS at 1 year post-ACA discontinuation is defined as the time from randomization to progression (needing therapy or not) or death from any cause. Patients alive and progression-free will be censored at the last disease assessment or at initiation of next treatment. Progression will be evaluated using iwCLL 2018 criteria

Secondary Outcome Measures

Name	Time	Method
OS is defined as the time from randomization to death from any cause. Patients alive will be censored at last follow-up news.		OS is defined as the time from randomization to death from any cause. Patients alive will be censored at last follow-up news.
TTNT is defined as the time from randomization to initiation of next treatment required for symptomatic CLL. Patients without initiation of next treatment will be censored at last follow-up date. This need for restarting therapy will be centrally validated by an independent board review and based on iwCLL 2018 criteria for symptomatic CLL.		TTNT is defined as the time from randomization to initiation of next treatment required for symptomatic CLL. Patients without initiation of next treatment will be censored at last follow-up date. This need for restarting therapy will be centrally validated by an independent board review and based on iwCLL 2018 criteria for symptomatic CLL.
QoL will be evaluated using the EORTC QLQ-C30 questionnaire		QoL will be evaluated using the EORTC QLQ-C30 questionnaire
Secondary end point (English)		Secondary end point (English)
Overall Response Rate (ORR) to re-treatment is defined as the proportion of re-treated patients who achieved best response of complete remission (CR), complete remission with incomplete marrow recovery (CRi), nodular partial remission (nPR), or partial remission (PR) per iwCLL 2018 criteria.		Overall Response Rate (ORR) to re-treatment is defined as the proportion of re-treated patients who achieved best response of complete remission (CR), complete remission with incomplete marrow recovery (CRi), nodular partial remission (nPR), or partial remission (PR) per iwCLL 2018 criteria.

Trial Locations

Locations (31)

Centre Hospitalier Le Mans; 🇫🇷 Le Mans Cedex 9, France

Assistance Publique Hopitaux De Paris; 🇫🇷 Paris Cedex 13, France

Institut Paoli Calmettes; 🇫🇷 Marseille, France

Hopital Prive Sevigne; 🇫🇷 Cesson Sevigne, France

Oncopole Claudius Regaud; 🇫🇷 Toulouse Cedex 9, France

Centre Hospitalier Universitaire De Saint Etienne; 🇫🇷 Saint Priest En Jarez, France

Centre Hospitalier Regional Universitaire De Tours; 🇫🇷 Tours Cedex 9, France

Hopital NOVO; 🇫🇷 Pontoise, France

CHRU De Nancy; 🇫🇷 Vandoeuvre Les Nancy Cedex, France

Centre Hospitalier Sud Francilien; 🇫🇷 Corbeil Essonnes Cedex, France

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Centre Hospitalier Le Mans

🇫🇷Le Mans Cedex 9, France

Kamel LARIBI

Site contact

0253040492

klaribi@ch-lemans.fr