A Study Combining Ibrutinib With Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone in Patients With CD20-Positive B-Cell Non Hodgkin Lymphoma
- Conditions
- CD20-positive B-cell Non-Hodgkin Lymphoma
- Interventions
- Drug: Part 1, Cohort 1Drug: Part 1, Cohort 2Drug: Part 1, Cohort 3Drug: Part 2, Cohort 1Drug: Part 2, Cohort 2
- Registration Number
- NCT01569750
- Lead Sponsor
- Janssen Research & Development, LLC
- Brief Summary
The purpose of this study is to identify if, and at what dose, ibrutinib may be administered with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and to document responses of this combination in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).
- Detailed Description
This is an open-label (individuals will know the identity of study treatments), dose escalation study to establish the recommended dose of ibrutinib combined with standard R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) in approximately 33 adults with CD20-positive B-cell non-Hodgkin lymphoma (NHL) for whom R-CHOP is an appropriate therapy. There will be 3 periods of the study: a pretreatment (screening) period of up to 28 days before enrollment; an open-label treatment period (up to 6 cycles of ibrutinib and R-CHOP; ending at the end-of-treatment visit); and a posttreatment follow-up period until the end of study (maximum of up to 1 year after the last patient has completed the end-of-treatment visit). There are 2 parts to the study (dose escalation \[Part 1\] and expansion \[Part 2\]). During the dose escalation period, the "3+3" design will be applied and approximately 18 patients with CD20 positive B cell NHL (diffuse large B-cell lymphoma \[DLBCL\], mantle cell lymphoma \[MCL\], and follicular lymphoma \[FL\]) may be enrolled. Patients will be assigned to cohorts of increasing oral daily doses of ibrutinib (280, 420, and 560 mg) administered in combination with R-CHOP. The maximum tolerated dose (MTD), assessed in Cycle 1 (dose-limiting toxicity \[DLT\] period), is defined as the highest dose of the combination regimen at which \<=33% of patients experience DLT. Baseline and follow-up electrocardiograms will be performed throughout the study. A Study Evaluation Team will review all available data upon completion of the first cycle for all patients at each dose cohort to determine DLTs, if dose escalation is acceptable, and subsequently will determine the recommended Phase 2 dose. Once the recommended Phase 2 dose is determined, approximately 15 patients with newly diagnosed DLBCL will be entered into the expansion cohort at the dose level selected to further assess the safety, pharmacokinetics, pharmacodynamics, pharmacogenomics, and activity of the combination. Patients whose disease has not progressed at the end of Cycle 1 will continue to receive ibrutinib and R CHOP up to a maximum of 6 cycles. During the posttreatment follow-up period, long term safety, survival status, disease progression, and subsequent antilymphoma therapy will be collected. The study will end 1 year after the last patient has completed the end of treatment visit.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 33
- Histopathologically-confirmed CD20-positive B-cell non Hodgkin lymphoma disease for whom R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) is an appropriate therapy (diffuse large B-cell lymphoma, mantle cell lymphoma, or follicular lymphoma); for the expansion cohort, at least 1 cohort will only include patients with newly diagnosed diffuse large B-cell lymphoma
- Stage I AX (bulk defined as single lymph node mass >=10 cm in diameter) to Stage IV disease
- At least 1 measurable site of disease based on the Revised Response Criteria for Malignant Lymphoma
- Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1, or 2
- Adequate bone marrow, liver, and renal function
- History of protocol-defined disallowed therapies
- Prior multidrug chemotherapy treatment for lymphoma
- History of stroke or intracranial hemorrhage within 6 months prior to the first dose of study drug
- Major surgery within 3 weeks before enrollment
- Known bleeding diatheses, platelet dysfunction disorders, or requires therapeutic anticoagulation
- Known lymphoma of the central nervous system
- Uncontrolled or severe cardiovascular disease including myocardial infarction within 6 months of enrollment, New York Heart Association Class III or IV heart failure, uncontrolled angina, pericardial disease, cardiac amyloidosis, clinically significant cardiac arrhythmia, or left ventricular ejection fraction outside of institutional limits
- Active systemic infection requiring treatment including hepatitis B and hepatitis C infection
- Documented or suspected human immunodeficiency virus infection
- Diagnosed or treated for a malignancy other than non-Hodgkin lymphoma except; adequately treated non-melanoma skin cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ of the breast, or other solid tumors curatively treated with no evidence of disease for >5 years
- Has any condition that, in the opinion of the investigator, would make study participation not be in the best interest (eg, compromise the well-being) of the patient or that could prevent, limit, or confound the protocol-specified assessments
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Ibrutinib Part 1, Cohort 3 Part 1 (Dose Escalation): Escalating doses of ibrutinib (starting on Day 3 for Cycle 1 and on Day 1 for subsequent cycles) administered once daily in with standard-of-care doses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) until maximum tolerated dose is achieved. Part 2: Ibrutinib at the recommended Part 1 dose administered once daily with standard-of-care doses of R-CHOP. Ibrutinib Part 1, Cohort 1 Part 1 (Dose Escalation): Escalating doses of ibrutinib (starting on Day 3 for Cycle 1 and on Day 1 for subsequent cycles) administered once daily in with standard-of-care doses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) until maximum tolerated dose is achieved. Part 2: Ibrutinib at the recommended Part 1 dose administered once daily with standard-of-care doses of R-CHOP. Ibrutinib Part 1, Cohort 2 Part 1 (Dose Escalation): Escalating doses of ibrutinib (starting on Day 3 for Cycle 1 and on Day 1 for subsequent cycles) administered once daily in with standard-of-care doses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) until maximum tolerated dose is achieved. Part 2: Ibrutinib at the recommended Part 1 dose administered once daily with standard-of-care doses of R-CHOP. Ibrutinib Part 2, Cohort 1 Part 1 (Dose Escalation): Escalating doses of ibrutinib (starting on Day 3 for Cycle 1 and on Day 1 for subsequent cycles) administered once daily in with standard-of-care doses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) until maximum tolerated dose is achieved. Part 2: Ibrutinib at the recommended Part 1 dose administered once daily with standard-of-care doses of R-CHOP. Ibrutinib Part 2, Cohort 2 Part 1 (Dose Escalation): Escalating doses of ibrutinib (starting on Day 3 for Cycle 1 and on Day 1 for subsequent cycles) administered once daily in with standard-of-care doses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) until maximum tolerated dose is achieved. Part 2: Ibrutinib at the recommended Part 1 dose administered once daily with standard-of-care doses of R-CHOP.
- Primary Outcome Measures
Name Time Method Part 1 maximum tolerated dose of ibrutinib Up to Cycle 1, Day 21 in Part 1 The Part 1 maximum tolerated dose (MTD) is the Part 2 recommended ibrutinib dose.
- Secondary Outcome Measures
Name Time Method Duration of response Up to Cycle 6, Day 21 in Part 2 Progression-free survival Up to Cycle 6, Day 21 in Part 2 Maximum observed plasma concentration of ibrutinib Up to Cycle 6, Day 21 in Part 2 Elimination half-life associated with the terminal slope of the semilogarithmic drug concentration-time curve of vincristine Up to Cycle 6, Day 21 in Part 2 Partial area under the plasma concentration versus time curve of vincristine Up to Cycle 6, Day 21 in Part 2 The number of participants affected by an adverse event Up to 30 days after the last dose of study medication Number of participants with potential drug-drug interactions between ibrutinib and vincristine Up to Cycle 6, Day 21 in Part 2 Time to reach the maximum plasma concentration of ibrutinib Up to Cycle 6, Day 21 in Part 2 Mean plasma concentrations of ibrutinib Up to Cycle 6, Day 21 in Part 2 The number of participants affected by a dose-limiting toxicity Up to Cycle 6, Day 21 in Part 1 Overall response rate Up to Cycle 6, Day 21 in Part 2 Area under the plasma concentration-time curve from time 0 to 24 hours of ibrutinib Up to Cycle 6, Day 21 in Part 2 Elimination half-life associated with the terminal slope of the semilogarithmic drug concentration-time curve of ibrutinib Up to Cycle 6, Day 21 in Part 2 The number of participants with pharmacodynamic markers of ibrutinib in peripheral blood mononuclear cells Up to Cycle 6, Day 21 in Part 2 The number of participants with biomarkers predictive of clinical response Up to Cycle 6, Day 21 in Part 2