A Study to Evaluate Glofitamab Monotherapy and Glofitamab + Chemoimmunotherapy in Pediatric and Young Adult Participants With Relapsed/Refractory Mature B-Cell Non-Hodgkin Lymphoma

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the safety and efficacy of glofitamab, as monotherapy and in combination with a standard chemoimmunotherapy regimen: rituximab, ifosfamide, carboplatin, and etoposide (R-ICE) in pediatric and young adult participants with relapsed and refractory (R/R) mature B-cell non-Hodgkin lymphoma (B-NHL).

Official Title
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A Phase I/II, Open-Label, Single-Arm, Two-Part Trial to Evaluate Safety, Tolerability, Pharmacokinetics, and Anti-Tumor Activity of Glofitamab in Monotherapy and in Combination With Chemoimmunotherapy in Pediatric and Young Adult Participants With Relapsed/Refractory Mature B-Cell Non-Hodgkin Lymphoma

Conditions
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Mature B-Cell Non-Hodgkin Lymphoma

Intervention / Treatment
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* Drug: Obinutuzumab
* Drug: Glofitamab
* Drug: Rituximab
* Drug: Ifosfamide
* Drug: Carboplatin
* Drug: Etoposide
* Drug: Tocilizumab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 6 months to < 18 years at the time of signing Informed Consent for Part 1 and Cohort B of the study, and age 6 months to ≤ 30 years old at the time of signing Informed Consent for Part 2 of the study Histologically re-confirmed diagnosis, via tissue biopsy, or bone marrow aspirate, pleural effusion, or ascites, prior to study entry of aggressive mature B-NHL that expresses CD20 (reconfirmed by IHC or flow cytometry if IHC is not possible), including BL, BAL (mature B-cell leukemia FAB L3), DLBCL, and PMBCL, at the time of first R/R disease for Cohort A and second or greater R/R disease for Cohort B Refractory or relapsed disease (i.e., prior treatment was ineffective or intolerable) following first-line standard-of-care chemoimmunotherapy for Cohort A and following at least two prior systemic chemoimmunotherapy regimens and who have exhausted all available established therapies for Cohort B Measurable disease, defined as: At least one bi-dimensionally measurable nodal lesion, defined as > 1.5 cm in its longest dimension, or at least one bi dimensionally measurable extranodal lesion, defined as > 1.0 cm in its longest dimension; or percentage of bone marrow involvement with lymphoma cells defined by cytomorphological analysis of bone marrow aspirates Adequate performance status, as assessed according to the Lansky or Karnofsky Performance Status scales: Participants < 16 years old: Lansky Performance Status ≥ 50%; Participants ≥ 16 years old: Karnofsky Performance Status ≥ 50% Adequate bone marrow, liver, and renal function Negative test results for acute or chronic hepatitis B virus (HBV), hepatitis C virus (HCV) Negative HIV test at screening, with the following exception: Individuals with a positive HIV test at screening are eligible provided they are stable on anti-retroviral therapy for at least 4 weeks, have a CD4 count ≥200/uL, have an undetectable viral load, and have not had a history of opportunistic infection attributable to AIDS within the last 12 months Negative SARS-CoV-2 antigen or PCR test within 7 days prior to enrollment Participants and/or caregivers who are willing and able to complete clinical outcome assessments throughout the study using either paper or interviewer methods Exclusion Criteria: Isolated CNS disease of mature B-NHL without systemic involvement, and primary CNS lymphoma Receipt of glofitamab prior to study enrollment Ongoing adverse events from prior anti-cancer therapy that were not resolved to Grade ≤ 1 (exceptions: alopecia, Grade 2 peripheral neuropathy) Grade ≥ 3 adverse events, with the exception of Grade 3 endocrinopathy managed with replacement therapy Participants with active infections which are not resolved prior to Day 1 of Cycle 1 Prior solid organ transplantation Known or suspected history of hemophagocytic lymphohistiocytosis (HLH), or chronic active Epstein-Barr viral infection (CAEBV) Active autoimmune disease requiring treatment History of severe allergic or anaphylactic reactions to monoclonal antibody therapy (or recombinant antibody-related fusion proteins) or known sensitivity or allergy to murine products, except if the participant was able to safely receive it after initial administration (consider consultation with Medical Monitor) History of confirmed progressive multifocal leukoencephalopathy Current or past history of uncontrolled non-malignant CNS disease, such as stroke, epilepsy, CNS vasculitis, or neurodegenerative disease Evidence of significant and uncontrolled concomitant diseases that could affect compliance with the protocol or interpretation of results Major surgery or significant traumatic injury < 28 days prior to the obinutuzumab pretreatment infusion (excluding biopsies) or anticipation of the need for major surgery during study treatment Administration of a live, attenuated vaccine within 4 weeks before the start of study treatment (obinutuzumab pretreatment) or at any time during the study treatment period and within 12 months after end of study treatment Participants with any other diseases, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that would contraindicate the use of an investigational drug

Ages Eligible for Study
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Minimum Age: 6 Months
Maximum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm A<br>Participants will receive glofitamab + R-ICE chemoimmunotherapy for up to 3 cycles (cycle length = 21 days). | Drug: Obinutuzumab<br>* Participants will receive intravenous (IV) obinutuzumab pretreatment on Days 1 and 2 of Cycle 1 (Cycle length = 21 days)<br>Drug: Glofitamab<br>* Arm A: Participants will receive IV glofitamab on Days 8 and 15 of Cycle 1, then on Day 1 of Cycles 2 and 3 Arm B: Participants will receive IV glofitamab on Days 8 and 15 of Cycle 1, then on Day 1 of each cycle thereafter (Cycle length = 21 days)<br>Drug: Rituximab<br>* Participants will receive IV rituximab on Days 5, 6, 7, and 8 of Cycles 2 and 3 (Cycle length = 21 days)<br>Drug: Ifosfamide<br>* Participants will receive IV ifosfamide on Days 3, 4, and 5 of cycle 1 and on Days 5, 6, 7, and 8 of Cycles 2 and 3 (Cycle length = 21 days)<br>Drug: Carboplatin<br>* Participants will receive IV carboplatin on Days 3, 4, and 5 of cycle 1 and on Days 5, 6, 7, and 8 of Cycles 2 and 3 (Cycle length = 21 days)<br>Drug: Etoposide<br>* Participants will receive IV etoposide on Days 3, 4, and 5 of cycle 1 and on Days 5, 6, 7, and 8 of Cycles 2 and 3 (Cycle length = 21 days)<br>Drug: Tocilizumab<br>* Participants will receive IV tocilizumab as needed to manage cytokine release syndrome (CRS) events<br>|
| Experimental: Arm B<br>Participants will receive glofitamab monotherapy for up to 12 cycles (cycle length = 21 days). | Drug: Obinutuzumab<br>* Participants will receive intravenous (IV) obinutuzumab pretreatment on Days 1 and 2 of Cycle 1 (Cycle length = 21 days)<br>Drug: Glofitamab<br>* Arm A: Participants will receive IV glofitamab on Days 8 and 15 of Cycle 1, then on Day 1 of Cycles 2 and 3 Arm B: Participants will receive IV glofitamab on Days 8 and 15 of Cycle 1, then on Day 1 of each cycle thereafter (Cycle length = 21 days)<br>Drug: Tocilizumab<br>* Participants will receive IV tocilizumab as needed to manage cytokine release syndrome (CRS) events<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Achievement of a complete response (CR) as determined by the investigator according to the International Pediatric NHL Response Criteria for pediatric participants and Lugano Classification for young adult participants (Arm A) |  | Up to 3 treatment cycles (cycle length = 21 days) | 
| Percentage of participants with adverse events (AEs) (Arm A) |  | Approximately 3 years | 
| Serum concentration of glofitamab in combination with R-ICE chemoimmunotherapy (Arm A) |  | Up to 3 treatment cycles (cycle length = 21 days) | 
| Serum concentration of glofitamab monotherapy (Arm B) |  | Up to 12 treatment cycles (Arm B) (cycle length = 21 days) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Objective response rate (ORR) (Arms A and B) |  | Up to 3 (Arm A) or 12 (Arm B) treatment cycles (cycle length = 21 days) | 
| Duration of complete response (DOCR) (Arm A) |  | From the first occurrence of a documented complete response (CR) to documented disease progression or death from any cause (whichever occurs first) (approximately 3 years) | 
| Progression-free survival (PFS) (Arm A) |  | From enrollment to the first occurrence of disease progression or death from any cause (whichever occurs first) (approximately 3 years) | 
| Event-free survival (EFS) (Arm A) |  | From enrollment to the first occurrence of disease progression, death from any cause, or start of new anti-lymphoma therapy (not including planned hematopoietic stem cell transplantation (HSCT)) (approximately 3 years) | 
| Overall survival (OS) (Arms A and B) |  | From the first study treatment to the date of death from any cause (Arm A = approximately 3 years, Arm B = approximately 4 years) | 
| Percentage of participants who proceed to HSCT after up to three cycles of treatment (Arm A) |  | Up to 3 treatment cycles (cycle length = 21 days) | 
| Duration of response (DOR) (Arm B) |  | From the first occurrence of a documented CR or partial response (PR) until documented disease progression or death from any cause, whichever occurs first (approximately 4 years) | 
| Percentage of participants with AEs (arm B) |  | Approximately 3 years | 
| Serum concentration of obinutuzumab (Arms A and B) |  | Up to 3 (Arm A) or 12 (Arm B) treatment cycles (cycle length = 21 days) | 
| Serum concentration of rituximab (Arm A) |  | Up to 3 treatment cycles (cycle length = 21 days) | 
| Percentage of participants with anti-drug antibodies (ADAs) (Arms A and B) |  | Up to 3 treatment cycles (cycle length = 21 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Relapsed, Refractory, Pediatrics, B-NHL