A Study to Evaluate the Safety, Pharmacokinetics and Preliminary Anti-Tumor Activity of RO7227166 in Combination With Obinutuzumab and in Combination With Glofitamab Following a Pre-Treatment Dose of Obinutuzumab Administered in Participants With Relapsed/Refractory B-Cell Non-Hodgkin's Lymphoma

Study Overview
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Brief Summary
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This is a phase I/II, open-label, dose-escalation study designed to evaluate the safety, tolerability, and efficacy of RO7227166 in participants with relapsed/refractory Non-Hodgkin's Lymphoma (r/r NHL). RO7227166 will be administered by intravenous (IV) infusion in combination with obinutuzumab and in combination with glofitamab. A fixed dose of obinutuzumab (Gpt; pre-treatment) will be administered seven days prior to the first administration of RO7227166 and seven days prior to the first administration of glofitamab. This entry-into-human study is divided into a dose-escalation stage (Part I and Part II) and a dose expansion stage (Part III).

Official Title
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An Open-Label, Phase I Study to Evaluate the Safety, Pharmacokinetics and Preliminary Antitumor Activity of RO7227166 (a CD19 Targeted 4-1BB Ligand) in Combination With Obinutuzumab and in Combination With Glofitamab Following a Pre-Treatment Dose of Obinutuzumab Administered in Participants With Relapsed/Refractory B-Cell Non-Hodgkin's Lymphoma

Conditions
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Lymphoma, Non-Hodgkin

Intervention / Treatment
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* Drug: RO7227166
* Drug: Obinutuzumab
* Drug: Glofitamab
* Drug: Tocilizumab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Depending upon study part: a history or status of a histologically-confirmed hematological malignancy that is expected to express CD19 and CD20; relapse after or failure to respond to at least two prior treatment regimens; and no available treatment options that are expected to prolong survival Must have at least one measureable target lesion (>/= 1.5 cm) in its largest dimension by computed tomography scan Able and willing to provide a fresh biopsy from a safely accessible site, per Investigator's determination, providing the participant has more than one measurable target lesion Eastern Cooperative Oncology Group performance status of 0 or 1 Life expectancy of >/= 12 weeks Adverse events from prior anti-cancer therapy must have resolved to Grade </= 1 Adequate liver, haematological, and renal function Negative test results for acute or chronic hepatitis B virus infection Negative test results for hepatitis C virus and HIV The contraception and abstinence requirements are intended to prevent exposure of an embryo to the study treatment. The reliability of sexual abstinence for male and/or female enrollment eligibility needs to be evaluated in relation to the duration of the clinical study and the preferred and usual lifestyle of the participant. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or post-ovulation methods) and withdrawal are not acceptable methods of preventing drug exposure Female participants: A female participant is eligible to participate if she is not pregnant and not breastfeeding, and if at least one of the following applies: women of non-childbearing potential (WONCBP); women of child bearing potential (WOCBP) who agree to remain abstinent or use two highly effective contraceptive methods with a failure rate of <1% per year during the treatment period and for at least 18 months after obinutuzumab or 3.5 months after the last dose of RO7227166, 2 months after last dose of glofitamab, or 3 months after the last dose of tocilizumab, whichever is longer. Examples of contraceptive methods with a failure rate of < 1% per year include bilateral tubal occlusion/ ligation, male sexual partner who is sterilized, established proper use of hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices and copper intrauterine devices. Hormonal contraceptive methods must be supplemented by a barrier method; have a negative pregnancy test (blood) within the 7 days prior to the first study treatment administration Male participants: During the treatment period and for at least 3 months after obinutuzumab, or 3.5 months after the last dose of RO7227166, 2 months after the last dose of glofitamab, or 2 months after the last dose of tocilizumab whichever is longer, agreement to: Remain abstinent or use contraceptive measures such as a condom plus an additional contraceptive method that together result in a failure rate of < 1% per year, with a partner who is a women of childbearing potential. With pregnant female partner, remain abstinent or use contraceptive measures such as a condom to avoid exposing the embryo; refrain from donating sperm during this same period Exclusion Criteria: Circulating lymphoma cells, defined by out of range (high) absolute lymphocyte count or the presence of abnormal cells in the peripheral blood differential signifying circulating lymphoma cells Participants with acute bacterial, viral, or fungal infection at baseline, confirmed by a positive blood culture within 72 hours prior to obinutuzumab infusion or by clinical judgment in the absence of a positive blood culture Participants with known active infection, or reactivation of a latent infection, whether bacterial, viral fungal, mycobacterial, or other pathogens (excluding fungal infections of nail beds) or any major episode of infection requiring hospitalization or treatment with IV antibiotics Pregnant or breast-feeding or intending to become pregnant during the study Prior treatment with systemic immunotherapeutic agents, including, but not limited to, radio-immunoconjugates, antibody-drug conjugates, immune/cytokines or monoclonal antibodies within 4 weeks or five half-lives of the drug, whichever is shorter, before obinutuzumab infusion on D-7 History of treatment-emergent immune-related AEs associated with prior immunotherapeutic agents and auto-immune disease Treatment with standard radiotherapy, any chemotherapeutic agent, or treatment with any other investigational or approved anti-cancer agent within 4 weeks or 5 half-lives of the drug, whichever is shorter, prior to obinutuzumab infusion Prior solid organ transplantation Prior allogeneic stem cell transplant (SCT) and prior chimeric antigen receptor -T-cell therapy Autologous SCT within 100 days prior to obinutuzumab infusion History of severe allergic or anaphylactic reactions to monoclonal antibody therapy and confirmed progressive multifocal leukoencephalopathy Current or past history of central nervous system (CNS) lymphoma and CNS disease Evidence of significant, uncontrolled concomitant diseases that could affect compliance with the protocol or interpretation of results, including diabetes mellitus, history of relevant pulmonary disorders and known autoimmune diseases Major surgery or significant traumatic injury < 28 days prior to the Gpt infusion or anticipation of the need for major surgery during study treatment Participants with another invasive malignancy in the last 2 years Significant cardiovascular disease Administration of a live, attenuated vaccine within 4 weeks before Gpt infusion or anticipation that such a live attenuated vaccine will be required during the study Received systemic immunosuppressive medications (including but not limited to cyclohosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor agents) within two weeks prior to Gpt, with the exception of corticosteroid treatment <=25 mg/day of prednisone or equivalent, however there must be documentation that the participant was on a stable dose of at least a 2-week duration prior to Gpt infusion. Inhaled and topical steriods are permitted

Ages Eligible for Study
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Minimum Age: 18 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
Allocation: Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Part I<br>Combination Dose-Escalation: Mixed r/r NHL participants will receive a fixed dose of obinutuzumab seven days prior to first administration of RO7227166. RO7227166 will be administered by intravenous (IV) infusion in combination with obinutuzumab in a three-weekly schedule (Q3W). | Drug: RO7227166<br>* RO7227166 will be administered by intravenous (IV) infusion three-weekly (Q3W) in combination with a fixed dose of obinutuzumab (Part I) and in combination with a fixed dose of glofitamab (Part II and Part III).<br>* Other names: A CD19 Targeted 4-1BB Ligand;Drug: Obinutuzumab<br>* A fixed dose of obinutuzumab will be administered seven days prior to first does of RO7227166 and glofitamab and then Q3W in combination with RO7227166 in Part I<br>* Other names: Gpt, RO5072759, Gazyva, Gazyvaro;Drug: Tocilizumab<br>* Participants will receive IV tocilizumab as needed to treat cytokine release syndrome (CRS).<br>* Other names: Actemra, RoActemra;|
| Experimental: Part II<br>Combination Dose-Escalation: Mixed r/r participants and participants with mixed r/r mantle cell lymphoma (MCL) and Richters transformation will receive a fixed dose of obinutuzumab seven days prior to first administration of RO7227166. RO7227166 will be administered by IV infusion in combination with glofitamab in a three-weekly schedule (Q3W). | Drug: RO7227166<br>* RO7227166 will be administered by intravenous (IV) infusion three-weekly (Q3W) in combination with a fixed dose of obinutuzumab (Part I) and in combination with a fixed dose of glofitamab (Part II and Part III).<br>* Other names: A CD19 Targeted 4-1BB Ligand;Drug: Obinutuzumab<br>* A fixed dose of obinutuzumab will be administered seven days prior to first does of RO7227166 and glofitamab and then Q3W in combination with RO7227166 in Part I<br>* Other names: Gpt, RO5072759, Gazyva, Gazyvaro;Drug: Glofitamab<br>* A fixed dose of glofitamab will be administered Q3W in combination with RO7227166 in Part II and Part III<br>* Other names: CD20-TCB, RO7082859;Drug: Tocilizumab<br>* Participants will receive IV tocilizumab as needed to treat cytokine release syndrome (CRS).<br>* Other names: Actemra, RoActemra;|
| Experimental: Part III<br>Dose-Expansion Stage: Participants with r/r follicular lymphoma (FL), r/r diffuse large B-cell lymphoma (DLBCL), and r/r MCL will receive RO7227166 administered by IV infusion in combination with glofitamab in a three-weekly schedule (Q3W). | Drug: RO7227166<br>* RO7227166 will be administered by intravenous (IV) infusion three-weekly (Q3W) in combination with a fixed dose of obinutuzumab (Part I) and in combination with a fixed dose of glofitamab (Part II and Part III).<br>* Other names: A CD19 Targeted 4-1BB Ligand;Drug: Obinutuzumab<br>* A fixed dose of obinutuzumab will be administered seven days prior to first does of RO7227166 and glofitamab and then Q3W in combination with RO7227166 in Part I<br>* Other names: Gpt, RO5072759, Gazyva, Gazyvaro;Drug: Glofitamab<br>* A fixed dose of glofitamab will be administered Q3W in combination with RO7227166 in Part II and Part III<br>* Other names: CD20-TCB, RO7082859;Drug: Tocilizumab<br>* Participants will receive IV tocilizumab as needed to treat cytokine release syndrome (CRS).<br>* Other names: Actemra, RoActemra;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nature and frequency of dose-limiting toxicities (DLTs) |  | 28 days in Part I and Part II | 
| Proportion of Participants with Adverse Event (AE) | Incidence, nature, and severity of AEs graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v5.0 | Part I: Up to 24 months; Part II/III: Up to 18 months | 
| Overall Response Rate (ORR) |  | Part I: Up to 24 months; Part II/III: Up to 18 months | 
| Disease Control Rate (DCR) |  | Part I: Up to 24 months; Part II/III: Up to 18 months | 
| Duration of Response (DOR) |  | After end of Study approximately every 3 months until death, loss to follow-up or study termination | 
| Progression-free Survival (PFS) |  | After end of Study approximately every 3 months until death, loss to follow-up or study termination | 
| Overall Survival (OS) |  | After end of Study approximately every 3 months until death, loss to follow-up or study termination | 
| Complete Response (CR) |  | Part III: Up to 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total exposure (area under the concentration time curve [AUC]) of RO7227166 in combination with obinutuzumab and glofitamab |  | Part I: Up to 24 months; Part II/III: Up to 18 months | 
| Maximum serum concentration (peak concentration, Cmax) of RO7227166 in combination with obinutuzumab and glofitamab |  | Part I: Up to 24 months; Part II/III: Up to 18 months | 
| Minimum serum concentration (trough concentration, Cmin) of RO7227166 in combination with obinutuzumab and glofitamab |  | Part I: Up to 24 months; Part II/III: Up to 18 months | 
| Clearance (CL) of RO7227166 in combination with obinutuzumab and glofitamab |  | Part I: Up to 24 months; Part II/III: Up to 18 months | 
| Volume of distribution of steady state (Vss) and half-life (t1/2) of RO7227166 in combination with obinutuzumab and glofitamab |  | Part I: Up to 24 months; Part II/III: Up to 18 months | 
| ORR |  | Part I: Up to 24 months; Part II/III Up to 18 months | 
| DCR |  | Part I: Up to 24 months; Part II/III Up to 18 months | 
| DOR |  | After end of Study approximately every 3 months until death, loss to follow-up or study termination | 
| PFS |  | After end of Study approximately every 3 months until death, loss to follow-up or study termination | 
| OS |  | After end of Study approximately every 3 months until death, loss to follow-up or study termination | 
| Proportion of Participants with Adverse Event (AE) | Incidence, nature, and severity of AEs graded according to the NCI CTCAE v5.0 | After end of Study approximately every 3 months until death, loss to follow-up or study termination | 
| Total exposure (area under the concentration time curve [AUC]) of RO7227166 in combination with glofitamab |  | Part III: Up to 18 months | 
| Maximum serum concentration (peak concentration, Cmax) of RO7227166 in combination with glofitamab |  | Part III: Up to 18 months | 
| Minimum serum concentration (trough concentration, Cmin) of RO7227166 in combination with glofitamab |  | Part III: Up to 18 months | 
| Clearance (CL) of RO7227166 in combination with glofitamab |  | Part III: Up to 18 months | 
| Volume of distribution of steady state (Vss) and half-life (t1/2) of RO7227166 in combination with glofitamab Part I/II/III |  | Part III: Up to 18 months | 
| T-cell and Natural killer (NK)-cell status in blood, using markers of T and NK-cell lineage, function and activation including, but not limited to, CD3, CD8, 41BB, and Ki67 expression |  | Part I: Up to 24 months; Part II/III: Up to 18 months | 
| B-cell reduction in blood and tumor tissue |  | Part I: Up to 24 months; Part II/III: Up to 18 months | 
| Change from Baseline in RO7227166 Anti-Drug Antibody (ADA) Titer |  | Part 1: Up to 24 months; Part ll/lll: Up to 18 months | 
| Time to First Complete Response (TFCR) |  | Up to 18 months | 
| Time to First Overall Response (TFOR) |  | Up to 18 months | 
| Duration of Complete Response (DOCR) |  | Part III: Up to 18 months | 
| Change from Baseline in Physical Function, Role Function, and Health-Related Quality of Life (HRQoL) Based on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) |  | Part III: Up to 18 months | 
| Change from Baseline in Physical Function, Role Function, and HRQoL According to the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) Lymphoma Scale |  | Part III: Up to 18 months |