Clinical trial NCT06986174: A Phase 2 Study to Evaluate the Safety and Efficacy of Pacritinib in Relapsed or Refractory Waldenström Macroglobulinemia
Official title: A Phase 2 Study to Evaluate the Safety and Efficacy of Pacritinib in Relapsed or Refractory Waldenström Macroglobulinemia
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: PHASE2
Conditions: Waldenström Macroglobulinemia
Lymphoplasmacytic Lymphoma
B-Cell Lymphoproliferative Disorder
Indolent Lymphoma
Keywords: Waldenström Macroglobulinemia
Lymphoplasmacytic Lymphoma
Lymphoma
B-Cell Lymphoproliferative Disorder
Indolent Lymphoma
Lead sponsor: Dana-Farber Cancer Institute
Sponsor class: OTHER
Collaborators: name: Sobi, Inc.
First posted: 2025-05-22
Enrollment: 30
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: This study is being done to examine the safety and effectiveness of pacritinib as a possible treatment for participants with Waldenström macroglobulinemia (WM).

The name of the study drug involved in this study is:

-Pacritinib (a type of kinase inhibitor)

Detailed description: This is a single-arm, open-label, Phase II study to evaluate the safety and efficacy of pacritinib in participants with symptomatic Waldenström macroglobulinemia (WM).

Pacritinib is a targeted therapy that blocks a protein called JAK2 that helps cells live and grow. It also inhibits IRAK1, which is important for the survival of WM cells. By blocking JAK2 \& IRAK1, pacritinib may kill abnormal cells or stop them from growing.

The U.S. Food and Drug Administration (FDA) has not approved pacritinib for WM but it has been approved for Myelofibrosis.

The research study procedures include screening for eligibility, in-clinic visits, questionnaires, blood tests, urine tests, Computerized Tomography (CT) scans, X-rays, echocardiograms (ECGs), bone marrow biopsies and aspirations

Participants will receive study treatment for up to 4 years and will be followed for 2 years, or until there is start of a new treatment.

It is expected that about 30 people will take part in this research study.

Sobi AG, Inc. is supporting this research study by providing study drug and funding.

Eligibility criteria: Inclusion Criteria:

* Age ≥18 years
* ECOG performance status ≤2
* Clinicopathological diagnosis of Waldenström Macroglobulinemia
* Symptomatic disease meeting criteria for treatment using consensus panel criteria from the Second International Workshop on Waldenström macroglobulinemia. At least one of the following:

  * constitutional symptoms: recurrent fever, night sweats, fatigue or weight loss
  * progressive or symptomatic lymphadenopathy or splenomegaly
  * hemoglobin ≤10 g/dL
  * platelet count ≤100 k/uL
  * hyperviscosity syndrome
  * symptomatic peripheral neuropathy
  * systemic amyloidosis
  * renal insufficiency
  * symptomatic cryoglobulinemia
* Serum IgM level ≥ 2 times the upper limit of normal
* Participants must meet the following organ and marrow functions as defined below:

  * absolute neutrophil count ≥0.5 k/uL without growth factor within 7 days
  * platelet count ≥50 k/uL without platelet transfusion within 7 days
  * total bilirubin ≤1.5 times the upper limit of normal or ≤3 times the upper limit of normal with documented liver involvement, hemolysis or Gilbert's disease
  * AST (SGOT) and ALT (SGPT) ≤2.5 times the upper limit of normal or ≤5 times the upper limit of normal with documented liver involvement
  * Creatinine clearance ≥30 ml/min using Cockcroft/Gault equation
* Ability to understand and the willingness to sign a written informed consent document. (Providing consents in as many languages as possible is encouraged)
* At least 2 prior lines of treatment for Waldenström Macroglobulinemia. Participants must either be BTK inhibitor exposed or not be a candidate for BTK therapy.
* Women of childbearing potential: Females of childbearing potential (FCBP) will be required to use two highly effective forms of contraception simultaneously or will remain abstinent from heterosexual intercourse during the following periods related to this study:

  1. while participating in the study; and 2) for at least three months (90 days) after discontinuation from the study. FCBP must be referred to a qualified provider of contraceptive methods if needed.

Exclusion Criteria:

* Current history of uncontrolled HIV
* Patients with a known history of HIV must have a viral load assessed for eligibility and must be on a stable antiretroviral regimen that can be administered concurrent with pacritinib.
* Known active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection based on criteria below

  * Hepatitis B virus (HBV): Patients with positive hepatitis B surface antigen (HBsAg) are excluded. Patients with positive hepatitis B core antibody (antiHBc) and negative HBsAg require hepatitis B polymerase chain reaction (PCR) evaluation before enrollment. Patients who are hepatitis B PCR positive will be excluded.
  * Hepatitis C virus (HCV): positive hepatitis C antibody. If positive hepatitis C antibody result, patient will need to have a negative result for hepatitis C ribonucleic acid (RNA) before enrollment. Patients who are hepatitis C RNA positive will be excluded.
* Participants with chronic liver disease and hepatic impairment meeting Child-Pugh class B or C (Appendix B)
* Participants who are pregnant, breast feeding, or planning to become pregnant while enrolled in this study or within 3 month after last study dose (2 weeks for breastfeeding)
* Current CNS involvement by WM
* Active alcohol or drug abuse
* Concurrent administration of medications that are moderate or strong inhibitors or inducers of CYP3A within 14 days or 5 half-lives, whichever is shorter, prior to first dose of study drug.
* Concurrent participation in another therapeutic clinical trial
* History of another malignancy, except adequately treated local basal cell or squamous cell carcinoma of the skin, cervical carcinoma in situ, superficial bladder cancer, localized prostate cancer, or other adequately treated cancer currently in complete remission
* Prior or ongoing clinically significant illness, including active infections requiring antibiotics, of medical condition that, in the investigator's opinion, could affect the safety of the patient; alter the absorption, distribution, metabolism or excretion of the study drug; or impair the assessment of study results
* Inability to swallow pills
* Significant cardiovascular disease defined as:

  * Unstable angina, or
  * History of myocardial infarction within 6 months prior to planned start
  * Previously documented left ventricular ejection fraction (LVEF) by any method of ≤ 45% in the 12 months prior to planned start; assessment of LVEF via echocardiogram or multigated acquisition (MUGA) scan during screening should be performed in selected patients as medically indicated, or
  * Any Class 3 or 4 cardiac disease as defined by the New York Heart Association Functional Classification, or
  * Uncontrolled or symptomatic arrhythmias
* Prolonged QT Interval with baseline QTc \>480 msec using the Bazette formula
* Ongoing, active infection.
* Active bleeding requiring blood transfusion or other medical intervention. Participants requiring anticoagulation therapy are not excluded.

Primary outcomes:
measure: Objective Response Rate (ORR)
timeFrame: Up to 48 months
Secondary outcomes:
measure: Complete Response Rate
timeFrame: Up to 48 months
measure: Very Good Partial Response Rate
timeFrame: Up to 48 months
measure: Partial Response Rate
timeFrame: Up to 48 months
measure: Minimal Response Rate
timeFrame: Up to 48 months
measure: Stable Disease Rate
timeFrame: Up to 48 months
measure: Progressive Disease Rate
timeFrame: Up to 48 months
measure: Time to Response (TTR)
timeFrame: Up to 48 months
measure: Time to Major Response (TTMR)
timeFrame: Up to 48 months
measure: Median Progression-free Survival (PFS)
timeFrame: Up to 48 months
measure: Time to Next Treatment (TTNT)
timeFrame: Up to 48 months
measure: Median Overall Survival (OS)
timeFrame: Up to 6 years
measure: Bone marrow response
timeFrame: Up to 48 months
measure: Overall Response Rate Among Participants Without MYD88 Mutations
timeFrame: Up to 48 months
measure: Overall Response Rate Among Participants With MYD88 Mutations
timeFrame: Up to 48 months
measure: Overall Response Rate Among Participants Without CXCR4 Mutations
timeFrame: Up to 48 months
measure: Overall Response Rate Among Participants With CXCR4 Mutations
timeFrame: Up to 48 months
measure: Overall Response Rate Among Participants With TP53 Mutations
timeFrame: Up to 48 months
measure: Overall Response Rate Among Participants Without TP53 Mutations
timeFrame: Up to 48 months
measure: Number of Participants With Treatment-related Adverse Events
timeFrame: Up to 48 months
measure: Overall Response Rate Among Participants who progressed on covalent BTK-inhibitors
timeFrame: Up to 48 months
Other outcomes:
Locations:
city: Boston
country: United States
facility: Dana Farber Cancer Institute
state: Massachusetts
Study officials:
affiliation: Dana-Farber Cancer Institute
name: Shayna Sarosiek, MD
role: PRINCIPAL_INVESTIGATOR
References: