Clinical trial NCT01569750: A Study Combining Ibrutinib With Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone in Patients With CD20-Positive B-Cell Non Hodgkin Lymphoma
Official title: A Phase 1b Study Combining Ibrutinib With Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP) in Subjects With CD20-Positive B-Cell Non Hodgkin Lymphoma (NHL)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: CD20-positive B-cell Non-Hodgkin Lymphoma
Keywords: CD20-positive B-cell non-Hodgkin lymphoma
Diffuse large B-cell lymphoma
Mantle cell lymphoma
Follicular lymphoma
Ibrutinib
R-CHOP
Rituximab
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone
Lead sponsor: Janssen Research & Development, LLC
Sponsor class: INDUSTRY
Collaborators: name: Pharmacyclics LLC.
First posted: 2012-04-03
Enrollment: 33
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: 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.

Eligibility criteria: Inclusion Criteria:

* 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

Exclusion Criteria:

* 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

Primary outcomes:
measure: Part 1 maximum tolerated dose of ibrutinib
timeFrame: Up to Cycle 1, Day 21 in Part 1
Secondary outcomes:
measure: The number of participants affected by a dose-limiting toxicity
timeFrame: Up to Cycle 6, Day 21 in Part 1
measure: Number of participants with potential drug-drug interactions between ibrutinib and vincristine
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: Overall response rate
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: Duration of response
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: Progression-free survival
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: Mean plasma concentrations of ibrutinib
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: Maximum observed plasma concentration of ibrutinib
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: Time to reach the maximum plasma concentration of ibrutinib
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: Area under the plasma concentration-time curve from time 0 to 24 hours of ibrutinib
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: Elimination half-life associated with the terminal slope of the semilogarithmic drug concentration-time curve of ibrutinib
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: Elimination half-life associated with the terminal slope of the semilogarithmic drug concentration-time curve of vincristine
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: Partial area under the plasma concentration versus time curve of vincristine
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: The number of participants with pharmacodynamic markers of ibrutinib in peripheral blood mononuclear cells
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: The number of participants with biomarkers predictive of clinical response
timeFrame: Up to Cycle 6, Day 21 in Part 2
measure: The number of participants affected by an adverse event
timeFrame: Up to 30 days after the last dose of study medication
Other outcomes:
Locations:
city: New York
country: United States
state: New York
city: Rochester
country: United States
state: New York
city: Nashville
country: United States
state: Tennessee
city: Houston
country: United States
state: Texas
city: Lille Cedex
country: France
city: Paris
country: France
city: Vandoeuvre Les Nancy
country: France
Study officials:
affiliation: Janssen Research & Development, LLC
name: Janssen Research & Development, LLC Clinical Trial
role: STUDY_DIRECTOR
References:
citation: Younes A, Thieblemont C, Morschhauser F, Flinn I, Friedberg JW, Amorim S, Hivert B, Westin J, Vermeulen J, Bandyopadhyay N, de Vries R, Balasubramanian S, Hellemans P, Smit JW, Fourneau N, Oki Y. Combination of ibrutinib with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) for treatment-naive patients with CD20-positive B-cell non-Hodgkin lymphoma: a non-randomised, phase 1b study. Lancet Oncol. 2014 Aug;15(9):1019-26. doi: 10.1016/S1470-2045(14)70311-0. Epub 2014 Jul 17.