Clinical trial NCT03467373: A Study of Glofitamab in Combination With Rituximab or Obinutuzumab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP), or Polatuzumab Vedotin Plus Rituximab, Cyclophosphamide, Doxorubicin, and Prednisone (CHP) in Participants With Non-Hodgkin Lymphomas or With DLBCL
Official title: A Phase Ib Study Evaluating Glofitamab (RO7082859) in Combination With Rituximab (R) or Obinutuzumab (G) Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP), or Polatuzumab Vedotin (POLA) Plus Rituximab (R), Cyclophosphamide, Doxorubicin, and Prednisone (CHP) in Participants With Relapsed or Refractory Non-Hodgkin Lymphoma (R/R NHL) or in Participants With Untreated Diffuse Large B-Cell Lymphoma (DLBCL)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: B-Cell Lymphoma
Non-Hodgkin Lymphoma
Lead sponsor: Hoffmann-La Roche
Sponsor class: INDUSTRY
First posted: 2018-03-16
Enrollment: 111
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a phase 1B, multi-center, dose-finding study of glofitamab administered in combination with obinutuzumab (Gazyva; \[G\]), rituximab (R) and standard doses of CHOP (G/R-CHOP or R-CHOP) in participants with r/r NHL and G/R CHOP or Pola-R-CHP in participants with untreated diffuse large B-cell lymphoma (DLBCL). Evaluating the safety, preliminary activity, pharmacokinetic (PK), and pharmacodynamic effects of this combination will be the main objectives of this study. The study is divided in two parts:

* Part I: Dose finding in participants with r/r NHL; test use of G vs R in Cycle 1
* Part II: Dose Expansion. The maximum tolerated dose or optimal biological dose (MTD or OBD) will be further assessed in participants with untreated DLBCL (\>18 years of age with an age-adjusted International Prognostic Index (IPI) of 2-5). Glofitamab will be studied in combination with R-CHOP and Pola-R-CHP.


Eligibility criteria: Inclusion Criteria:

* Age \>/=18 years
* For Part I r/r NHL dose-escalation, and Part II r/r NHL expansion: Histologically-confirmed NHL that is expected to express CD20, and which has relapsed/progressed following at least one prior treatment regimen containing R or G. Participants must be appropriate for treatment with CHOP and typically should not have been exposed to prior anthracyclines or must not exceed the cumulative lifetime dose of anthracyclines
* For Part II untreated DLBCL expansion: Histologically confirmed previously-untreated DLBCL that is expected to express CD20
* Able to provide a pretreatment biopsy between the final dose of last prior therapy and initiation of study medication at Cycle 1/Day 1
* 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.
* Participants must have at least one measurable target lesion (\> or = 1.5 cm) in its largest dimension by computed tomography (CT) scan
* Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 for participants with r/r NHL; ECOG performance status 0-3 for participants with untreated DLBCL
* Life expectancy (in the opinion of the Investigator) of 18 weeks
* Adverse events (AEs) from prior anti-cancer therapy must have resolved to Grade \</= 1
* Adequate liver function
* Adequate hematological function
* Adequate renal function
* Negative serologic or polymerase chain reaction (PCR) test results for acute or chronic hepatitis B virus (HBV) infection
* Negative test results for hepatitis C virus (HCV) and human immunodeficiency virus (HIV)

Exclusion Criteria:

* Inability to comply with protocol mandated hospitalization and restrictions
* Participants with known active infection, or reactivation of a latent infection, whether bacterial, viral (including, but not limited to Epstein Barr virus (EBV), cytomegalovirus (CMV), HBV, HCV, and HIV), fungal, mycobacterial, or other pathogens (excluding fungal infections of nail beds) or any major episode of infection requiring hospitalization or treatment with IV antibiotics (for IV antibiotics, this pertains to completion of last course of antibiotic treatment) within 4 weeks of dosing
* Prior treatment with systemic immunotherapeutic agents, including, but not limited to, radioimmuno-conjugates, antibody-drug conjugates, immune/cytokines, and monoclonal antibodies (e.g., anti-CTLA4, anti-PD1, and anti-PDL1) within 4 weeks or five half-lives of the drug, whichever is shorter, before G- or R-CHOP or Pola-R-CHP infusion on Cycle 1/Day 1
* Current Grade \> 1 peripheral neuropathy by clinical examination or demyelinating form of Charcot-Marie-Tooth disease (only for participants treated in the polatuzumab vedotin arm)
* History of treatment-emergent immune-related AEs associated with prior immunotherapeutic agents, as follows: Grade \>/=3 AEs, with the exception of Grade 3 endocrinopathy managed with replacement therapy; Grade 1-2 AEs that did not resolve to baseline after treatment completion
* Contraindication to any of the individual components of the immunochemotherapy
* Treatment with standard radiotherapy, any chemotherapeutic agent, or treatment with any other investigational anti-cancer agent within 4 weeks prior to study treatment at Cycle 1/Day 1 infusion
* Prior solid organ transplantation
* Prior allogeneic stem cell transplantation
* Autologous stem cell transplantation within 100 days prior to Cycle 1/Day 1
* Prior treatment with CAR T-cell therapy within 30 days prior to study treatment at Cycle 1 Day 1
* History of autoimmune disease
* History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibody therapy (or recombinant antibody-related fusion proteins)
* A history of confirmed progressive multifocal leukoencephalopathy
* Current or past history of central nervous system (CNS) lymphoma
* Ongoing corticosteroid use \> 30 mg/day of prednisone or equivalent. Participants who received corticosteroid treatment with \</=30 mg/day of prednisone or equivalent must be documented to be on a stable dose of at least 4 weeks' duration prior to Cycle 1/Day 1. Participants may have received a brief (\<7 days) course of systemic steroids (\</=100 mg prednisone equivalent per day) prior to initiation of study therapy for control of lymphoma-related symptoms
* Current or past history of CNS disease, such as stroke, epilepsy, CNS vasculitis, or neurodegenerative 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 (bronchospasm, obstructive pulmonary disease), and known autoimmune diseases
* Major surgery or significant traumatic injury \< 28 days prior to the study treatment infusion at Cycle 1/Day 1 (excluding biopsies) or anticipation of the need for major surgery during study treatment
* Participants with another invasive malignancy that could affect compliance with the protocol or interpretation of results
* Significant or extensive cardiovascular disease
* Left ventricular ejection fraction \< 50%
* Administration of a live, attenuated vaccine within 4 weeks before study treatment infusion on Cycle 1 Day 1 or anticipation that such a live, attenuated vaccine will be required during the study
* History of illicit drug or alcohol abuse within 12 months prior to screening, in the Investigator's judgment
* Any other diseases, metabolic dysfunction, physical examination finding (including mental status), or clinical laboratory finding giving reasonable suspicion of a disease or condition that would contraindicate the use of an investigational drug
* Participants with latent or active tuberculosis

Primary outcomes:
measure: Part I: Percentage of Participants with Dose Limiting Toxicities (DLTs)
timeFrame: Up to 29 months
measure: Part I and II: Percentage of Participants with Adverse Events
timeFrame: Up to 29 months
Secondary outcomes:
measure: Parts I and II: Percentage of Participants with a Complete Response (CR) as Assessed by the Investigator using Modified Lugano 2014 Criteria
timeFrame: Up to 29 months
measure: Parts I and II: Percentage of Participants with Overall Response (Partial Response [PR] or Complete Response [CR])
timeFrame: Up to 29 months
measure: Parts I and II: Duration of Response (DOR)
timeFrame: Up to 29 months
measure: Duration of CR
timeFrame: Up to 29 months
measure: Progression-Free Survival (PFS)
timeFrame: Up to 29 months
measure: Overall Survival (OS)
timeFrame: Up to 29 months
measure: Time to First Complete Response (TFCR)
timeFrame: Up to 29 months
measure: Time to First Response (TFOR)
timeFrame: Up to 29 months
measure: Parts I and II: Area Under the Serum Concentration Versus Time Curve (AUC) of Glofitamab
timeFrame: Cycle 1 Day 1 up to 29 months
measure: Parts I and II: Time to Maximum Serum Concentration (tmax) of Glofitamab
timeFrame: Cycle 1 Day 1 up to 29 months
measure: Parts I and II: Maximum Serum Concentration (Cmax) of Glofitamab
timeFrame: Cycle 1 Day 1 up to 29 months
measure: Parts I and II: Minimum Serum Concentration (Cmin) of Glofitamab
timeFrame: Cycle 1 Day 1 up to 29 months
measure: Change from Baseline in T-cell Activation Markers
timeFrame: Up to 29 months
Other outcomes:
Locations:
city: Birmingham
country: United States
facility: University of Alabama Medical Center
state: Alabama
city: Charlotte
country: United States
facility: Levine Cancer Institute
state: North Carolina
city: Philadelphia
country: United States
facility: Fox Chase-Temple Cancer Center
state: Pennsylvania
city: Melbourne
country: Australia
facility: Peter Maccallum Cancer Centre
state: Victoria
city: Toronto
country: Canada
facility: Princess Margaret Cancer Center
state: Ontario
city: København Ø
country: Denmark
facility: Rigshospitalet
city: Lille
country: France
facility: Hopital Claude Huriez
city: Nantes
country: France
facility: Hopital Hotel Dieu Et Hme
city: Rouen
country: France
facility: Centre Henri Becquerel
city: Erlangen
country: Germany
facility: Universitätsklinikum Erlangen, Translational Research Center (TRC), Medizin 5
city: Freiburg
country: Germany
facility: Universitätsklinikum Freiburg
city: Ulm
country: Germany
facility: Universitätsklinikum Ulm
city: Wuerzburg
country: Germany
facility: Universitätsklinikum Würzburg
city: Napoli
country: Italy
facility: Istituto Nazionale Tumori Irccs Fondazione g. Pascale
state: Campania
city: Ravenna
country: Italy
facility: UO Ematologia, Ospedale S.Maria delle Croci
state: Emilia-Romagna
city: Bergamo
country: Italy
facility: Asst Papa Giovanni Xxiii
state: Lombardia
city: Rozzano
country: Italy
facility: Istituto Clinico Humanitas
state: Lombardia
city: Barcelona
country: Spain
facility: Hospital Universitari Vall d'Hebron
city: Barcelona
country: Spain
facility: Hospital Clínic i Provincial
city: Madrid
country: Spain
facility: START Madrid-FJD, Hospital Fundacion Jimenez Diaz
city: London
country: United Kingdom
facility: University College London Hospitals NHS Foundation Trust
city: Nottingham
country: United Kingdom
facility: Nottingham University Hospitals NHS Trust - City Hospital
Study officials:
affiliation: Hoffmann-La Roche
name: Clinical Trials
role: STUDY_DIRECTOR
References: