Clinical trial NCT03677596: A Study Of Two Inotuzumab Ozogamicin Doses in Relapsed/ Refractory Acute Lymphoblastic Leukemia Transplant Eligible Patients
Official title: A PHASE 4, OPEN-LABEL, RANDOMIZED STUDY OF TWO INOTUZUMAB OZOGAMICIN DOSE LEVELS IN ADULT PATIENTS WITH RELAPSED OR REFRACTORY B-CELL ACUTE LYMPHOBLASTIC LEUKEMIA ELIGIBLE FOR HEMATOPOIETIC STEM CELL TRANSPLANTATION AND WHO HAVE RISK FACTOR(S) FOR VENO-OCCLUSIVE DISEASE
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Leukemia
Precursor b-Cell Lymphoblastic Leukemia-Lymphoma
ACUTE LYMPHOBLASTIC LEUKEMIA
Keywords: Leukemia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
ACUTE LYMPHOBLASTIC leukemia
inotuzumab ozogamicin
Besponsa
transplant
Lead sponsor: Pfizer
Sponsor class: INDUSTRY
First posted: 2018-09-19
Enrollment: 102
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: The study will be conducted in 2 phases: a run in phase and a randomized phase.

Run in phase: a total of up to 22 patients will be enrolled to receive the starting dose of 1.2 mg/m2/cycle (dose level 2). A Simon Two Stage optimal design will be used. If acceptable efficacy (CR/CRi and MRD negativity) is observed in the run in phase, the study will enter the randomized phase.

Randomized phase: if acceptable efficacy is observed in the run in phase, the study will enter the randomized phase. A total of approximately 80 patients will be randomized (1:1) to 1 of 2 dose levels of inotuzumab ozogamicin (40 patients per dose level).
Primary purpose: TREATMENT

Brief summary: This study will explore 2 different doses of inotuzumab ozogamicin including the dose that is approved and a lower dose. The main purpose of this study is to evaluate whether a dose of inotuzumab ozogamicin, lower than the approved dose, could be recommended for adult patient with relapsed or refractory ALL who may be at higher risk for severe liver problems after inotuzumab ozogamicin treatment and stem cell transplant (a potentially curative therapy that can replace cancer cells with healthy cells). Efficacy and safety of the 2 doses will be evaluated.


Eligibility criteria: Inclusion Criteria:

1. Relapsed or refractory precursor CD22 positive B cell ALL with M2 or M3 marrow (≥5% blasts) and who are eligible for HSCT;
2. Have 1 or more of the following risk factors for developing VOD:

   1. Due to receive Salvage 2 or greater;
   2. Prior HSCT;
   3. Age ≥55 years.
   4. Ongoing or prior hepatic disease which may include a prior history of hepatitis or drug induced liver injury, as well as hepatic steatosis, nonalcoholic steatohepatitis, baseline elevations of bilirubin \> upper limit of normal (ULN) and ≤1.5 x ULN.
3. Ph+ ALL patients must have failed treatment with at least 1 second or third generation tyrosine kinase inhibitor and standard multi agent induction chemotherapy;
4. Patients in Salvage 1 with late relapse should be deemed poor candidates for reinduction with initial therapy;
5. Patients with lymphoblastic lymphoma and bone marrow involvement 5% lymphoblasts by morphologic assessment;
6. Age 18 years to 75 years;
7. Eastern Cooperative Oncology Group (ECOG) performance status 0 2;
8. Adequate liver function, including total serum bilirubin ≤1.5 x ULN unless the patient has documented Gilbert syndrome, and aspartate and alanine aminotransferase (AST and ALT) ≤2.5 x ULN;
9. Serum creatinine ≤1.5 x ULN or any serum creatinine level associated with a measured or calculated creatinine clearance of \>=40 mL/min;
10. Male and female patients of childbearing potential and at risk for pregnancy must agree to use a highly effective method of contraception throughout the study and for a minimum of 8 months (females) and 5 months (males) after the last dose of assigned treatment. A patient is of childbearing potential if, in the opinion of the Investigator, he/she is biologically capable of having children and is sexually active. Female subjects of nonchildbearing potential must meet at least 1 of the following criteria:

    1. Achieved postmenopausal status, defined as follows: cessation of regular menses for at least 12 consecutive months with no alternative pathological or physiological cause; and have a serum follicle stimulating hormone (FSH) level confirming the postmenopausal state;
    2. Have undergone a documented hysterectomy and/or bilateral oophorectomy;
    3. Have medically confirmed ovarian failure. All other female subjects (including female subjects with tubal ligations) are considered to be of childbearing potential.
11. Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study; patients with mental capacity which requires the presence of a legally authorized representative will be excluded from the study;
12. Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.

Exclusion Criteria:

1. Isolated extramedullary relapse (ie, testicular or central nervous system);
2. Burkitt's or mixed phenotype acute leukemia based on the WHO 2008 criteria;
3. Active central nervous system (CNS) leukemia, as defined by unequivocal morphologic evidence of lymphoblasts in the cerebrospinal fluid (CSF), use of CNS directed local treatment for active disease within the prior 28 days, symptomatic CNS leukemia (ie, cranial nerve palsies or other significant neurologic dysfunction) within 28 days. Prophylactic intrathecal medication is not a reason for exclusion;
4. Prior chemotherapy within 2 weeks before randomization with the following exceptions:

   1. To reduce the circulating lymphoblast count or palliation: ie, steroids, hydroxyurea or vincristine;
   2. For ALL maintenance: mercaptopurine, methotrexate, vincristine, thioguanine, and/or tyrosine kinase inhibitors.

   Patients must have recovered from acute non hematologic toxicity (to Grade 1 or less) of all previous therapy prior to enrollment.
5. Prior monoclonal antibodies within 6 weeks of randomization, with the exception of rituximab which must be discontinued at least 2 weeks prior to randomization;
6. Prior inotuzumab ozogamicin treatment or other anti CD22 immunotherapy within 6 months before randomization;
7. Prior allogeneic hematopoietic stem cell transplant (HSCT) within 90 days before randomization. Patients must have completed immunosuppression therapy for treatment of graft versus host disease (GvHD) prior to enrollment. At randomization, patients must not have Grade 2 or higher acute GvHD, or extensive chronic GvHD;
8. Peripheral absolute lymphoblast count \>=10,000 /L (treatment with hydroxyurea and/or steroids/vincristine is permitted within 2 weeks of randomization to reduce the white blood cell \[WBC\] count);
9. Known systemic vasculitides (eg, Wegener's granulomatosis, polyarteritis nodosa, systemic lupus erythematosus), primary or secondary immunodeficiency (such as human immunodeficiency virus \[HIV\] infection or severe inflammatory disease);
10. Active hepatitis B infection as evidenced by hepatitis B surface antigen, active hepatitis C infection (must be anti-hepatitis C antibody negative or hepatitis C ribonucleic acid negative), or known seropositivity for HIV. HIV testing may need to be performed in accordance with local regulations or local practice;
11. Major surgery within 4 weeks before randomization;
12. Unstable or severe uncontrolled medical condition (eg, unstable cardiac function or unstable pulmonary condition);
13. Concurrent active malignancy other than non-melanoma skin cancer, carcinoma in situ of the cervix, or localized prostate cancer that has been definitely treated with radiation or surgery. Patients with previous malignancies are eligible provided that they have been disease free for \>=2 years;
14. Patients with active heart disease or the presence of New York Heart Association (NYHA) stage III or IV congestive heart failure;
15. QTcF \>470 msec (based on the average of 3 consecutive electrocardiogram \[ECGs\]);
16. Myocardial infarction within 6 months before randomization;
17. History of clinically significant ventricular arrhythmia, or unexplained syncope not believed to be vasovagal in nature, or chronic bradycardic states such as sinoatrial block or higher degrees of atrioventricular (AV) block unless a permanent pacemaker has been implanted;
18. Uncontrolled electrolyte disorders that can compound the effects of a QTc prolonging drug (eg, hypokalemia, hypocalcemia, hypomagnesemia);
19. Prior confirmed or ongoing hepatic veno occlusive disease (VOD) or sinusoidal obstruction syndrome (SOS), or other serious or current ongoing liver disease such as cirrhosis or nodular regenerative hyperplasia;
20. Administration of live vaccine within 6 weeks before randomization;
21. Evidence of uncontrolled current serious active infection (including sepsis, bacteremia, fungemia) or patients with a recent history (within 4 months) of deep tissue infections such as fascitis or osteomyelitis;
22. Patients who have had a severe allergic reaction or anaphylactic reaction to any humanized monoclonal antibodies;
23. Pregnant female subjects; breastfeeding female subjects; fertile male subjects and female subjects of childbearing potential who are unwilling or unable to use highly effective contraception as outlined in this protocol for the duration of the study and for a minimum of 8 months (females) and 5 months (males) after the last dose of investigational product;
24. Investigative site staff members directly involved in the conduct of the study and their family members, site staff members otherwise supervised by the Investigator, or subjects who are Pfizer employees, including their family members, directly involved in the conduct of the study;
25. Participation in other studies involving investigational drug(s) within 2 weeks prior to study entry and/or during study participation (up through the end of treatment visit);
26. Other acute or chronic medical or psychiatric condition including recent (within the past year) or active suicidal ideation or behavior or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the Investigator, would make the subject inappropriate for entry into this study.

Primary outcomes:
measure: Percentage of Participants With Veno-occlusive Disease (VOD)
timeFrame: 2 years from randomization
measure: Rate of Hematologic Remission (Complete Response [CR] / Complete Response With Incomplete Hematologic Recovery[CRi])
timeFrame: From first dose of study treatment of 6 cycles till follow-up up to 2 years, in total approximately 2.5 years
Secondary outcomes:
measure: Number of Participants With Treatment-Emergent Adverse Events (All Causalities)
timeFrame: From first dose of study treatment drug through 63 days after last dose (approximately 52 weeks)
measure: Number of Participants With Treatment-Emergent Adverse Events (Treatment-related)
timeFrame: From first dose of study treatment drug through 63 days after last dose (approximately 52 weeks)
measure: Number of Participants With Treatment-Emergent Serious Adverse Events (Post-HSCT)
timeFrame: Starting from the first transplant after inotuzumab ozogamicin treatment and including the entire duration of subsequent follow up (approximately 52 weeks))
measure: Shift Summary of Hematology Laboratory Test Results From Grade <=2 at Baseline to Grade 3 or 4 Post-Baseline
timeFrame: From first dose of study treatment drug through 63 days after last dose (approximately 52 weeks)
measure: Shift Summary of Chemistry Laboratory Test Results From Grade <=2 at Baseline to Grade 3 or 4 Post-Baseline
timeFrame: From first dose of study treatment drug through 63 days after last dose (approximately 52 weeks)
measure: Number of Participants Achieving a CR/CRi With Minimal Residual Disease (MRD) Negativity
timeFrame: At screening, once at Day 16-28 of Cycles 1 and 2, or until CR/CRi and MRD negativity were achieved, then after every 1-2 cycles as clinically indicated, and at EOT visit (maximum of 2.5 years)
measure: Duration of Remission (DoR) in Participants Achieving CR/CRi
timeFrame: From first dose of study treatment of 6 cycles till follow-up up to 2 years, in total approximately 2.5 years
measure: Progression-Free Survival
timeFrame: From first dose of study treatment of 6 cycles till follow-up up to 2 years, in total approximately 2.5 years
measure: Overall Survival
timeFrame: From first dose of study treatment of 6 cycles till follow-up up to 2 years, in total approximately 2.5 years
measure: Number of Participant Received HSCT Post Inotuzumab Ozogamicin Treatment
timeFrame: From first dose of study treatment of 6 cycles till follow-up up to 2 years, in total approximately 2.5 years
measure: The Cumulative Incidence Rate of Post-HSCT Relapse at Month 12
timeFrame: From first dose of study treatment to Month 12
measure: Number of Participants With Post-HSCT Mortality
timeFrame: From first dose of study treatment of 6 cycles till follow-up up to 2 years, in total approximately 2.5 years
measure: Number of Participants With Post HSCT Non-Relapse Mortality
timeFrame: From first dose of study treatment of 6 cycles till follow-up up to 2 years, in total approximately 2.5 years
measure: Number of Participants With Post HSCT Relapse-Related Mortality
timeFrame: From first dose of study treatment of 6 cycles till follow-up up to 2 years, in total approximately 2.5 years
measure: Mean Predose Concentrations (Ctrough) of Inotuzumab Ozogamicin
timeFrame: Pre-dose on Cycle 1 Day 1, 8 and 15, and on Day1 and 8 of Cycle 2, 3 and 4.
measure: Number of Participants With Positive Anti-Drug Antibody (ADA)
timeFrame: At Day 1 of every cycle prior to the beginning of inotuzumab ozogamicin infusion and at the EOT visit, up to approximately 52 weeks.
measure: Number of Participants With Positive Neutralizing Antibody (NAb)
timeFrame: At Day 1 of every cycle prior to the beginning of inotuzumab ozogamicin infusion and at the EOT visit, up to approximately 52 weeks.
Other outcomes:
Locations:
city: Los Angeles
country: United States
facility: Keck Hospital of USC
state: California
city: Los Angeles
country: United States
facility: LAC+USC Medical Center
state: California
city: Los Angeles
country: United States
facility: USC/Norris Comprehensive Cancer Center
state: California
city: Chicago
country: United States
facility: Rush University Medical Center
state: Illinois
city: Baltimore
country: United States
facility: University of Maryland- Greenebaum Comprehensive Cancer Center
state: Maryland
city: Seattle
country: United States
facility: Seattle Cancer Care Alliance
state: Washington
city: Seattle
country: United States
facility: University of Washington Medical Center
state: Washington
city: Debrecen
country: Hungary
facility: Debreceni Egyetem Klinikai Központ, Orvosi Kepalkotó Klinika, Radiológia
city: Debrecen
country: Hungary
facility: Debreceni Egyetem Klinikai Központ, Pathológiai lntézet
city: Nyiregyhaza
country: Hungary
facility: Szabolcs-Szatmar Bereg Megyei Korhazak es Egyetemi Oktatokorhaz, Josa Andras Korhaz, Hematologia
city: Gurugram
country: India
facility: Artemis hospital
state: Haryana
city: Pune
country: India
facility: Sahyadri Clinical Research and Development Centre
state: Maharashtra
city: Pune
country: India
facility: Sahyadri Super Speciality Hospital
state: Maharashtra
city: Pune
country: India
facility: Sahyadri Super Speciality Hospital Nagar Road
state: Maharashtra
city: Pune
country: India
facility: Sahyadri Super Speciality Hospital
state: Maharashtra
city: Vellore
country: India
facility: Christian Medical College
state: Tamil NADU
city: Ranipet - 632517, Tamil Nadu, India
country: India
facility: Christian Medical College Vellore- Ranipet Campus
city: Gdansk
country: Poland
facility: Klinika Hematologii i Transplantologii, Uniwersyteckie Centrum Kliniczne
city: Warsaw
country: Poland
facility: Instytut Hematologii i Transfuzjologii
city: Wroclaw
country: Poland
facility: Uniwersytecki Szpital Kliniczny im. Jana Mikulicza - Radeckiego we Wroclawiu
city: Wroclaw
country: Poland
facility: Apteka Centralna
city: Singapore
country: Singapore
facility: National University Hospital
city: Singapore
country: Singapore
facility: Raffles Hospital
city: Singapore
country: Singapore
facility: Raffles Radiology
city: Oviedo
country: Spain
facility: Hospital Universitario Central de Asturias
state: Asturias
city: Barcelona
country: Spain
facility: Hospital Universitari Vall d'Hebron
city: Madrid
country: Spain
facility: Hospital General Universitario Gregorio Maranon
city: Madrid
country: Spain
facility: Hospital Universitario Ramon y Cajal
city: Sevilla
country: Spain
facility: Hospital General - Semisótano
city: Sevilla
country: Spain
facility: Hospital Universitario Virgen del Rocio
city: Valencia
country: Spain
facility: Hospital Clinico Universitario de Valencia
city: Valencia
country: Spain
facility: Hospital Universitari i Politecnic La Fe
city: Changhua
country: Taiwan
facility: Changhua Christian Hospital
city: Taipei
country: Taiwan
facility: National Taiwan University Hospital
city: Gebze
country: Turkey
facility: Anadolu Health Center Hospital
state: Istanbul
city: Ankara
country: Turkey
facility: Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital Clinical Research Center
city: Ankara
country: Turkey
facility: Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital Hematology Department
city: Ankara
country: Turkey
facility: Ankara University Faculty of Medicine Cebeci Hospital Hematology Department
city: Antalya
country: Turkey
facility: Private Medstar Antalya Hosp. Hematology and Stem Cell Transplantation Center
city: Istanbul
country: Turkey
facility: Marmara University Pendik Training and Research Hospital Hematology Unit
city: Izmir
country: Turkey
facility: Ege University Medical Faculty
city: Izmir
country: Turkey
facility: Dokuz Eylul University Medical Faculty
city: Izmir
country: Turkey
facility: Medicalpark Izmir Hospital
city: Kayseri
country: Turkey
facility: Erciyes Universitesi Tip Fakultesi Hastaneleri
city: Samsun
country: Turkey
facility: Ondokuz Mayis University Faculty Of Medicine Hospital
Study officials:
affiliation: Pfizer
name: Pfizer CT.gov Call Center
role: STUDY_DIRECTOR
References:
citation: Shi Z, Zhu Y, Zhang J, Chen B. Monoclonal antibodies: new chance in the management of B-cell acute lymphoblastic leukemia. Hematology. 2022 Dec;27(1):642-652. doi: 10.1080/16078454.2022.2074704.