Clinical trial NCT04531046: Axi-Cel as a 2nd Line Therapy in Patients With Relapsed/Refractory Aggressive B Lymphoma Ineligible to Autologous Stem Cell Transplantation
Official title: Phase 2, Open-Label Study Evaluating Axi-Cel as a 2nd Line Therapy in Patients With Relapsed/Refractory Aggressive B-Non Hodgkin Lymphoma (B-NHL) Who Are Ineligible to Autologous Stem Cell Transplantation
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE2
Conditions: B-Cell Lymphoma Refractory
B-cell Lymphoma Recurrent
Lead sponsor: The Lymphoma Academic Research Organisation
Sponsor class: OTHER
First posted: 2020-08-28
Enrollment: 62
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: open-label, multicenter study
Primary purpose: TREATMENT

Brief summary: This is a phase 2, open-label, multicenter study evaluating axicabtagene ciloleucel (axi-cel) as a 2nd line therapy in patients with Relapsed/Refractory aggressive B-NHL who are ineligible to receive Autologous Stem Cell Transplantation but eligible to receive CAR T-cell therapy.

Detailed description: Axicabtagene ciloleucel (axi-cel) is a chimeric antigen receptor (CAR) T-cell therapy directed against CD19 which has been approved for the treatment of relapse/refractory diffuse large B-cell lymphoma DLBCL and primary mediastinal large B-cell lymphoma (PMBCL) after 2 or more lines of systemic therapy.

But administrating CAR T-cells earlier in the therapeutic strategy may be beneficial to patients.

Axi-cel will improve the outcome of patients with DLBCL who are refractory or relapse early (i.e. within 1 year from end of treatment) after first-line therapy and who are not eligible for Autologous Stem Cell Transplantation (ASCT).

Transplant-ineligible patients will include those who are deemed ineligible for high-dose chemotherapy and Hematopoietic Stem Cell Transplantation (HSCT) due to age, comorbidity, or prior ASCT.

The primary endpoint will be complete metabolic response (CMR) at 3 months after Axi-cel infusion.

Eligibility criteria: Inclusion Criteria:

* Patient who understands and speaks one of the country official languages and signed Informed Consent Form
* Histologically proven relapsed or refractory aggressive B-cell non-Hodgkin lymphoma (B-NHL) of the following histology at relapse: diffuse large B-cell lymphoma (DLBCL), high-grade B-cell lymphoma (HGBL), follicular lymphoma Grade 3B per World Health Organization (WHO) 2016 classification and Primary mediastinal Bcell lymphomas. Indolent B-NHL who transformed into aggressive B-NHL and were previously treated with Rituximab-Cyclophosphamide, Hydroxydaunomycin, Oncovin, and Prednisone (R-CHOP) are eligible.
* Tumoral tissue (at diagnosis or relapse) available for central pathology review, exploratory endpoints and ancillary studies
* Positron-emission tomography (PET)-positive disease
* Patients must have received adequate first-line therapy including at a minimum: an anti-CD20 monoclonal antibody (rituximab or obinutuzumab), and Cyclophosphamide, Hydroxydaunomycin, Oncovin, and Prednisone (CHOP) or CHOP-like chemotherapy
* Relapsed or refractory disease after first-line chemoimmunotherapy (full dose of R-CHOP or R-CHOP-like regimen), documented by PET-scan
* At least 2 weeks must have elapsed since any prior systemic cancer therapy at the time the patient provides consent
* Patients must be autologous stem cell transplantation (ASCT)-ineligible
* Patients must be CAR-T-eligible
* Females of childbearing potential must have a negative serum or urine pregnancy test (females who have undergone surgical sterilization or who have been postmenopausal for at least 12 months are not considered to be of childbearing potential)

Exclusion Criteria:

* Patients who received more than one prior line of systemic therapy
* Patients who are intolerant to first-line therapy or who received suboptimal first-line therapy, including dose-reduced R-CHOP ("R-miniCHOP"), and those who discontinued prematurely first-line therapy due to toxicity are not eligible
* Prior CD19 targeted therapy
* Patients with cardiac atrial or cardiac ventricular lymphoma involvement
* Requirement for urgent therapy due to tumor mass effects, such as bowel obstruction or blood vessel compression
* Patient with clinically significant pleural effusion
* History of another primary malignancy that has not been in remission for at least 2 years (except for nonmelanoma skin cancer or carcinoma in situ (eg, cervix, bladder, breast))
* Patients with detectable Central Nervous System (CNS) lymphoma
* History or presence of non-malignant CNS disorder, such as seizure disorder requiring anti-convulsive therapy, cerebellar disease, or any autoimmune disease with CNS involvement disease
* Active hepatitis B or hepatitis C infection, positive serology of human immunodeficiency virus (HIV) and syphilis at the time of screening
* Uncontrolled systemic fungal, bacterial, viral or other infection despite appropriate antibiotics or other treatment at the time of leukapheresis or axi-cel administration
* History of any one of the following cardiovascular conditions within the past 6 months: Class III or IV heart failure as defined by the New York Heart Association, cardiac angioplasty or stenting, myocardial infarction, unstable angina, or other clinically significant cardiac disease
* History of autoimmune disease requiring systemic immunosuppression and/or systemic disease modifying agents within the last year
* History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis per chest computed tomography (CT) scan at screening.
* History of severe immediate hypersensitivity reaction to tocilizumab or any of the agents used in this study
* History of severe immediate hypersensitivity reaction attributed to aminoglycosides, cyclophosphamide and fludarabine
* Treatment with a live, attenuated vaccine within 6 weeks prior to initiation of study treatment or anticipation of need for such a vaccine during the course of the study
* Women of childbearing potential who are pregnant or breastfeeding (from the time of consent during treatment and for at least 6 months after conditioning chemotherapy dosing or axicabtagene ciloleucel dosing, whichever is later)
* In the investigator's judgment, the patient is unlikely to complete all protocol-required study visits or procedures, including follow-up visits, or comply with the study requirements for participation
* Adult person unable to provide informed consent because of intellectual impairment, any serious medical condition, laboratory abnormality or psychiatric illness

Primary outcomes:
measure: Complete Metabolic Response (CMR) - determined by investigator
timeFrame: 3 months from axi-cel infusion
Secondary outcomes:
measure: Complete Metabolic Response (CMR) - determined by central imaging review
timeFrame: 3 months from axi-cel infusion
measure: Best objective response
timeFrame: between Day 14 and Month 12
measure: Number of Serious Adverse Events (SAE)
timeFrame: at 30 days after axi-cel infusion
measure: Event-free survival (EFS) based on investigator disease assessment
timeFrame: at 3 months
measure: Event-free survival (EFS) based on investigator disease assessment
timeFrame: at 6 months
measure: Event-free survival (EFS) based on investigator disease assessment
timeFrame: at 12 months
measure: Event-free survival (EFS) based on central imaging review
timeFrame: at 3 months
measure: Event-free survival (EFS) based on central imaging review
timeFrame: at 6 months
measure: Event-free survival (EFS) based on central imaging review
timeFrame: at 12 months
measure: Modified EFS (mEFS) based on investigator assessment
timeFrame: at 6 months
measure: Modified EFS (mEFS) based on investigator assessment
timeFrame: at 12 months
measure: Modified EFS (mEFS) based on central imaging review
timeFrame: at 6 months
measure: Modified EFS (mEFS) based on central imaging review
timeFrame: at 12 months
measure: Best objective response
timeFrame: at 2 years
measure: Best objective response
timeFrame: at 3 years
measure: Duration of response (DOR)
timeFrame: at 2 years
measure: Duration of response (DOR)
timeFrame: at 3 years
measure: Overall survival (OS) from leukaphaeresis and Axi-cel infusion
timeFrame: at 2 years
measure: Overall survival (OS) from leukaphaeresis and Axi-cel infusion
timeFrame: at 3 years
Other outcomes:
Locations:
city: Liège
country: Belgium
facility: CH Liège
city: Bordeaux
country: France
facility: CHU de Bordeaux - Hôpital Haut Lévêque
city: Clermont-Ferrand
country: France
facility: CHU Clermont Ferrand - Hôpital Estaing
city: Créteil
country: France
facility: APHP - Hôpital Henri Mondor
city: Dijon
country: France
facility: CHU de Dijon - Hôpital le Bocage
city: Lille
country: France
facility: Hôpital Claude Huriez
city: Montpellier
country: France
facility: Hôpital Saint Eloi
city: Nantes
country: France
facility: CHU de Nantes - Hôtel Dieu
city: Paris Cedex 10
country: France
facility: APHP - Hôpital Saint Louis
city: Paris
country: France
facility: Hopital La Pitié Salpétriere
city: Paris
country: France
facility: Hôpital Saint Antoine
city: Pierre Bénite
country: France
facility: Centre Hospitalier Lyon Sud
city: Rennes
country: France
facility: CHU de Rennes - Hôpital de Pontchaillou
city: Toulouse
country: France
facility: IUCT Oncopole
city: Vandoeuvre les Nancy
country: France
facility: CHU Brabois
city: Villejuif
country: France
facility: Institut de Cancérologie Gustave Roussy
Study officials:
affiliation: Rennes University Hospital, Rennes, France
name: Roch Houot, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Henri Mondor Hospital, Créteil, France
name: François Lemonnier, PhD
role: PRINCIPAL_INVESTIGATOR
References: