Clinical trial NCT04974216: Study of Tafasitamab and Lenalinomide Associated to Rituximab in Frontline Diffuse Large B-Cell Lymphoma Patients of 80 y/o or Older
Official title: Phase II, Open-Label Study Evaluating Efficacy of Tafasitamab and Lenalinomide Associated to Rituximab in Frontline Diffuse Large B-Cell Lymphoma Patients of 80 y/o or Older
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE2
Conditions: DLBCL
Lead sponsor: The Lymphoma Academic Research Organisation
Sponsor class: OTHER
First posted: 2021-07-23
Enrollment: 71
Sex: ALL
Minimum age (years): 80
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: This study evaluate the efficacy of Tafasitamab and Lenalinomide associated to Rituximab in elderly patients with frontline Diffuse Large B-Cell Lymphoma as assessed by the Overall Response Rate (ORR) after 3 cycles of treatment according to Lugano Response Criteria.

Detailed description: This study is an open-label, multi-centric, phase II study designed to evaluate the efficacy of Tafasitamab and Lenalinomide associated to Rituximab in elderly patients with frontline Diffuse Large B-Cell Lymphoma as assessed by the Overall Response Rate (ORR) after 3 cycles of treatment according to Lugano Response Criteria.

After a screening phase, eligible patients will be enrolled and start the prephase treatment with vincristine and prednisone before day 1 of cycle 1 of the experimental drugs.

Patients with Progressive Disease or Stable Disease after 3 cycles should start a conventional chemotherapy (R-miniCHOP) at Investigator's discretion and will remain in the study.

Eligibility criteria: Inclusion Criteria:

2.Patient with histologically proven CD20+ diffuse large B-cell lymphoma (DLBCL) (WHO classification 2017) including all clinical subtypes (primary mediastinal, intravascular, etc...), with all International Prognostic Index (IPI). May also be enrolled the following malignancies:

* De Novo transformed DLBCL from low grade lymphoma (Follicular, other...) and DLBCL associated with some small cell infiltration in bone marrow or lymph node.
* High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements
* High-grade B-cell lymphoma, Not Otherwise Specified (NOS)
* Follicular lymphoma grade 3B 3.Positron-Emission Tomography (PET)-positive disease 4.Previously untreated high-grade B-cell lymphoma 5.Aged ≥ 80 years old at the time of signing the informed consent form (ICF) 6.Ann Arbor stage I, II, III or IV 7.Eastern Cooperative Oncology Group (ECO)G performance status ≤ 2 8.With a minimum life expectancy of 3 months 9.Male patients must practice complete abstinence or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions, and for 4 months following study drug discontinuation, even if they have undergone a successful vasectomy 10. Patients should be able to receive R-miniCHOP regimen (left ventricular ejection fraction \> 50% and good general condition, according to investigator's judgment) 11. Patients should be able to receive adequate prophylaxis and/or therapy for thromboembolic events (aspirin or low molecular weight heparin) 12. Patient covered by any social security system (France)

Exclusion Criteria:

1. Any other histological type of lymphoma, Burkitt included
2. Any history of treated or non-treated Small-B cell lymphoma prior Aggressive B Cell lymphoma diagnosis
3. Central nervous system or meningeal involvement by lymphoma
4. Any serious active disease (according to the investigator's decision)
5. Poor renal function (calculated Cockcroft-Gault creatinine clearance \< 30 ml/min)
6. Poor hepatic function (total bilirubin level \>30 μmol/l, transaminases \>2.5 upper normal limits) unless these abnormalities are related to lymphoma
7. Poor bone marrow reserve as defined by neutrophils \<1.5 G/l or platelets \<100 G/l, unless related to bone marrow infiltration by lymphoma cells (Bone Marrow Aspiration will be mandatory in case of severe cytopenias prior inclusion)
8. Any history of cancer during the last 5 years with the exception of non-melanoma skin tumors or stage 0 (in situ) cervical carcinoma. Patients previously diagnosed with prostate cancer are eligible if (1) their disease was T1-T2a, N0, M0, with a Gleason score ≤7, and a prostate specific antigen (PSA) ≤10 ng/mL prior to initial therapy, (2) they had definitive curative therapy (i.e., prostatectomy or radiotherapy) 2 years before Day 1 of Cycle 1, and (3) at a minimum 2 years following therapy they had no clinical evidence of prostate cancer, and their PSA was undetectable if they underwent prostatectomy or \<1 ng/mL if they did not undergo prostatectomy
9. Treatment with any investigational drug within 30 days prior to prephase treatment and during the study
10. Known HIV, active Hepatitis C Virus (HCV) infection or positive Hepatitis B Virus (HBV) test within 4 weeks before enrollment (except after hepatitis B vaccination or for patients who are HBs Ag negative, anti-HBs positive and/or anti-HBc positive but viral DNA negative)
11. Prior treatment with anti-CD20/anti-CD19 monoclonal antibody or alemtuzumab within 3 months prior to prephase treatment
12. Prior ≥ Grade 3 allergic reaction/hypersensitivity to thalidomide
13. Contra-indication to highly dosed glucocorticoid (60 mg/m2/d)
14. Neuropathy ≥ Grade 2 or painful
15. Patient deprived of his/her liberty by a judicial or administrative decision
16. Adult patient under legal protection

Primary outcomes:
measure: Overall Response Rate (ORR) by local assessment
timeFrame: 3 months (3 cycles of 28 days)
Secondary outcomes:
measure: Number of Serious Adverse Events (SAE) of patients treated with lenalidomide and tafasitamab
timeFrame: 13 months
measure: Number of SAE of patients who switched to RminiCHOP
timeFrame: 7 months
measure: Progression free survival (PFS)
timeFrame: 2 years
measure: Overall survival (OS)
timeFrame: 2 years
measure: Overall Response Rate (ORR) by central assessment
timeFrame: 3 months (3 cycles of 28 days)
measure: Complete Metabolic Response (CMR) by local assessment
timeFrame: 3 months (3 cycles of 28 days)
measure: Complete Metabolic Response (CMR) by central assessment
timeFrame: 3 months (3 cycles of 28 days)
measure: Complete Metabolic Response (CMR) by local assessment
timeFrame: 6 months (6 cycles of 28 days)
measure: Complete Metabolic Response (CMR) by central assessment
timeFrame: 6 months (6 cycles of 28 days)
measure: Complete Metabolic Response (CMR) by local assessment
timeFrame: 12 months (12 cycles of 28 days = end of treatment)
measure: Complete Metabolic Response (CMR) by central assessment
timeFrame: 12 months (12 cycles of 28 days = end of treatment)
measure: Overall Response Rate (ORR) by local assessment
timeFrame: 6 months (6 cycles of 28 days)
measure: Overall Response Rate (ORR) by central assessment
timeFrame: 6 months (6 cycles of 28 days)
measure: Overall Response Rate (ORR) by local assessment
timeFrame: 12 months (12 cycles of 28 days = end of treatment)
measure: Overall Response Rate (ORR) by central assessment
timeFrame: 12 months (12 cycles of 28 days = end of treatment)
measure: Progression free survival (PFS) of patients who switched to RminiCHOP
timeFrame: 3 years
measure: Overall survival (OS) of patients who switched to RminiCHOP
timeFrame: 3 years
Other outcomes:
Locations:
city: Brussels
country: Belgium
facility: Clinique Universitaire Saint LUC
city: Liège
country: Belgium
facility: CHU de Liège
city: Yvoir
country: Belgium
facility: CHRU Mont Godinne
city: Bordeaux
country: France
facility: CHU de Bordeaux - Hôpital Haut Lévêque
city: Bordeaux
country: France
facility: Institut Bergonié - Bordeaux
city: Lille
country: France
facility: CH Saint Vincent de Paul
city: Lille
country: France
facility: CHRU de LILLE - Claude Huriez
city: Limoges
country: France
facility: Chu de Limoges - Hopital Dupuytren
city: Nantes
country: France
facility: CHU de Nantes - Hôtel Dieu
city: Nice
country: France
facility: Centre Antoine Lacassagne
city: Paris
country: France
facility: APHP - Hôpital Saint Louis
city: Rouen
country: France
facility: Centre Henri Becquerel
city: Saint-Cloud
country: France
facility: Centre René Huguenin - Institut Curie
city: Saint-Priest-en-Jarez
country: France
facility: Institut de Cancérologie de la Loire Lucien Neuwirth
city: Vandoeuvre les Nancy
country: France
facility: CHU Brabois
Study officials:
References: