Clinical trial NCT02827617: Identification of Biomarkers That Are Predictive of Early Ibrutinib Treatment Failure in High Risk TP53 Mutated Chronic Lymphocytic Leukemia
Official title: Prospective, Observational, Multi-centred, Non-interventional Study on the Identification of Biomarkers That Are Predictive of Early Ibrutinib Treatment Failure in High Risk TP53 Mutated Chronic Lymphocytic Leukemia
Study type: OBSERVATIONAL
Overall status: ACTIVE_NOT_RECRUITING
Conditions: Chronic Lymphocytic Leukemia
Keywords: Ibrutinib
TP53
Chronic lymphocytic leukemia
Lead sponsor: Oncology Institute of Southern Switzerland
Sponsor class: OTHER
First posted: 2016-07-11
Enrollment: 56
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Adult CLL patients harboring TP53 genetic abnormalities, independent of whether treatment naïve or previously treated, who warrants treatment according to iwCLL 2008 criteria, and who is planned to receive ibrutinib at standard dose as per clinical practice

Brief summary: The general aim of the project is the identification of dynamic molecular markers that can help the early and real time prediction of sustained benefit or no benefit from ibrutinib treatment in CLL harboring TP53 mutations. Specific aims of the project include: 1) Assess whether clearance of TP53 mutated clones translates into a predictive biomarker of long term benefit from ibrutinib treatment in CLL. 2) Assess whether plasma cell free DNA represents a sensitive tool that can early and dynamically inform on the development of ibrutinib resistant mutations in CLL.

Detailed description: In the chemoimmunotherapy era, TP53 mutations defined a subgroup of high risk chronic lymphocytic leukemia (CLL) patients in whom allogeneic stem cell transplantation had to be strongly considered. As a result of the accumulating favorable outcome data reported for new biological drugs, including ibrutinib, in high risk CLL harboring TP53 mutations, there is concern about whether these patients should continue to be offered allogeneic stem cell transplantation. Despite their improved outcome, a proportion of high risk CLL harboring TP53 mutations is going to develop ibrutinib resistance, which in turns translate in a very poor survival. On these bases, in the setting of ibrutinib treatment, novel biomarkers are required to re-define high risk CLL patients candidate for consolidation strategies including allogeneic stem cell transplantation. Our working hypotheses are that: i) clearance of high risk TP53 mutated clones upon treatment with ibrutinib may associate with long progression free survival (PFS), while conversely, the persistence or increase of high risk TP53 mutated subclones under ibrutinib may associate with acquisition of resistance and disease progression; and ii) plasma cell free DNA represents an accessible source of tumor DNA for the early and sensitive identification of mutations causing resistance to ibrutinib. By using highly sensitive ultra-deep next generation sequencing strategies to monitor molecular biomarkers potentially relevant for ibrutinib in DNA coming from both cellular and the plasma fractions of peripheral blood, the project has the chance of identifying new dynamic molecular markers that can help the early and real time prediction of sustained benefit from ibrutinib treatment vs imminent progression in TP53 mutated CLL patients. In the end, the results of this study will provide the bases to refine the current approach for treatment tailoring in TP53 mutated patients by allowing the identification of cases who, though being in clinical response under ibrutinib, will conceivably benefit from immediate switch to alternative options (i.e. novel drugs, allogeneic stem cell transplantation, or CART).

Eligibility criteria: Inclusion Criteria:

* Male or female adults 18 years or older
* Documented diagnosis of CLL, according to iwCLL 2008 criteria
* Presence of TP53 mutation as demonstrated by sequencing at the local laboratory and/or presence of 17p deletion as demonstrated by fluorescence in situ hybridization (FISH) testing performed at the local laboratory
* CLL that warrants treatment
* Planned treatment with ibrutinib 420 mg quaque die
* Willing and able to comply with scheduled visits, laboratory tests, and study procedures
* Evidence of a signed informed consent

Exclusion Criteria:

* Current or prior histological transformation from CLL to an aggressive lymphoma (ie, Richter transformation).
* Prior treatment with ibrutinib or idelalisib

Primary outcomes:
measure: Impact of clonal response on PFS
timeFrame: 2/2016-2/2021
Secondary outcomes:
measure: Proportion of clonal response at Week 24 after treatment start
timeFrame: 2/2016-2/2021
measure: Cumulative proportion of clonal response
timeFrame: 2/2016-2/2021
measure: Impact of clonal response on overall survival
timeFrame: 2/2016-2/2021
measure: Effect of clonal response on the cumulative incidence of acquisition of resistance-mutations
timeFrame: 2/2016-2/2021
measure: Effect clonal response on the cumulative incidence of transformation to Richter syndrome
timeFrame: 2/2016-2/2021
measure: Impact of treatment-emergent BTK and PLCγ2 resistance mutations on PFS
timeFrame: 2/2016-2/2021
measure: Impact of treatment-emergent BTK and PLCγ2 resistance mutations on OS
timeFrame: 2/2016-2/2021
measure: Impact of treatment-emergent BTK and PLCγ2 resistance mutations on the cumulative incidence of transformation to Richter syndrome
timeFrame: 2/2016-2/2021
measure: Accuracy of plasma cell free DNA for the identification of BTK and PLCγ2 resistance mutations
timeFrame: 2/2016-2/2021
Other outcomes:
Locations:
city: Aviano
country: Italy
facility: Onco Ematologia Clinico Sperimentale, I.R.C.C.S. Centro di Riferimento Oncologico
city: Milano
country: Italy
facility: Ospedale San Raffaele
city: Milano
country: Italy
facility: Dipartimento di Ematologia, Niguarda Cancer Center, Ospedale Niguarda
city: Modena
country: Italy
facility: Department of Medical and Surgical Sciences, section of Hematology
city: Novara
country: Italy
facility: Divisione di Ematologia, Universita' del Piemonte Orientale
city: Roma
country: Italy
facility: Institute of Hematology, Catholic University S. Cuore
city: Rome
country: Italy
facility: Department of Haematology, Tor Vergata Hospital
city: Udine
country: Italy
facility: Clinica Ematologica, Centro Trapianti e Terapie Cellulari "Carlo Melzi"
city: Varese
country: Italy
facility: Ematologia, Ospedale di Circolo e Fondazione Macchi
city: Basel
country: Switzerland
facility: Division of Hematology, Department of Internal Medicine, Basel University Hospital
city: Bellinzona
country: Switzerland
facility: Oncology Institute of Southern Switzerland
city: Lugano
country: Switzerland
facility: Clinica Luganese Moncucco
city: Luzern
country: Switzerland
facility: Hematology, Luzern Kantonsspital
Study officials:
affiliation: Oncology Institute of Southern Switzerland
name: Davide Rossi, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References: