Clinical trial NCT02004522: A Phase 3 Study of Duvelisib Versus Ofatumumab in Patients With Relapsed or Refractory CLL/SLL (DUO)
Official title: A Phase 3 Study of Duvelisib Versus Ofatumumab in Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia/ Small Lymphocytic Lymphoma (DUO)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Chronic Lymphocytic Leukemia
Small Lymphocytic Lymphoma
Keywords: Phase 3
CLL/SLL
Pi3K
Lead sponsor: SecuraBio
Sponsor class: INDUSTRY
First posted: 2013-12-09
Enrollment: 319
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: A Phase 3 clinical trial to examine the efficacy of duvelisib monotherapy versus ofatumumab monotherapy in subjects with relapsed or refractory Chronic Lymphocytic Leukemia (CLL) or Small Lymphocytic Lymphoma (SLL).

Detailed description: This is an open-label, two- arm, randomized phase 3, superiority trial designed to evaluate the efficacy and safety of duvelisib compared to ofatumumab administered to patients who have been diagnosed with CLL/SLL whose disease is relapsed or refractory.

Approximately 150 subjects will receive a starting dose of 25 mg duvelisib BID initially over the course of 21-day treatment cycle followed by 28-day treatment cycles for up to 18 cycles or until disease progression or unacceptable toxicity (whichever comes first). After 18 complete cycles of treatment, subjects may receive additional cycles of duvelisib until disease progression or unacceptable toxicity if they, in the judgment of the Investigator, may derive benefit from continued treatment, and if the subject meets the criteria for additional treatment at Cycle 19 Day 1.

Approximately 150 subjects will receive a starting dose of 300 mg ofatumumab on Day 1 followed by seven weekly doses of 2000 mg. Thereafter, subjects will receive 2000 mg ofatumumab once every month for four months. Administration of ofatumumab will not exceed the 12 doses (within 7 cycles).

Eligibility criteria: Inclusion Criteria:

* Diagnosis of active CLL or SLL that meets at least one of the IWCLL 2008 criteria for requiring treatment (Binet Stage ≥ B and/or Rai Stage ≥ I)
* Disease that has progressed during or relapsed after at least one previous CLL/SLL therapy
* Not appropriate for treatment with a purine-based analogue regimen (per National Comprehensive Cancer Network \[NCCN\] or European Society for Medical Oncology \[ESMO\] guidelines), including relapse ≤ 36 months from a purine-based chemoimmunotherapy regimen or relapse ≤ 24 months from a purine-based monotherapy regimen
* A cytogenetics or fluorescence in situ hybridization (FISH) analysis of the leukemic cells within 24 months of randomization is required to document the presence or absence of del(17p). Note: if a sample from within 24 months is not available, it should be evaluated as part of the screening laboratory evaluation to inform stratification
* Measurable disease with a lymph node or tumor mass \> 1.5 cm in at least one dimension as assessed by computed tomography (CT)
* Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2 (corresponds to Karnofsky Performance Status \[KPS\] ≥ 60%)
* Willingness by subject to be randomized to receive either ofatumumab or duvelisib at the dose and schedule defined in the protocol
* Must meet the following laboratory parameters:

  1. Serum aspartate transaminase (AST/SGOT) or alanine transaminase (ALT/SGPT) ≤ 3 x upper limit of normal (ULN)
  2. Total bilirubin ≤ 1.5 x ULN
  3. Serum creatinine ≤ 2.0 x ULN
  4. Hemoglobin ≥ 8.0 g/dL with or without transfusion support
  5. Platelet count ≥ 10,000 μL with or without transfusion support
* For women of childbearing potential (WCBP): negative serum β-human chorionic gonadotropin (βhCG) pregnancy test within 1 week before randomization (WCBP defined as a sexually mature woman who has not undergone surgical sterilization or who has not been naturally post-menopausal for at least 24 consecutive months \[women ≤ 55 years\] or 12 consecutive months \[women \> 55 years\])
* Willingness of male and female subjects who are not surgically sterile or postmenopausal to use medically acceptable methods of birth control from the first dose of study drug to 30 days after the last dose of duvelisib and for 12 months after last dose of ofatumumab. Sexually active men, and women using oral contraceptive pills, should also use barrier contraception
* Ability to voluntarily sign consent for and adhere to the entire study visit schedule and all protocol requirements
* Signed and dated institutional review board (IRB)/independent ethics committee (IEC)-approved informed consent form (ICF) before any study specific screening procedures are performed

Exclusion Criteria:

* History of Richter's transformation or prolymphocytic leukemia
* Uncontrolled autoimmune hemolytic anemia (AIHA) or idiopathic thrombocytopenia purpura (ITP) that is uncontrolled or requiring \> 20 mg once daily (QD) of prednisone (or equivalent) to maintain hemoglobin \> 8.0 g/dL or platelets \> 10,000 μL without transfusion support
* Refractory to ofatumumab (progression or relapse \<12 months of receiving ofatumumab therapy or \<24 months of receiving an ofatumumab- containing regimen)
* Prior allogeneic transplant (prior autologous stem cell transplant \>6 months prior to study entry is permitted)
* Known central nervous system lymphoma or leukemia; subjects with symptoms of CNS disease must have a negative CT scan or negative diagnostic lumbar puncture prior to randomization
* Use of any of the following medications or procedures within the specified timeframe:
* Use of live or live attenuated vaccines within 30 days prior to randomization
* Chemotherapy, radiation therapy, or ablative therapy within 3 weeks of randomization
* Tyrosine kinase inhibitor within 7 days of randomization
* Other investigational therapy (not included above) within 3 weeks of randomization
* Previous treatment with a PI3K inhibitor or BTK inhibitor
* Ongoing treatment with chronic immunosuppressants (eg, cyclosporine) or systemic steroids \> 20 mg prednisone (or equivalent) QD
* History of tuberculosis treatment within the preceding two years
* Ongoing systemic bacterial, fungal, or viral infections at the time of initiation of study treatment (defined as requiring IV antimicrobial, antifungal or antiviral agents)
* Subjects on antimicrobial, antifungal or antiviral prophylaxis are not specifically excluded if all other inclusion/exclusion criteria are met and there is no evidence of active infection at randomization
* Human immunodeficiency virus (HIV) infection
* Prior, current, or chronic hepatitis B or hepatitis C infection
* History of alcohol abuse or chronic liver disease (other than metastatic disease to the liver)
* Unable to receive prophylactic treatment for pneumocystis or herpes simplex virus (HSV)
* Baseline QT interval corrected with Fridericia's method (QTcF) \> 480 ms (average of triplicate readings) Note: This criterion does not apply to subjects with a right or left bundle branch block (BBB)
* Unstable or severe uncontrolled medical condition (eg, unstable cardiac function, unstable pulmonary condition), or any important medical illness or abnormal laboratory finding that would, in the investigator's judgment, increase the subject's risk while participating in this study
* Concurrent active malignancy other than nonmelanoma skin cancer or carcinoma in situ of the cervix, bladder, or prostate not requiring treatment. Subjects with previous malignancies are eligible provided that they have been disease free for ≥2 years
* History of stroke, unstable angina, myocardial infarction, or ventricular arrhythmia requiring medication or mechanical control within the last 6 months
* Administration of medications or foods that are strong inhibitors or inducers of CYP3A within 2 weeks of randomization
* Prior surgery or gastrointestinal dysfunction that may affect drug absorption (eg, gastric bypass surgery, gastrectomy)
* Major surgery or invasive intervention within 4 weeks prior to randomization
* Pregnant or breastfeeding women
* Hypersensitivity to ofatumumab or its excipients

Primary outcomes:
measure: Progression-free Survival (PFS)
timeFrame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 3 years
Secondary outcomes:
measure: Overall Response Rate (ORR)
timeFrame: Until disease progression or unacceptable toxicity assessed up to 6 years
measure: Number of Subjects With Hematologic Improvements
timeFrame: 3 years
measure: Overall Survival
timeFrame: Every 6 months for up to 3 years after first dose
measure: Lymph Node Response Rate
timeFrame: 3 years
measure: Duration of Response (DOR)
timeFrame: Time from the first documentation of response to first documentation of progressive disease or death due to any cause
measure: Treatment-Emergent Adverse Events (TEAEs) and Changes in Safety Laboratory Values
timeFrame: From 04 Feb 2014 till 19 June 2018
measure: Number of Subjects With Samples Available for Duvelisib Pharmacokinetics (PK)
timeFrame: Cycle 2, Cycle 3, and Cycle 7
Other outcomes:
Locations:
city: La Jolla
country: United States
state: California
city: Denver
country: United States
state: Colorado
city: Altamonte Springs
country: United States
state: Florida
city: Bonita Springs
country: United States
state: Florida
city: Bradenton
country: United States
state: Florida
city: Brandon
country: United States
state: Florida
city: Cape Coral
country: United States
state: Florida
city: Clearwater
country: United States
state: Florida
city: Englewood
country: United States
state: Florida
city: Fort Myers
country: United States
state: Florida
city: Gainesville
country: United States
state: Florida
city: Hudson
country: United States
state: Florida
city: Inverness
country: United States
state: Florida
city: Largo
country: United States
state: Florida
city: Naples
country: United States
state: Florida
city: New Port Richey
country: United States
state: Florida
city: Orange City
country: United States
state: Florida
city: Orlando
country: United States
state: Florida
city: Port Charlotte
country: United States
state: Florida
city: Saint Petersburg
country: United States
state: Florida
city: Sarasota
country: United States
state: Florida
city: Spring Hill
country: United States
state: Florida
city: Tampa
country: United States
state: Florida
city: Tavares
country: United States
state: Florida
city: Venice
country: United States
state: Florida
city: Crestview Hills
country: United States
state: Kentucky
city: Boston
country: United States
state: Massachusetts
city: Boston
country: United States
state: Massachusetts
city: Saint Louis
country: United States
state: Missouri
city: Hackensack
country: United States
state: New Jersey
city: New Brunswick
country: United States
state: New Jersey
city: New York
country: United States
state: New York
city: New York
country: United States
state: New York
city: Cincinnati
country: United States
state: Ohio
city: Fairfield
country: United States
state: Ohio
city: Nashville
country: United States
state: Tennessee
city: Charlottesville
country: United States
state: Virginia
city: Bedford Park
country: Australia
city: East Melbourne
country: Australia
city: Melbourne
country: Australia
city: Vienna
country: Austria
city: Wels
country: Austria
city: Wien
country: Austria
city: Bruxelles
country: Belgium
city: Bruxelles
country: Belgium
city: Gent
country: Belgium
city: Leuven
country: Belgium
city: Sint- Niklaas
country: Belgium
city: Argenteuil
country: France
city: Bobigny
country: France
city: Bordeaux
country: France
city: Caen
country: France
city: Clermont-Ferrand
country: France
city: La Roche Sur Yon
country: France
city: Limoges Cedex
country: France
city: Nantes
country: France
city: Rennes
country: France
city: Vendœuvres
country: France
city: Berlin
country: Germany
city: Köln
country: Germany
city: Leer
country: Germany
city: Rostock
country: Germany
city: Ulm
country: Germany
city: Budapest
country: Hungary
city: Budapest
country: Hungary
city: Debrecen
country: Hungary
city: Gyor
country: Hungary
city: Kaposvár
country: Hungary
city: Pecs
country: Hungary
city: Szeged
country: Hungary
city: Catania
country: Italy
city: Lecce
country: Italy
city: Meldola
country: Italy
city: Milano
country: Italy
city: Milano
country: Italy
city: Padova
country: Italy
city: Ravenna
country: Italy
city: Rimini
country: Italy
city: Roma
country: Italy
city: Auckland
country: New Zealand
city: Palmerston North
country: New Zealand
city: Barcelona
country: Spain
city: Barcelona
country: Spain
city: Barcelona
country: Spain
city: Madrid
country: Spain
city: Madrid
country: Spain
city: Pamplona
country: Spain
city: Bournemouth
country: United Kingdom
city: Leeds
country: United Kingdom
city: Manchester
country: United Kingdom
city: Nottingham
country: United Kingdom
city: Oxford
country: United Kingdom
Study officials:
References:
citation: Flinn IW, Hillmen P, Montillo M, Nagy Z, Illes A, Etienne G, Delgado J, Kuss BJ, Tam CS, Gasztonyi Z, Offner F, Lunin S, Bosch F, Davids MS, Lamanna N, Jaeger U, Ghia P, Cymbalista F, Portell CA, Skarbnik AP, Cashen AF, Weaver DT, Kelly VM, Turnbull B, Stilgenbauer S. The phase 3 DUO trial: duvelisib vs ofatumumab in relapsed and refractory CLL/SLL. Blood. 2018 Dec 6;132(23):2446-2455. doi: 10.1182/blood-2018-05-850461. Epub 2018 Oct 4.