Study of Betalutin for Treatment of Relapsed or Refractory Non-Hodgkin Lymphoma (LYMRIT-37-05)

• ClinicalTrials.gov Identifier: NCT02658968
• Recruitment Status: Completed
• First Posted: January 20, 2016
• Last Update Posted: September 2, 2021
• Sponsor: Nordic Nanovector
• Information provided by (Responsible Party): Nordic Nanovector

Study Description

Brief Summary:

This study is a phase 1, dose finding, open-label study in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). This is a dose escalating study to define the maximum tolerable dose of lutetium (177Lu)-lilotomab satetraxetan (Betalutin®) in DLBCL patients who are not eligible for autologous stem cell transplant. The study will also assess safety and toxicity, pharmacokinetics, biodistribution and efficacy.

Condition or disease	Intervention/treatment	Phase
Relapsed, Diffuse Large B-cell Lymphoma; Refractory Diffuse Large B-Cell Lymphoma	Drug: Betalutin	Phase 1

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 18 participants
• Allocation: N/A
• Intervention Model: Sequential Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 1 Dose Finding Study of Lutetium (177Lu)-Lilotomab Satetraxetan (Betalutin®) in Patients With Relapsed/Refractory, Diffuse Large B-cell Lymphoma, Not Eligible for Autologous Stem Cell Transplant
• Actual Study Start Date: March 2, 2017
• Actual Primary Completion Date: June 4, 2021
• Actual Study Completion Date: July 10, 2021

Arms and Interventions

Arm	Intervention/treatment
Experimental: Betalutin; 10 MBq/kg b.w., in escalated doses with lilotomab pre-dosing	Drug: Betalutin; Dose finding study, starting on 10 MBq/kg b.w. Betalutin® (lutetium (177Lu)-lilotomab satetraxetan), single injection with lilotomab pre-dosing.; Other Name: Betalutin, lutetium (177Lu)-lilotomab satetraxetan

Outcome Measures

Primary Outcome Measures :

1. Determine the Maximum Tolerated Dose [ Time Frame: 12 weeks ]
   To determine the maximum tolerated dose of Betalutin that can be given to patients with relapsed/refractory, diffuse large B-cell lymphoma, not eligible for autologous stem cell transplant.

Secondary Outcome Measures :

1. The best overall tumour response rate [ Time Frame: 3 months - 2 years ]
   Efficacy evaluations are measured by tumour response rates using CT and PET/CT imaging with responses classified according to revised response criteria for NHL (Cheson, 2014).
2. Dosimetry [ Time Frame: 3 weeks ]
   Dosimetry will be evaluated by the estimated absorbed radiation dose to target organs.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Male or female aged ≥18 years.
2. Histologically confirmed DLBCL (WHO classification).
3. Received at least one prior line of therapy including immuno-chemotherapy.
4. In first or subsequent relapse, or refractory to the last treatment (defined as less than a complete metabolic response to the last treatment, or within 6 months from the last treatment).
5. Not suitable for, or declined high dose chemotherapy and autologous stem cell transplantation (ASCT).
6. Presence of radiographically measurable lymphadenopathy or extranodal lymphoid malignancy (at least one objectively bi-dimensionally measurable (nodal) lesion (>2 cm in its largest dimension by CT scan).
7. Negative human anti-murine antibody (HAMA) test.
8. Life expectancy of at least 3 months.
9. Bone marrow tumour infiltration <25% tumour cells.
10. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2

11. Normal organ and bone marrow function defined as:

    1. Absolute neutrophil count ≥1.5 x 109/L;
    2. Platelet count ≥150 x 109/L;
    3. Haemoglobin ≥9 g/dL;
    4. Total bilirubin ≤1.5 x upper limit of normal (ULN) (except patients with documented Gilbert's syndrome);
    5. Liver enzymes: Aspartate transaminase (AST); Alanine transaminase (ALT) or Alkaline phosphatase (ALP) ≤2.5 x ULN (or ≤5.0 x ULN if liver involvement by primary disease);
    6. Adequate renal function as demonstrated by a serum creatinine ≤1.5 mg/dL or a creatinine clearance >60 mL/min;
    7. Normal coagulation parameters (elevated international normalized ratio (INR), prothrombin time or activated partial thromboplastin time (APTT) ≤1.3 ULN range acceptable).

12. Women of childbearing potential must

    1. understand that the study medication may have teratogenic risk
    2. have a negative serum pregnancy test at screening and before Betalutin injection

    3. commit to continued abstinence from heterosexual intercourse (excluding periodic abstinence or the withdrawal method) or begin two acceptable methods of birth control with a Pearl-Index ≤ 1%. without interruption from 4 weeks before starting study drug, throughout study drug therapy and for 12 months after end of study drug therapy, even if she has amenorrhoea. Apart from abstinence, acceptable methods of birth control are:

       • Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation
       • oral
       • intravaginal
       • transdermal
       • Progestogen-only hormonal contraception associated with inhibition of ovulation
       • oral
       • injectable
       • implantable
       • Intrauterine device (IUD)
       • Intrauterine hormone-releasing system ( IUS)
       • Bilateral tubal occlusion
       • Vasectomised partner
13. Male patients must agree to use condoms during intercourse throughout study drug therapy and the following 12 months.
14. Ability to give written, informed consent prior to any study-specific screening procedures, with the understanding that the consent may be withdrawn by the patient at any time without prejudice.
15. Capable of understanding the protocol requirements, is willing and able to comply with the study protocol procedures, and has signed the informed consent document.
16. A negative Hepatitis B test (HBsAg and anti-HBc) and negative HIV test during screening

Exclusion Criteria:

1. Prior hematopoietic allogenic stem cell transplantation.
2. Prior autologous stem cell transplantation.
3. Previous total body irradiation, or irradiation of >25% of the patient's bone marrow.
4. Prior anti-lymphoma therapy (chemotherapy, immunotherapy or other investigational agent) within 4 weeks prior to start of study treatment (corticosteroid treatment at doses of ≤20 mg/day, G-CSF or GM CSF are permitted up to 2 weeks prior to start of study treatment.). Note: excluding pre-treatment with rituximab as part of this study
5. Patients who are receiving any other investigational agents.
6. Patients with known or suspected central nervous system involvement of lymphoma.

7. History of a previous treated cancer except for the following:

   1. adequately treated local basal cell or squamous cell carcinoma of the skin;
   2. cervical carcinoma in situ;
   3. superficial bladder cancer;
   4. localized prostate cancer undergoing surveillance or surgery;
   5. localised breast cancer treated with surgery and radiotherapy but not including systemic chemotherapy;
   6. other adequately treated Stage 1 or 2 cancer currently in complete remission;
8. Pregnant or breastfeeding women.
9. Exposure to another CD37 targeting drug.
10. Allergy to X ray contrast agents.
11. A known hypersensitivity to rituximab, HH1, Betalutin or murine proteins or any excipient used in rituximab, HH1 or Betalutin.
12. Has received a live attenuated vaccine within 30 days prior to enrolling in the study.

13. Evidence of severe or uncontrolled systemic diseases:

    1. uncontrolled infection including evidence of ongoing systemic bacterial, fungal, or viral infection (excluding viral upper respiratory tract infections) at the time of initiation of study treatment;
    2. pulmonary conditions e.g. unstable or uncompensated respiratory disease
    3. hepatic, renal neurological or metabolic conditions - which in the opinion of the investigator would compromise the protocol objectives.
    4. psychiatric conditions e.g. patients unlikely to comply with the protocol, e.g. mental condition rendering the patient unable to understand the nature, scope, and possible consequences of participating in the study
    5. history of erythema multiforme, toxic epidermal necrolysis or Stevens-Johnson syndrome;

    6. cardiac conditions, including

       • history of acute coronary syndromes (including unstable angina)
       • class II, III, or IV heart failure as defined by the New York Heart Association (NYHA) functional classification system;
       • known uncontrolled arrhythmias (except sinus arrhythmia) in the past 24 weeks.

Contacts and Locations

Locations

United States, California

University of California, San Diego (UCSD) - Moores Cancer Center

San Diego, California, United States, 92093

University of California, San Francisco (UCSF) - Innovation, Technology & Alliances

San Francisco, California, United States, 94117

United States, Florida

Sylvester Comprehensive Cancer Centre

Miami, Florida, United States, 33146

Germany

Klinikum rechts der Isar der TU München

Munich, Germany, 81675

Italy

Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi

Bologna, Italy, 40138

Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino

Torino, Italy, 10126

Azienda Ospedaliera Universitaria Integrata Verona - Ospedale Borgo Trento

Verona, Italy, 37134

Spain

Hospital Universitari i Politècnic La Fe

Valencia, Spain, 46026

United Kingdom

University Hospitals Bristol NHS Foundation Trust - Bristol Haematology and Oncology Centre

Bristol, United Kingdom, BS2 8ED

Christie NHS Foundation Trust

Manchester, United Kingdom, M20 4BX

Sponsors and Collaborators

Nordic Nanovector

Investigators

• Principal Investigator: Timothy Illidge, PhD MB BS; University of Manchester, The Christie NHS Foundation Trust

More Information

Publications:

Dahle J, Repetto-Llamazares AH, Mollatt CS, Melhus KB, Bruland OS, Kolstad A, Larsen RH. Evaluating antigen targeting and anti-tumor activity of a new anti-CD37 radioimmunoconjugate against non-Hodgkin's lymphoma. Anticancer Res. 2013 Jan;33(1):85-95.

Repetto-Llamazares AH, Larsen RH, Mollatt C, Lassmann M, Dahle J. Biodistribution and dosimetry of (177)Lu-tetulomab, a new radioimmunoconjugate for treatment of non-Hodgkin lymphoma. Curr Radiopharm. 2013 Mar;6(1):20-7. doi: 10.2174/1874471011306010004.

• Responsible Party: Nordic Nanovector
• ClinicalTrials.gov Identifier: NCT02658968
• Other Study ID Numbers: EudraCT: 2015-001933-26
• First Posted: January 20, 2016
• Last Update Posted: September 2, 2021
• Last Verified: September 2021

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Nordic Nanovector:

• Betalutin; Radioimmunotherapy; Lu-177; Phase I study; ARC; Antibody Radionuclide Conjugate; HH1; Rituximab; 177Lu-DOTA-HH1; Lilotomab; Lutetium (177Lu)-lilotomab satetraxetan; Additional relevant MeSH terms: Lymphoma; Lymphoma, Non-Hodgkin; Immune System Diseases; Immunoproliferative Disorders; Diffuse Large B-Cell Lymphoma; Lymphatic Diseases; Lymphoproliferative Disorders; Neoplasms; Neoplasms by Histologic Type; DLBCL; Refractory DLBCL; Relapsed DLBCL

Additional relevant MeSH terms:

Lymphoma; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Immune System Diseases; Lymphoma, Non-Hodgkin