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Ibrutinib, Obinutuzumab and Venetoclax for Patients With Chronic Lymphocytic Leukemia

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ClinicalTrials.gov Identifier: NCT03755947
Recruitment Status : Recruiting
First Posted : November 28, 2018
Last Update Posted : April 26, 2019
Sponsor:
Information provided by (Responsible Party):
Grupo Cooperativo de Hemopatías Malignas

Tracking Information
First Submitted Date  ICMJE November 20, 2018
First Posted Date  ICMJE November 28, 2018
Last Update Posted Date April 26, 2019
Actual Study Start Date  ICMJE December 1, 2018
Estimated Primary Completion Date December 31, 2020   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: November 26, 2018)
Best response obtained [ Time Frame: Two months after finishing the triple sequencing therapy ]
The best response obtained will be defined as CR with negative MRD by the iwCLL response criteria measured subsequent a cytoreduction treatment, induction and consolidation with the triple sequencing therapy with Ibrutinib, Obinutuzumab and Venetoclax in patients with chronic lymphocytic leukemia.
Original Primary Outcome Measures  ICMJE Same as current
Change History Complete list of historical versions of study NCT03755947 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures  ICMJE
 (submitted: November 26, 2018)
  • Overall Survival [ Time Frame: Three years ]
    Defined as the time since the end of treatment to time of death in the patients diagnosed with chronic lymphocytic leukemia in treatment with a triple sequencing therapy with Ibrutinib, Obinutuzumab and Venetoclax
  • Relapse-Free Survival [ Time Frame: Three years ]
    Defined as the time since the end of treatment to time to relapse in the patients diagnosed with chronic lymphocytic leukemia in treatment with a triple sequencing therapy with Ibrutinib, Obinutuzumab and Venetoclax
  • Rate of AcuteToxicity [ Time Frame: Two years ]
    Adverse effects associated to triple sequencing therapy with Ibrutinib, Obinutuzumab and Venetoclax
  • Rate of Late Toxicity [ Time Frame: Three years ]
    Adverse effects associated to triple sequencing therapy with Ibrutinib, Obinutuzumab and Venetoclax on long term follow up.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Ibrutinib, Obinutuzumab and Venetoclax for Patients With Chronic Lymphocytic Leukemia
Official Title  ICMJE Sequential Triple Therapy With Ibrutinib, Obinutuzumab and Venetoclax in First and Second Line for Patients With Chronic Lymphocytic Leukemia
Brief Summary

Background: Chronic Lymphocytic Leukemia (CLL) is the most common leukemia in the occidental countries. Until now, it is considered a chronic disease without a cure. The development of new molecular therapies have showed that the cure may be an option. This protocol propose a triple sequential therapy with three direct therapies for the leukemic cell: an inhibitor of Bruton´s tyrosine kinase (ibrutinib), a second generation monoclonal antibody versus CD20 (obinutuzumab) and a BCL-2 inhibitor (venetoclax) as treatment of first or second line in CLL.

Objective: Negativize the minimal residual disease and by this way obtain longer survivals (overall survival and relapse free survival).

Design: This is a multicenter, longitudinal, experimental, open, non-randomized and non-comparable study coordinated by the "Grupo Cooperativo de Hemopatías Malignas" situated on Hospital Angeles Lomas in Huixquilucan, México. The study, is a phase II clinical study that will employ three target therapy drugs in sequencing phases. It will start with a BTK inhibitor as induction, later an anti-CD20 will be used for consolidation and it will end with a BH3 analog as maintenance for one year. The primary outcome is the negativization of minimal residual disease.

Detailed Description

The international recommendations indicate that the first line of treatment for patients <65 years old and with no significant comorbidities (fit patients) the known regime of FCR with recommendation of category 1 and later bendamustine with antiCD20 or ibrutinib. For patients >65 years old or not fit for intensive treatment it is recommended chlorambucil with obinutuzumab, monotherapy with ibrutinib, bendamustine with antiCD20 or chlorambucil with another antiCD20 like rituximab or ofatumumab. In case of patients with high-risk alterations of relapse due to positive MRD at the end of the treatment it is recommended a maintenance schedule with lenalidomide.

The antibodies against CD20 have shown through the years its activity in diverse alterations of B-cells. Rituximab was approved in 1998 for B-cells Non-Hodgkin lymphomas including CLL. Currently there are new anti-CD20 with more activity than rituximab. One of them is obinutuzumab which, by the monoclonal antibody engineering shows a greater affinity to the union of the epitope CD20 generating increased cellular cytotoxicity.

Bruton's tyrosine kinase (BTK), generates signaling cascades for the cell survival by the NF-KB and MAP kinases way, which leads to the transduction of the B cell receptor (BCR). Ibrutinib is a molecule that inhibits BTK inducing apoptosis in the B cells being currently used in the diverse mature B cell neoplasms.

Another therapeutic target is the BCL-2 protein (B-cell lymphoma 2) which is a key regulator in the apoptotic and it's compromised in the B cell neoplasms. Venetoclax is a mimetic drug to BH3 that blocks the function of BCL-2.

Based in the old and new drugs described in CLL, there is a great number of combinations that can be applied in the different phases of the disease as well as by risk stages and physical state of the patient. Before this scenario diverse CLL study groups proposes the strategy of sequencing in three phases (triple T) trying to prevent the development of leukemic subclones, minimize the use of chemotherapy that generates secondary mutations in CLL and other neoplasms. These type of treatment counts with the advantage of: 1) being available for patients physically fit or not due to the a limited toxicity of the drugs, 2) applying in an out-of-hospital environment and 3) adjusting the treatment according to the response to generate an effective cost in the new drugs. Thus, it is proposed the cytoreduction sequencing for 1 to 2 cycles, induction for 6 to 12 months and the MRD maintenance that could go from one year up to undefined with ibrutinib, obinutuzumab and venetoclax in that order.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 2
Study Design  ICMJE Intervention Model: Single Group Assignment
Intervention Model Description:
This is a multicenter, longitudinal, experimental, open, non-randomized and non-comparable study
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE
  • B-Cell Chronic Lymphocytic Leukemia
  • B-Cell Chronic Lymphocytic Leukemia in Relapse (Diagnosis)
Intervention  ICMJE
  • Drug: Ibrutinib
    Ibrutinib Oral Capsule [Imbruvica] Tablets 120 mg. Oral. 420mg/day, day 1 to 28, every 28 days. 3 cycles.
    Other Name: Imbruvica
  • Drug: Obinutuzumab
    Obinutuzumab Injection. Intravenous Solution [Gazyva] Parenteral. 1000 mg, day 1 of every cycle, every 28 days. 6 cycles.
    Other Name: Gazyva
  • Drug: Venetoclax
    Venetoclax Oral Tablets [Venclexta] Tablets 100 mg. Oral. 400 mg/day. Day 1 to 28, every 28 days. 12 cycles.
    Other Name: Venclexta
Study Arms  ICMJE Experimental: IGV

Cytoreduction 3 cycles (I) Ibrutinib, [Imbruvica, Janssen]

Induction 6 cycles (G) Obinutuzumab, [Gazyva, Roche]

Consolidation 12 cycles (V) Venetoclax, [Venclexta, Abbvie].

Interventions:
  • Drug: Ibrutinib
  • Drug: Obinutuzumab
  • Drug: Venetoclax
Publications *

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Recruiting
Estimated Enrollment  ICMJE
 (submitted: November 26, 2018)
40
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE February 28, 2023
Estimated Primary Completion Date December 31, 2020   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Patients diagnosed with B cell chronic lymphocytic leukemia according to 2017 WHO criteria by immunophenotype/immunohistochemistry with active disease according to the 2018 International Workshop on Chronic Lymphocytic Leukemia (iwCLL) criteria and do not present TP53 mutation and/or del(17)p. (Cohort 1).
  • Patients diagnosed with relapsed/refractory chronic lymphocytic leukemia that have previously received at least one line of treatment that does not include the drugs in the study scheme. (Cohort 2).
  • Functional stage of 0 - 2 measured by the Eastern Cooperative Oncology Group (ECOG) scale.
  • Creatinine depuration ≥ 30 ml/min measured in a 24-hour urine recollection or utilizing the CKD-EPI formula.
  • Proper liver function: total bilirubin ≤ 1.5 x upper limit of normal (ULN) or ≤ 3 x ULN in patients with Gilbert syndrome, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3.0 x ULN.
  • Capacity and willingness to provide a written informed consent.

Exclusion Criteria:

  • T cell lymphocytic leukemia diagnosis.
  • TP53 mutation and/or del(17)p presence.
  • Non-controlled systematic active infection (viral, bacterial and/or fungic).
  • Patients with known infection by human immunodeficiency virus (HIV).
  • Active infection by hepatitis B (defined as the presence of detectable HBV's DNA, HBe antigen or HBs antigen). Patients with serological evidence of previous vaccination (HBsAg negative, anti-HBs positive antibodies, anti-HBc negative antibodies) are eligible. The patients that are HBsAg negative/ anti-Hbs positive antibodies but anti-HBc positive antibodies are eligible, if the HBV DNA is negative, and the HBV-DNA PCR is realized every 12 months after the last cycle of treatment.
  • Active infection by hepatitis C, defined by the ribonucleic acid (RNA) of hepatitis C is detectable in plasma by polymerase chain reaction (PCR).
  • Significant cardiovascular diseases such as uncontrolled or symptomatic arrhythmias, congestive heart failure or acute myocardial infarction within 2 months prior to screening, or any class 3 or 4 heart disease according to the functional classification of the NYHA.
  • Diagnosis of previous malignancies for 2 years, with exception of patients with basal or squamous cell carcinoma or "in situ" carcinoma of cervix or breast.
  • Requiring therapy with inhibitors or potent inducers of CYP3A4 and CYP3A5 inhibitors.
  • Anticoagulant therapy with acenocoumarol or warfarin.
  • History of cerebrovascular accident or intracranial hemorrhage within 6 months prior to screening.
  • History of allergic reaction or severe anaphylaxis to humanized or murine monoclonal antibodies.
  • Pregnant or lactating women.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Listed Location Countries  ICMJE Mexico
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03755947
Other Study ID Numbers  ICMJE HAL 306/2018
Has Data Monitoring Committee Not Provided
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Grupo Cooperativo de Hemopatías Malignas
Study Sponsor  ICMJE Grupo Cooperativo de Hemopatías Malignas
Collaborators  ICMJE Not Provided
Investigators  ICMJE Not Provided
PRS Account Grupo Cooperativo de Hemopatías Malignas
Verification Date April 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP