Objectives:Primary:- To evaluate efficacy as measured by overall survival (OS), with a goal of demonstrating the superiority of inotuzumab ozogamicin when administered in combination with rituximab, compared with an active comparator arm.Secondary…
ID
Source
Brief title
Condition
- Other condition
- Lymphomas non-Hodgkin's unspecified histology
Synonym
Health condition
Subject with a diagnosis of CD20 and CD22- positive agressive non-Hodgin lymphoma
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Overall survival (OS).
Secondary outcome
- Progression free survival (PFS);
- Overall (objective) response rate (ORR);
- Duration of response (DoR);
- Patient-reported health-related quality of life, lymphoma specific symptoms,
and health status for subjects in each treatment arm as measured by the
Functional Assessment of Cancer Therapy for Lymphoma (FACT-Lym) and EuroQol-5D
(EQ-5D) questionnaires
Background summary
Inotuzumab ozogamicin is an antibody targeting CD22, conjugated with a
cytotoxic antitumor antibiotic (calicheamicin) in development for the treatment
of Non-Hodgkin Lymphoma (NHL), the tenth most commonly diagnosed cancer
worldwide. The majority (>90%) of NHL represents malignancies of B-lymphocyte
lineage, expressing both CD20 and CD22.
Aggressive NHLs, including diffuse large B-cell lymphoma (DLBCL) which
represents the largest sub-group of NHL patients, are potentially curable
cancers. First line treatment options often include rituximab (an antibody
targeting CD20) in combination with chemotherapy, and response rates are high
(overall response rate, ORR = 75% to 90%). However, approximately half of all
responding patients relapse and subsequent treatments, which typically include
rituximab, tend to be less efficacious (ORR = 20% to 85%) and are not
considered curative without further consolidation therapy (involving high-dose
chemotherapy and autologous stem cell transplant [aSCT]). Consolidation therapy
is limited to those patients with adequate medical status to tolerate
additional myeloablative conditioning. Thus, a robust therapy for the majority
of patients with relapsed aggressive NHLs (ie, including those who are not
eligible for consolidation therapy) remains an unmet medical need. The current
clinical experience of inotuzumab ozogamicin in combination with rituximab
suggests this regimen has similar or greater activity compared to that observed
with other commonly used 2nd line or later therapies for relapsed aggressive
NHLs. To date, an ORR of 80% and median progression free survival (PFS) of 15.1
months has been achieved in 40 relapsed DLBCL patients participating in a
nearly completed phase 1/2 study, with 79% of patients surviving 1 year after
initiation of treatment with inotuzumab ozogamicin in combination with
rituximab. Responses have also been observed in patients with other aggressive
NHL subtypes, including mantle cell lymphoma. Based on these favorable
findings, this study will further evaluate the clinical activity and safety of
inotuzumab ozogamicin plus rituximab in subjects with relapsed/refractory
aggressive NHLs who are not candidates for intensive high-dose chemotherapy
compared to an investigators best choice between 2 rituximab (R)-containing
chemotherapy regimens, R-bendamustine and R-gemcitabine. Each of these regimens
has demonstrated activity for treatment of relapsed aggressive NHLs in phase 2,
single-arm clinical trials.
Study objective
Objectives:
Primary:
- To evaluate efficacy as measured by overall survival (OS), with a goal of
demonstrating the superiority of inotuzumab ozogamicin when administered in
combination with rituximab, compared with an active comparator arm.
Secondary:
- To evaluate the safety and tolerability of inotuzumab ozogamicin in
combination with rituximab compared with an active comparator arm.
- To evaluate the efficacy of inotuzumab ozogamicin in combination with
rituximab compared with an active comparator arm using the following endpoints:
- ORR;
- PFS;
- Duration of response (DoR).
- To compare patient-reported health-related quality of life (HRQOL), lymphoma
specific symptoms, and health status between treatment arms.
Study design
This is a 2-arm, randomized, open-label, phase 3 trial designed to evaluate
efficacy and safety of inotuzumab ozogamicin in combination with rituximab
compared to the investigator*s choice of 1 of 2 defined chemotherapy regimens
(R-bendamustine or R-gemcitabine
Intervention
Subjects will be randomly assigned to 1 of 2 treatment arms in a 1:1 ratio.
Subjects in Arm 1 will receive inotuzumab ozogamicin in combination with
rituximab (R-inotuzumab ozogamicin).
Subjects in Arm 2 will receive the investigator*s choice regimen (rituximab +
bendamustine orrituximab + gemcitabine).
Study burden and risks
Subject undergo the following during this research:
Questions about:
- medical history;
- cancer history and treatment;
- usual physical activity;
- regular care of assistance received because of you condition;
- Other anti-cancer treatment received;
Physical examination;
Urine collection;
Blood collection: the total volume of blood collected from each subject will be
approximately up to 320 mL over 2 years;
CT, MRI or PET;
ECG and ECHO or MUGA;
2 questionnaires ((FACT-Lym and EQ-5D)
Bone marrow aspirate and/or biopsy (optional)
see also question E9 and E9a
East 42nd Street 235
New York NY10017
US
East 42nd Street 235
New York NY10017
US
Listed location countries
Age
Inclusion criteria
1. Subjects with a diagnosis of CD20 and CD22-positive aggressive NHL (based on local immunophenotyping and histopathology) who have:
a. Refractory disease: defined as disease progression while receiving their most recent prior cytotoxic chemotherapy (single-agent immunotherapy as maintenance is not considered cytotoxic therapy);
b. Persistent disease: defined as stable disease or partial response at the completion of their most recent prior cytotoxic chemotherapy;
c. Relapsed/recurrent disease: defined as complete response at the end of their most recent prior cytotoxic chemotherapy with subsequent relapse or disease recurrence.
Eligible aggressive subtypes identified per the 2008 World Health Organization classification include: a) DLBCL (including DLBCL with follicular elements), b) transformed indolent lymphoma with DLBCL, and c) primary mediastinal large B-cell lymphomas.
2. Subjects must have received prior rituximab and may have received up to 3 prior regimens containing cytotoxic chemotherapies for aggressive NHL. In order to ensure consistency in the application of the inclusion criterion:
•Only count regimens that contain 1 or more cytotoxic drug. Do not count palliation with steroids alone, vaccines, non-systemic therapy such as radiation, or maintenance therapies such as rituximab.
•Only count INDUCTION regimens. Do not count maintenance or consolidation therapy.
•If a patient had progression of disease between 2 cytotoxic regimens, they always count as 2 separate regimens.
Note: If a regimen was changed (e.g. because the patient did not tolerate it or for financial reasons) and the patient did not progress before the regimen was changed, it is not counted as a separate regimen.
•If a patient has transformed indolent lymphoma with DLBCL, only count the regimens received for aggressive lymphoma.
3. Subjects must not be candidates for intensive high-dose chemotherapy, with or without an autologous stem cell transplant (aSCT), due to one or more of the following factors: age, comorbid disease, performance status, prior high-dose chemotherapy, or persisting toxicities from prior chemotherapy (*transplant preparatory regimen, eg, BEAM, BEAC).
4. Age 18 years or older (For Japan: Age 20 years or older).
5. Absolute neutrophil count (ANC) >=1.0 x 109/L (1000/µL) and platelets >= 75 x 109/L (75,000/µL), unless related to bone marrow infiltration.
6. Serum creatinine <=1.5 x the upper limit of normal (ULN) (or any serum creatinine level associated with a measured or calculated creatinine clearance of >=40 mL/min).
7. Total bilirubin <=1.5 mg/dL (25.65 µmol/L) unless Gilbert*s syndrome, aspartate and alanine aminotransferase (AST, ALT) <=2.5 x ULN.
8. At least 1 measurable disease lesion that is >=1.0 cm in 2 perpendicular dimensions, with the product diameter >=2.25 cm2 by computed tomography (CT) or magnetic resonance imaging (MRI).
Tumor lesions that are located in a previously irradiated area will be considered measurable only if progression is documented following completion of radiation therapy.
Exclusion criteria
1. Prior allogeneic hematopoietic stem cell transplant (HSCT).
2. Within <=6 months before first dose of investigational product:
a. Prior treatment with anti-CD22 antibodies;
b. Prior radioimmunotherapy.
3. Prior autologous stem cell transplant within <=4 months before first dose of investigational product.
4. Contraindication to rituximab.
5. Contraindication to both investigator*s choice immuno-chemotherapy regimens.
6. Eastern Cooperative Oncology Group (ECOG) performance status of 4 and/or a life expectancy <12 weeks.
7. Subjects with known systemic vasculitides (eg, Wegener's granulomatosis, polyarteritis nodosa, systemic lupus erythematosus), primary or secondary immunodeficiency (such as HIV infection or severe inflammatory disease).
8. Current or chronic hepatitis B or C infection as evidenced by hepatitis B surface antigen and anti-hepatitis C antibody positivity, respectively, or known seropositivity for human immunodeficiency virus (HIV). HIV testing may need to be performed in accordance with local regulations or local practice.
9. History of veno-occlusive disease (VOD) or sinusoidal obstruction syndrome (SOS).
10. Evidence of serious active infection (eg, requiring an intravenous [IV] antibiotic, antiviral, or antifungal agent), or subjects with a recent history of deep tissue infections such as fascitis or osteomyelitis.
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2010-020147-12-NL |
ClinicalTrials.gov | NCT01232556 |
CCMO | NL34594.078.11 |