Overview
CLL Induction Treatment With Venetoclax and Ibrutinib, Followed by Ibrutinib and Obinutuzumab in Patients With MRD.
Status:
Active, not recruiting
Active, not recruiting
Trial end date:
2028-12-01
2028-12-01
Target enrollment:
0
0
Participant gender:
All
All
Summary
A recent study showed that 6 cycles of obinutuzumab when given after at least 1 year of ibrutinib did result in MRD conversion in a significant proportion of patients (50%). The precise influence, timing and interplay of venetoclax, ibrutinib and obinutuzumab on clearance of CLL cells in different compartments (PB, BM, LN), and achievement of uMRD and complete remission (CR) are not well known. Therefore, the investigators set out a study to evaluate whether patients who are not in CR or who have detectable MRD after 12 months of combination treatment with ibrutinib and venetoclax (15 months total treatment including three months ibrutinib lead-in) could be converted into uMRD CR with an additional 6 cycles obinutuzumab in combination with ibrutinib.Phase:
Phase 2Accepts Healthy Volunteers?
NoDetails
Lead Sponsor:
Stichting Hemato-Oncologie voor Volwassenen NederlandCollaborator:
Nordic Lymphoma GroupTreatments:
Obinutuzumab
Venetoclax
Criteria
Inclusion Criteria:- Documented CLL or SLL requiring treatment according to IWCLL criteria33, including
minimal required markers (CD5/CD19/CD23 triple positive with light chain restriction);
- WHO performance status 0-3 (appendix C), stage 3 only if attributable to CLL/SLL;
- No prior treatment for CLL/SLL;
- Age at least 18 years;
- Adequate BM function defined as:
- Hb > 5 mmol/l or Hb > 8 g/dL
- Absolute neutrophil count (ANC) ≥ 0.75 x 109/L or 750/μL
- Platelet count ≥ 50 x 109/L or 50,000 /μL Unless directly attributable to CLL/SLL
infiltration of the BM, proven by BM biopsy;
- Estimated Glomerular Filtration Rate (eGFR) (MDRD) or estimated creatinine clearance
(CrCl) ≥ 30ml/min (Cockcroft-Gault appendix E); Please note: in case eGFR or CrCl is
<50ml/min the patient needs to be considered high risk for TLS
- Adequate liver function as indicated:
- Serum aspartate transaminase (ASAT) and alanine transaminase (ALAT) ≤ 3.0 x upper
limit of normal (ULN)
- Bilirubin ≤1.5 x ULN (unless bilirubin rise is due to Gilbert's syndrome or of
nonhepatic origin);
- Prothrombin time (PT)/International normal ratio (INR) <1.5 x ULN and activated
partial thromboplastin time (aPTT) <1.5 x ULN;
- Negative serological testing for hepatitis B virus (Hepatitis B surface antigen
(HBsAg) negative and hepatitis B core antibody (anti-HBc) negative) and hepatitis C
virus (hepatitis C antibody). Subjects who are positive for hepatitis B core antibody,
hepatitis B surface antigen, or hepatitis C antibody must have a negative PCR result
before enrollment. Those who are PCR positive will be excluded;
- Ability and willingness to adhere to the study visit schedule and other protocol
requirements;
- Patient is capable of giving informed consent;
- Written informed consent.
Exclusion Criteria:
- Transformation of CLL (Richter's transformation);
- Malignancies other than CLL/SLL currently requiring systemic therapy or not being
treated in curative intention or showing signs of progression after curative
treatment;
- Patient with CNS involvement
- Known allergy to xanthine oxidase inhibitors and/or rasburicase;
- Intolerance of exogenous protein administration;
- History of severe allergic or anaphylactic reactions to humanized or murine monoclonal
antibodies. Known sensitivity or allergy to murine products;
- Active fungal, bacterial, and/or viral infection that requires systemic therapy;
Please note: active controlled as well as chronic/recurrent infections are at risk of
reactivation/infection during treatment (see section 9.2.3.1);
- Concurrent severe and/or uncontrolled medical condition (e.g. uncontrolled: infection,
auto-immune hemolysis, immune thrombocytopenia, diabetes, hypertension,
hyperthyroidism or hypothyroidism etc.);
- Patients known to be HIV-positive;
- Patient requiring treatment with a strong cytochrome P450 (CYP) 3A inhibitor (see
appendix K) or anticoagulant therapy with warfarin or phenprocoumon n or other vitamin
K antagonists; Please note: Patients being treated with DOACs apixaban, edoxaban or
rivaroxaban can be included, but must be properly informed about the potential risk of
bleeding under treatment with ibrutinib. Treatment with dabigatran should be avoided,
due to risk of toxicity based on P-gp substrate (see appendix K)
- History of stroke or intracranial hemorrhage within 6 months prior to registration;
- Severe cardiovascular disease (arrhythmias requiring chronic treatment, congestive
heart failure or symptomatic ischemic heart disease) (CTCAE grade III-IV, see appendix
D);
- Severe pulmonary dysfunction (CTCAE grade III-IV, see appendix D);
- Patient with Child Pugh C
- Severe neurological or psychiatric disease (CTCAE grade III-IV, see appendix D);
- Vaccination with live vaccines within 28 days prior to registration;
- Use of any other experimental drug or therapy within 28 days prior to registration
- Major surgery within 28 days prior to registration;
- Steroid therapy within 10 days prior to registration, with the exception of inhaled
steroids for asthma, topical steroids, steroids up to 20 mg of dose equivalents of
prednisolone daily to control autoimmune phenomenon's, or replacement/stress
corticosteroids;
- Pregnant women and nursing mothers;
- Fertile men or women of childbearing potential unless: (1) surgically sterile or ≥ 2
years after the onset of menopause, and/or (2) willing to use a highly effective
contraceptive method such as oral contraceptives, intrauterine device, sexual
abstinence or barrier method of contraception in conjunction with spermicidal jelly
during study treatment and in female patients for 3 months after end of induction
treatment and 18 months after end of treatment with obinutuzumab and male patients for
6 months after end of treatment;
- Current participation in other clinical trial;
- Any psychological, familial, sociological and geographical condition potentially
hampering compliance with the study protocol and follow-up schedule.