A Phase 2 interventional study of enzastaurin in Mantle-Cell Lymphoma, sponsored by Eli Lilly and Company. Completed at 17 sites in 4 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-07-01.
Sponsored by Eli Lilly and Company · Phase 2, Interventional, and Treatment
The purposes of this study are to determine the safety of oral enzastaurin and any side effects that might be associated with it and whether enzastaurin can help participants with mantle cell lymphoma.
5,578 studies on the registry are indexed under Lymphoma; 825 are open to participants now.
This study's enrollment of 60 is above the median of 40 across 4,508 interventional studies indexed under Lymphoma.
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Exclusion Criteria:
Drug: enzastaurin
500 milligrams (mg), oral, daily, up to six 28-day cycles
Also known as: LY317615
Percentage of Participants With Freedom From Progression (FFP) for at Least 3 Cycles
Using the Standardized Response Criteria for non-Hodgkin's lymphomas, participants were considered to have progressive disease if there was a 50% increase in the sum of the products of the greatest diameters (SPD) of the dominant nodal and non-nodal sites or appearance of new-involved site or lesion. The percentage of FFP was computed as the number of participants documented to be progression free after 3 cycles of treatment divided by the number of treated participants and then multiplied by 100.
Time frame: Baseline through at least 3 cycles of treatment (28-day cycle)
Percentage of Participants With Complete Response (CR) Plus Unconfirmed Complete Response (CRu) Plus Partial Response (PR) (Objective Response Rate)
Time frame: Baseline to 22.01 months
Progression-Free Survival (PFS)
PFS time was defined as the time from the date of enrollment to the first date of documented progressive disease or death due to any cause, whichever occurred first. Using the Standardized Response Criteria for non-Hodgkin's lymphomas, participants were considered to have progressive disease if there was a 50% increase in the sum of the products of the greatest diameters (SPD) of the dominant nodal and non-nodal sites or appearance of new-involved site or lesion. Progression-free survival time was censored at the date of the last assessment visit for participants who were still alive and who had not had documented progressive disease.
Time frame: Baseline to measured progressive disease or death due to any cause up to 22.01 months
Overall Survival (OS)
OS was defined as the time from the date of enrollment to the date of death due to any cause. For each participant who was not known to have died as of the data-inclusion cut-off date, OS was censored for that analysis at the date of the last assessment visit prior to the cut-off date.
Time frame: Baseline to date of death from any cause at least up to 23.10 months
Duration of CR, CRu, PR or Stable Disease (SD) [Duration of Overall Response]
Duration of overall response for responders was measured from the date that measurement criteria were met for CR, CRu, PR or SD (whichever status occurred first) until the first date of documented progressive disease or death due to any cause, whichever occurred first. Using the Standardized Response Criteria for non-Hodgkin's lymphomas Guidelines, CR was defined as the disappearance of all lesions. CRu was the disappearance of clinical and radiographic evidence of disease, normal appearance of spleen and greater than 75% regression in lymph node mass. PR was defined as at least a 50% decrease in the six largest dominant nodes. SD was when the response was poorer than partial response with no new lesions consistent with progressive disease. Duration of response was censored at the date of the last assessment visit for responders who were still alive and had not had documented progressive disease.
Time frame: Date of progression or death due to any cause up to 22.01 months
Time to New Treatment
Time to new treatment was as the time from enrollment to the date new treatment for the cancer under study was initiated. Time to new treatment was censored at the date of the last assessment visit for participants who were not documented to have initiated a new treatment.
Time frame: Baseline to date of new treatment up to 23.10 months
Change in Scores From Baseline to Cycle 6 in Functional Assessment of Cancer Therapy Lymphoma Version 4 ( FACT-Lym v.4)
The B symptoms, tumor-related symptoms, participant functioning, and health-related quality of life were assessed with FACT-Lym v. 4. FACT-Lym v. 4 consists of 42 items with 5-point rating scales for each item, where 0 = "not at all" and 4 = "very much." Physical well-being, social/family well-being and functional well-being subscales consist of 7 items each with scores ranging from 0-28. The emotional well-being subscale consists of 6 items with a score ranging from 0-24. The lymphoma tumor - specific subscale consists of 15 items with a score ranging from 0-60. Fact-Lymphoma total score ranges from 0-168. A higher score represents better quality of life.
Time frame: Baseline, Cycles 2, 4 and 6 (28-day cycle)
Change From Baseline to Cycle 6 in European Quality of Life-5D (EuroQol-5D) Index Score (Overall Health Status)
Overall health status and participant utility values were measured with the EuroQol-5D questionnaire. EuroQol-5D describes health status in terms of 5 dimensions: mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Each dimension is divided into 3 levels: 1 (no problem), 2 (some problem), and 3 (extreme problem). The questionnaire records the level of problems on each of 5 dimensions and is converted into the EuroQol-5D index based on preference weights (Dolan 1997), where a score of 0.0 = death and 1.0 = perfect health.
Time frame: Baseline, Cycles 2, 4 and 6
Number of Participants With Protein Kinase C Beta (PKCβ) Expression by Immunohistochemistry (IHC) Staining
IHC staining of tumor samples was carried out to determine PKCβ expression. Staining intensity was measured on a semiquantitative scale of 0 (or negative) to 3 (high intensity). The final score combined the components of staining intensity and the percentage of positive cells and was defined as \[1 \* (percentage of cells staining at 1)\] + \[2 \* (percentage of cells staining at 2)\] + \[3 \* (percentage of cells staining at 3)\]. Score ≥100 and staining intensity ≥2 indicates high expression for PKCβ, while score \<100 and staining intensity ≤1 indicates low expression for PKCβ.
Time frame: Baseline
Number of Participants With High Ki-67 Expression by IHC Staining
IHC staining of tumor samples was carried out to determine Ki-67 expression. High expression is defined as the percentage of positive cells ≥40%.
Time frame: Baseline
Number of Participants With Adverse Events (AEs) and Serious AEs (SAEs) (Safety of Enzastaurin)
Data presented are the number of participants who experienced SAEs, AEs, deaths due to progressive disease (PD), and deaths due to AEs while on treatment and death during the 30-day post-treatment follow-up. A summary of SAEs and other non-serious AEs, regardless of causality, is located in the Reported Adverse Events module.
Time frame: Each cycle (28-day cycle) up to 21 cycles and 30-day follow-up
Average Steady-State Plasma Concentration (Cav,ss,) of Enzastaurin and Total Analytes (Pharmacokinetics of Enzastaurin and Total Analytes)
The Steady-state plasma concentrations of total analytes (enzastaurin plus its active metabolite, LSN326020) observed after once-daily dosing were evaluated using sparse sampling methodology.
Time frame: Cycles 1 [1-4 hours (h) and 4-8 h postdose], 2 (predose, 2-4 h and 6-8 h postdose), and 3 (predose and 2-8 h postdose) of Day 1 of each 28-day cycle
| Milestone | Enzastaurin |
|---|---|
| Started | 60 |
| Received at least 1 dose of study drug | 60 |
| Efficacy population | 59 |
| Completed | 0 |
| Not completed | 60 |
| Withdrew: Adverse event | 4 |
| Withdrew: Progressive disease | 51 |
| Withdrew: Physician decision | 1 |
| Withdrew: Death due to study disease | 4 |
Using the Standardized Response Criteria for non-Hodgkin's lymphomas, participants were considered to have progressive disease if there was a 50% increase in the sum of the products of the greatest diameters (SPD) of the dominant nodal and non-nodal sites or appearance of new-involved site or lesion. The percentage of FFP was computed as the number of participants documented to be progression free after 3 cycles of treatment divided by the number of treated participants and then multiplied by 100.
| percentage of participants | Enzastaurin |
|---|---|
| Percentage of Participants With Freedom From Progression (FFP) for at Least 3 Cycles | 35.6 (23.4 to 47.8) |
No measurements were reported for this outcome.
PFS time was defined as the time from the date of enrollment to the first date of documented progressive disease or death due to any cause, whichever occurred first. Using the Standardized Response Criteria for non-Hodgkin's lymphomas, participants were considered to have progressive disease if there was a 50% increase in the sum of the products of the greatest diameters (SPD) of the dominant nodal and non-nodal sites or appearance of new-involved site or lesion. Progression-free survival time was censored at the date of the last assessment visit for participants who were still alive and who had not had documented progressive disease.
| months | Enzastaurin |
|---|---|
| Progression-Free Survival (PFS) | 1.97 (1.45 to 2.66) |
OS was defined as the time from the date of enrollment to the date of death due to any cause. For each participant who was not known to have died as of the data-inclusion cut-off date, OS was censored for that analysis at the date of the last assessment visit prior to the cut-off date.
| months | Enzastaurin |
|---|---|
| Overall Survival (OS) | 22.01 (13.93 to NA) |
Duration of overall response for responders was measured from the date that measurement criteria were met for CR, CRu, PR or SD (whichever status occurred first) until the first date of documented progressive disease or death due to any cause, whichever occurred first. Using the Standardized Response Criteria for non-Hodgkin's lymphomas Guidelines, CR was defined as the disappearance of all lesions. CRu was the disappearance of clinical and radiographic evidence of disease, normal appearance of spleen and greater than 75% regression in lymph node mass. PR was defined as at least a 50% decrease in the six largest dominant nodes. SD was when the response was poorer than partial response with no new lesions consistent with progressive disease. Duration of response was censored at the date of the last assessment visit for responders who were still alive and had not had documented progressive disease.
| months | Enzastaurin |
|---|---|
| Duration of CR, CRu, PR or Stable Disease (SD) [Duration of Overall Response] | 5.55 (4.67 to 8.15) |
Time to new treatment was as the time from enrollment to the date new treatment for the cancer under study was initiated. Time to new treatment was censored at the date of the last assessment visit for participants who were not documented to have initiated a new treatment.
| months | Enzastaurin |
|---|---|
| Time to New Treatment | 3.52 (2.37 to 4.04) |
The B symptoms, tumor-related symptoms, participant functioning, and health-related quality of life were assessed with FACT-Lym v. 4. FACT-Lym v. 4 consists of 42 items with 5-point rating scales for each item, where 0 = "not at all" and 4 = "very much." Physical well-being, social/family well-being and functional well-being subscales consist of 7 items each with scores ranging from 0-28. The emotional well-being subscale consists of 6 items with a score ranging from 0-24. The lymphoma tumor - specific subscale consists of 15 items with a score ranging from 0-60. Fact-Lymphoma total score ranges from 0-168. A higher score represents better quality of life.
| units on a scale | Enzastaurin |
|---|---|
| Physical Well-being- Baseline | 22.45 ± 4.298 |
| Physical Well-being- Cycle 2 | 22.06 ± 4.49 |
| Physical Well-being- Cycle 4 | 22.15 ± 4.52 |
| Physical Well-being- Cycle 6 | 21.6 ± 3.406 |
| Social Family Well-being- Baseline | 21.13 ± 4.792 |
| Social Family Well-being- Cycle 2 | 20.32 ± 6.165 |
| Social Family Well-being- Cycle 4 | 19.2 ± 5.421 |
| Social Family Well-being- Cycle 6 | 21.26 ± 4.021 |
| Emotional Well-being- Baseline | 17.41 ± 4.547 |
| Emotional Well-being- Cycle 2 | 17.65 ± 4.953 |
| Emotional Well-being- Cycle 4 | 17.56 ± 4.961 |
| Emotional Well-being- Cycle 6 | 17.25 ± 5.514 |
| Functional Well-being- Baseline | 16.38 ± 5.768 |
| Functional Well-being- Cycle 2 | 16.56 ± 6.05 |
| Functional Well-being- Cycle 4 | 16.17 ± 4.076 |
| Functional Well-being- Cycle 6 | 17.43 ± 4.871 |
| Lymphoma Subscale- Baseline | 46.27 ± 8.78 |
| Lymphoma Subscale- Cycle 2 | 46.01 ± 8.841 |
| Lymphoma Subscale- Cycle 4 | 46.9 ± 7.555 |
| Lymphoma Subscale- Cycle 6 | 46.8 ± 8.108 |
| Fact-Lymphoma Total Score- Baseline | 123.6 ± 22.21 |
| Fact-Lymphoma Total Score- Cycle 2 | 122.6 ± 23.8 |
| Fact-Lymphoma Total Score- Cycle 4 | 122 ± 20.67 |
| Fact-Lymphoma Total Score- Cycle 6 | 124.3 ± 21.92 |
Overall health status and participant utility values were measured with the EuroQol-5D questionnaire. EuroQol-5D describes health status in terms of 5 dimensions: mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Each dimension is divided into 3 levels: 1 (no problem), 2 (some problem), and 3 (extreme problem). The questionnaire records the level of problems on each of 5 dimensions and is converted into the EuroQol-5D index based on preference weights (Dolan 1997), where a score of 0.0 = death and 1.0 = perfect health.
| units on a scale | Enzastaurin |
|---|---|
| Baseline | 0.70 ± 0.28 |
| Cycle 2 | 0.76 ± 0.19 |
| Cycle 4 | 0.74 ± 0.16 |
| Cycle 6 | 0.68 ± 0.27 |
IHC staining of tumor samples was carried out to determine PKCβ expression. Staining intensity was measured on a semiquantitative scale of 0 (or negative) to 3 (high intensity). The final score combined the components of staining intensity and the percentage of positive cells and was defined as \[1 \* (percentage of cells staining at 1)\] + \[2 \* (percentage of cells staining at 2)\] + \[3 \* (percentage of cells staining at 3)\]. Score ≥100 and staining intensity ≥2 indicates high expression for PKCβ, while score \<100 and staining intensity ≤1 indicates low expression for PKCβ.
| Participants | Enzastaurin |
|---|---|
| Score ≥100 and staining intensity ≥2 | 14 |
| Score <100 and staining intensity ≤1 | 4 |
IHC staining of tumor samples was carried out to determine Ki-67 expression. High expression is defined as the percentage of positive cells ≥40%.
| Participants | Enzastaurin |
|---|---|
| Number of Participants With High Ki-67 Expression by IHC Staining | 4 |
Data presented are the number of participants who experienced SAEs, AEs, deaths due to progressive disease (PD), and deaths due to AEs while on treatment and death during the 30-day post-treatment follow-up. A summary of SAEs and other non-serious AEs, regardless of causality, is located in the Reported Adverse Events module.
| Participants | Enzastaurin |
|---|---|
| SAEs | 20 |
| Other non-serious AEs | 54 |
| Deaths due to PD | 4 |
| Deaths due to AEs | 0 |
| Deaths during 30-day follow-up | 6 |
The Steady-state plasma concentrations of total analytes (enzastaurin plus its active metabolite, LSN326020) observed after once-daily dosing were evaluated using sparse sampling methodology.
| nanomoles/liter (nmol/L) | Enzastaurin |
|---|---|
| Enzastaurin | 627 ± 74.4 |
| Total analytes | 1160 ± 58.4 |
Collected over From randomization through 21 cycles (28-day cycle) and 30-day follow-up. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Enzastaurin | — | 20/60 (33.3%) | 54/60 (90%) |
| Event | Enzastaurin |
|---|---|
| Abdominal painGastrointestinal disorders | 2/60 |
| Pleural effusionRespiratory, thoracic and mediastinal disorders | 2/60 |
| Febrile bone marrow aplasiaBlood and lymphatic system disorders | 1/60 |
| Febrile neutropeniaBlood and lymphatic system disorders | 1/60 |
| LymphadenopathyBlood and lymphatic system disorders | 1/60 |
| DiarrhoeaGastrointestinal disorders | 1/60 |
| Gastric ulcerGastrointestinal disorders | 1/60 |
| Intestinal polypGastrointestinal disorders | 1/60 |
| MelaenaGastrointestinal disorders | 1/60 |
| VomitingGastrointestinal disorders | 1/60 |
| Event | Enzastaurin |
|---|---|
| DyspnoeaRespiratory, thoracic and mediastinal disorders | 11/60 |
| DiarrhoeaGastrointestinal disorders | 10/60 |
| FatigueGeneral disorders | 9/60 |
| VomitingGastrointestinal disorders | 8/60 |
| Abdominal painGastrointestinal disorders | 7/60 |
| PyrexiaGeneral disorders | 7/60 |
| HyperhidrosisSkin and subcutaneous tissue disorders | 7/60 |
| Night sweatsSkin and subcutaneous tissue disorders | 7/60 |
| CoughRespiratory, thoracic and mediastinal disorders | 6/60 |
| AnaemiaBlood and lymphatic system disorders | 5/60 |
All enrolled participants who received at least 1 dose of study drug.
| Age, Continuous(years) | Enzastaurin |
|---|---|
| Median | 66.0 (45.0 to 84.0) |
| Sex: Female, Male(Participants) | Enzastaurin |
|---|---|
| Female | 18 |
| Male | 42 |
| Race (NIH/OMB)(Participants) | Enzastaurin |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 0 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 0 |
| White | 60 |
| More than one race | 0 |
| Unknown or Not Reported | 0 |
| Region of Enrollment(Participants) | Enzastaurin |
|---|---|
| France | 28 |
| Australia | 12 |
| Germany | 13 |
| Netherlands | 7 |
| Baseline B Symptoms(Participants) | Enzastaurin |
|---|---|
| Low (0-1) | 9 |
| Medium (2-3) | 39 |
| High (4-5) | 8 |
| Not available | 4 |
| Participants with High Lactate Dehydrogenase (LDH)(Participants) | Enzastaurin |
|---|---|
| Count of participants | 19 |
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