A Phase 2 interventional study of Onalespib in Recurrent Anaplastic Large Cell Lymphoma, Recurrent Diffuse Large B-Cell Lymphoma and Recurrent Mantle Cell Lymphoma, sponsored by National Cancer Institute (NCI). Terminated at 19 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-09-13.
Sponsored by National Cancer Institute (NCI) · Phase 2, Interventional, and Treatment
This phase II trial studies how well onalespib works in treating patients with anaplastic large cell lymphoma, mantle cell lymphoma, or diffuse large B-cell lymphoma that has not responded to previous treatment (refractory) or that has returned after a period of improvement (recurrent). Onalespib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
PRIMARY OBJECTIVE:
I. Overall response rate (ORR) to single agent AT13387 (onalespib) as measured by the proportion of partial and complete responses (PR + CR) in patients with relapsed/refractory ALK positive (+) anaplastic large cell lymphoma (ALCL), mantle cell lymphoma (MCL), and BCL6+ diffuse large B cell lymphoma (DLBCL).
SECONDARY OBJECTIVES:
I. Progression free survival (PFS) and overall survival (OS), as well as duration of response (DOR) of single agent AT13387 (onalespib) in patients with ALK+ ALCL, MCL, and BCL6+ DLBCL.
II. Safety and tolerability of single agent AT13387 (onalespib) in patients with ALK+ ALCL, MCL, and BCL6+ DLBCL.
EXPLORATORY OBJECTIVES:
I. Measurement of on-target activity of AT13387 (onalespib) in ALK+ ALCL, MCL, and BCL6+ DLBCL through immunoblotting and immunohistochemistry of pre-treatment, on-treatment, and time of progression tumor biopsies for HSP90 clients.
II. Determination of genetic and transcriptional markers for response and resistance to AT13387 (onalespib) in patients with ALK+ ALCL, MCL, and BCL6+ DLBCL.
OUTLINE:
Patients receive onalespib intravenously (IV) over 1 hour on days 1, 2, 8, 9, 15, and 16. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 6 months for up to 1 year.
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This study's enrollment of 25 is below the median of 40 across 4,508 interventional studies indexed under Lymphoma.
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Of its 402 completed or terminated interventional studies of FDA-regulated products, 365 (91%) have results posted.
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Patients must have measurable disease that has not been previously irradiated, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as >= 20 mm (>= 2 cm) with conventional imaging or >= 10 mm with spiral computed tomography (CT) scan; if the patient has been previously irradiated, there must be evidence of progression since the radiation
Prior therapy
Human immunodeficiency virus (HIV)+ patients are eligible for the trial provided they meet the other study criteria in addition to the following:
Exclusion Criteria:
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Patients receive 160-mg/m2 onalespib by IV over 1 hour on days 1, 2, 8, 9, 15, and 16 of each 28-day cycle. Patients will continue on treatment indefinitely as long as they are responding and tolerating treatment.
Drug: Onalespib
Patients receive 160-mg/m2 onalespib by IV over 1 hour on days 1, 2, 8, 9, 15, and 16 of each 28-day cycle. Patients will continue on treatment indefinitely as long as they are responding and tolerating treatment.
Drug: Onalespib
Patients receive 160-mg/m2 onalespib by IV over 1 hour on days 1, 2, 8, 9, 15, and 16 of each 28-day cycle. Patients will continue on treatment indefinitely as long as they are responding and tolerating treatment.
Drug: Onalespib
Given IV
Also known as: AT 13387, AT-13387, AT13387
Objective Response Rate
Objective response (OR) = Complete + Partial (CR + PR) Per International Harmonization Project for lymphoma criteria, CR is defined as the disappearance of all evidence of disease. For FDG-avid or PET positive sites of disease prior to therapy, a mass of any size is permitted if PET negative; for variably FDG avid or PET negative lesions, regression to normal size on CT is necessary. The spleen or liver must also be nonpalpable with disappearance of any nodules, and the bone marrow, if initially involved, must be cleared on repeat biopsy. PR is defined as regression of measurable disease and no new sites of disease: a \>50% decrease in the sum of the diameters of the up to 6 largest dominant masses with no increase in size of other masses. If the sites of disease were PET positive at baseline, there must be at least one previously involved site that remains PET positive.
Time frame: Assessed every 2 cycles during treatment until disease progression; patients who discontinue for reasons other than progression will be evaluated every 6 months for up to 1 year after ending treatment or until progression or next therapy
Frequency of Toxicities
Will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (version 5.0 is used staring April 1, 2018). Toxicities will be summarized with counts and proportions within each cohort and overall.
Time frame: Assessed days 1, 2, 8, 9, 15, 16 of each 28-day cycle during treatment until progression; patients who discontinue for reasons other than progression evaluated every 6 months for up to 1 year after ending treatment or until progression or next therapy
Progression-free Survival
The progression-free survival will be estimated by Kaplan-Meier method. Progressive disease is defined by the International Harmonization Project for lymphoma criteria: any new lesion or an increase by \> 50% of previously involved sites from nadir. This includes the appearance of any new lesion(s) \> 1.5cm in any axis, a \> 50% increase in the sum of diameters of \> 1 site of disease or \> 50% increase in the longest diameter of a previously identified node \>1cm in short axis. If the sites of disease were PET positive at baseline, they must remain PET positive.
Time frame: From the date of study entry until documentation of first progression or death from any cause; progression assessed every 2 cycles during treatment until disease progression or death
Overall Survival
The overall survival will be estimated by Kaplan-Meier method. Median follow-up time will be assessed using the reverse Kaplan-Meier method.
Time frame: From the date of study entry until death from any cause; assessed every 6 months for up to 1 year after ending treatment
Duration of Response
Duration of response will be evaluated only in patients who respond with either a partial response or complete response while on study.
Time frame: From first objective response (partial response or complete response) until the first date of documented progression assessed every 2 cycles or death due to any cause; assessed every 6 months up to 1 year after ending treatment
Change in Protein Levels of BCL6 in Diffuse Large B Cell Lymphoma
Will be assessed via immunohistochemistry. Comparisons will be made between baseline, on treatment, and time of progression protein levels and changes will be characterized as differences and as differences at the referenced time point as a proportion of baseline levels. An H-score will be used. The Wilcoxon rank sum test will be used to compare changes between responders and non-responders and a one-sided significance level will be used.
Time frame: Assessed days 1, 8, 15 of each 28-day cycle and at treatment completion visit
Change in Protein Levels of Cyclin D1 in Mantle Cell Lymphoma
Will be assessed via immunohistochemistry. Comparisons will be made between baseline, on treatment, and time of progression protein levels and changes will be characterized as differences and as differences at the referenced time point as a proportion of baseline levels. An H-score will be used. The Wilcoxon rank sum test will be used to compare changes between responders and non-responders and a one-sided significance level will be used.
Time frame: Assessed days 1, 8, 15 of each 28-day cycle and at treatment completion visit
Change in Protein Levels of ALK in ALK+ Anaplastic Large Cell Lymphoma
Will be assessed via immunohistochemistry. Comparisons will be made between baseline, on treatment, and time of progression protein levels. An H-score will be used. Results at each time point and as changes as a proportion of baseline levels will be reported descriptively.
Time frame: Assessed days 1, 8, 15 of each 28-day cycle and at treatment completion visit
Onalespib Activity
Will be measured by changes in protein levels via immunoblotting. Will use a one-sided significance level.
Time frame: Assessed days 1, 8, 15 of each 28-day cycle and at treatment completion visit
Genetic and Transcriptional Analysis for Markers of Response and Resistance
Will be assessed via exome sequencing and ribonucleic acid sequencing. Absolute algorithm will be used to determine the cancer cell fraction.
Time frame: Assessed days 1, 8, 15 of each 28-day cycle and at treatment completion visit
| Milestone | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL |
|---|---|---|---|
| Started | 1 | 4 | 20 |
| Completed | 1 | 4 | 20 |
| Not completed | 0 | 0 | 0 |
Objective response (OR) = Complete + Partial (CR + PR) Per International Harmonization Project for lymphoma criteria, CR is defined as the disappearance of all evidence of disease. For FDG-avid or PET positive sites of disease prior to therapy, a mass of any size is permitted if PET negative; for variably FDG avid or PET negative lesions, regression to normal size on CT is necessary. The spleen or liver must also be nonpalpable with disappearance of any nodules, and the bone marrow, if initially involved, must be cleared on repeat biopsy. PR is defined as regression of measurable disease and no new sites of disease: a \>50% decrease in the sum of the diameters of the up to 6 largest dominant masses with no increase in size of other masses. If the sites of disease were PET positive at baseline, there must be at least one previously involved site that remains PET positive.
| Participants | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL |
|---|---|---|---|
| Objective Response Rate | 0 | 0 | 2 |
Will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (version 5.0 is used staring April 1, 2018). Toxicities will be summarized with counts and proportions within each cohort and overall.
| Participants | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL |
|---|---|---|---|
| Any grade | 1 | 4 | 19 |
| Grade 1 (highest) | 1 | 1 | 1 |
| Grade 2 (highest) | 0 | 2 | 4 |
| Grade 3 (highest) | 0 | 0 | 7 |
| Grade 4 (highest) | 0 | 1 | 7 |
The progression-free survival will be estimated by Kaplan-Meier method. Progressive disease is defined by the International Harmonization Project for lymphoma criteria: any new lesion or an increase by \> 50% of previously involved sites from nadir. This includes the appearance of any new lesion(s) \> 1.5cm in any axis, a \> 50% increase in the sum of diameters of \> 1 site of disease or \> 50% increase in the longest diameter of a previously identified node \>1cm in short axis. If the sites of disease were PET positive at baseline, they must remain PET positive.
| months | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL |
|---|---|---|---|
| Progression-free Survival | 1.8 (1.8 to 1.8) | 2.0 (1.2 to 3.1) | 1.8 (0.4 to 8.8) |
The overall survival will be estimated by Kaplan-Meier method. Median follow-up time will be assessed using the reverse Kaplan-Meier method.
| months | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL |
|---|---|---|---|
| Overall Survival | 1.6 (1.6 to 1.6) | 7.5 (1.1 to 7.5) | 2.9 (0.6 to 8.8) |
Duration of response will be evaluated only in patients who respond with either a partial response or complete response while on study.
| months | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL |
|---|---|---|---|
| Duration of Response | — | — | 6.1 (0.03 to 6.1) |
Will be assessed via immunohistochemistry. Comparisons will be made between baseline, on treatment, and time of progression protein levels and changes will be characterized as differences and as differences at the referenced time point as a proportion of baseline levels. An H-score will be used. The Wilcoxon rank sum test will be used to compare changes between responders and non-responders and a one-sided significance level will be used.
Results for this outcome have not been posted.
Will be assessed via immunohistochemistry. Comparisons will be made between baseline, on treatment, and time of progression protein levels and changes will be characterized as differences and as differences at the referenced time point as a proportion of baseline levels. An H-score will be used. The Wilcoxon rank sum test will be used to compare changes between responders and non-responders and a one-sided significance level will be used.
Results for this outcome have not been posted.
Will be assessed via immunohistochemistry. Comparisons will be made between baseline, on treatment, and time of progression protein levels. An H-score will be used. Results at each time point and as changes as a proportion of baseline levels will be reported descriptively.
Results for this outcome have not been posted.
Will be measured by changes in protein levels via immunoblotting. Will use a one-sided significance level.
Results for this outcome have not been posted.
Will be assessed via exome sequencing and ribonucleic acid sequencing. Absolute algorithm will be used to determine the cancer cell fraction.
Results for this outcome have not been posted.
Collected over Assessed days 1, 2, 8, 9, 15, 16 of each 28-day cycle during treatment until progression; patients who discontinue for reasons other than progression evaluated every 6 months for up to 1 year after ending treatment or until progression or next therapy. Patients who discontinue due to unacceptable toxicity will be followed until resolution. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| ALK+ ALCL | 0/1 (0%) | 0/1 (0%) | 1/1 (100%) |
| Relapsed MCL | 1/4 (25%) | 0/4 (0%) | 4/4 (100%) |
| BCL6+ DLBCL | 13/20 (65%) | 5/20 (25%) | 19/20 (95%) |
| Event | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL |
|---|---|---|---|
| NauseaGastrointestinal disorders | 0/1 | 0/4 | 2/20 |
| NeutropeniaInvestigations | 0/1 | 0/4 | 2/20 |
| AnemiaBlood and lymphatic system disorders | 0/1 | 0/4 | 1/20 |
| ThrombocytopeniaInvestigations | 0/1 | 0/4 | 1/20 |
| White blood cell decreasedInvestigations | 0/1 | 0/4 | 1/20 |
| SepsisInfections and infestations | 0/1 | 0/4 | 1/20 |
| PainGeneral disorders | 0/1 | 0/4 | 1/20 |
| Lung infectionInfections and infestations | 0/1 | 0/4 | 1/20 |
| FeverGeneral disorders | 0/1 | 0/4 | 1/20 |
| AspirationRespiratory, thoracic and mediastinal disorders | 0/1 | 0/4 | 1/20 |
| Event | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL |
|---|---|---|---|
| DiarrheaGastrointestinal disorders | 1/1 | 3/4 | 13/20 |
| Platelet count decreasedInvestigations | 0/1 | 4/4 | 12/20 |
| Peripheral sensory neuropathyNervous system disorders | 1/1 | 0/4 | 1/20 |
| DyspneaRespiratory, thoracic and mediastinal disorders | 1/1 | 0/4 | 1/20 |
| NauseaGastrointestinal disorders | 0/1 | 3/4 | 8/20 |
| Alkaline phosphatase increasedInvestigations | 0/1 | 3/4 | 1/20 |
| White blood cell decreasedInvestigations | 0/1 | 2/4 | 7/20 |
| Blurred visionEye disorders | 0/1 | 2/4 | 4/20 |
| MyalgiaMusculoskeletal and connective tissue disorders | 0/1 | 2/4 | 3/20 |
| Alanine aminotransferase increasedInvestigations | 0/1 | 2/4 | 1/20 |
| Age, Categorical(Participants) | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL | Total |
|---|---|---|---|---|
| <=18 years | 0 | 0 | 0 | 0 |
| Between 18 and 65 years | 1 | 2 | 12 | 15 |
| >=65 years | 0 | 2 | 8 | 10 |
| Age, Continuous(years) | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL | Total |
|---|---|---|---|---|
| Median | 36 (36 to 36) | 66 (60 to 72) | 64 (25 to 84) | 64 (25 to 84) |
| Sex: Female, Male(Participants) | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL | Total |
|---|---|---|---|---|
| Female | 0 | 1 | 6 | 7 |
| Male | 1 | 3 | 14 | 18 |
| Ethnicity (NIH/OMB)(Participants) | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL | Total |
|---|---|---|---|---|
| Hispanic or Latino | 0 | 0 | 1 | 1 |
| Not Hispanic or Latino | 1 | 4 | 17 | 22 |
| Unknown or Not Reported | 0 | 0 | 2 | 2 |
| Race (NIH/OMB)(Participants) | ALK+ ALCL | Relapsed MCL | BCL6+ DLBCL | Total |
|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 1 | 1 |
| White | 1 | 4 | 17 | 22 |
| More than one race | 0 | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 2 | 2 |
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