A Phase 2 interventional study of Polatuzumab Vedotin and Rituximab in Recurrent B-Cell Non-Hodgkin Lymphoma, Recurrent Grade 1 Follicular Lymphoma and Recurrent Grade 2 Follicular Lymphoma, sponsored by Academic and Community Cancer Research United. Terminated at 5 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-09-19.
Sponsored by Academic and Community Cancer Research United · Phase 2, Interventional, and Treatment
This phase II trial studies the effect of polatuzumab vedotin, venetoclax, and rituximab and hyaluronidase human in treating patients with mantle cell lymphoma that has come back (relapsed) or does not respond to treatment (refractory). Polatuzumab vedotin is a monoclonal antibody, polatuzumab, linked to a toxic agent called vedotin. Polatuzumab attaches to CD79B positive cancer cells in a targeted way and delivers vedotin to kill them. Venetoclax may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cell growth. Rituximab hyaluronidase is a combination of rituximab and hyaluronidase. Rituximab binds to a molecule called CD20, which is found on B cells (a type of white blood cell) and some types of cancer cells. This may help the immune system kill cancer cells. Hyaluronidase allows rituximab to be given by injection under the skin. Giving rituximab and hyaluronidase by injection under the skin is faster than giving rituximab alone by infusion into the blood. Giving polatuzumab vedotin, venetoclax, and rituximab and hyaluronidase human may work better than standard therapy in treating patients with mantle cell lymphoma.
PRIMARY OBJECTIVE:
I. To evaluate the end of induction (EOI) complete response rate (CR) for treatment with the regimen of rituximab and hyaluronidase human + polatuzumab vedotin + venetoclax (RSc + Pola + Ven) in relapsed/refractory mantle cell lymphoma (MCL).
SECONDARY OBJECTIVES:
I. To evaluate the EOI overall response rate (ORR) for the combination of RSc + Pola + Ven in relapsed/refractory MCL.
II. To evaluate the best response (CR, partial response [PR]) in patients who continue on to maintenance therapy and evaluate the improvement in the depth of response.
III. To evaluate the progression free survival (PFS) and overall survival (OS) for the combination of RSc + Pola + Ven) in relapsed/ refractory MCL.
IV. To compare the ORR, CR, PFS, and OS in ibrutinib refractory compared to ibrutinib naive patients.
V. To evaluate regimen-related toxicity for patients treated with RSc + Pola + Ven.
CORRELATIVE RESEARCH OBJECTIVES:
I. To evaluate changes in minimal residual disease (MRD) status in both responding and non-responding patients at EOI and end of maintenance and compared to baseline as well as correlate MRD status with PFS and OS.
II. To evaluate changes in systemic immune profiles and T cell activation induced by treatment with RSc + Pola + Ven.
III. To evaluate the prognostic importance of high risk cytogenetic alterations, and other risk stratification scores in patients with relapsed/refractory MCL receiving RSc + Pola + Ven.
IV. To evaluate features of the tumor microenvironment in patients with relapsed/refractory MCL receiving RSc +Pola+Ven.
V. To evaluate molecular features associated with response in PDX models from patients with relapsed/refractory MCL receiving RSc +Pola+Ven.
OUTLINE:
INDUCTION: Patients receive rituximab intravenously (IV) on day 1 of cycle 1 and rituximab and hyaluronidase human subcutaneously (SC) over 5 minutes on day 1 of cycles 2-6. Patients also receive polatuzumab vedotin IV over 30-90 minutes on day 1 and venetoclax orally (PO) daily on days 1-21. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.
MAINTENANCE: Patients receive venetoclax PO daily on days 1-21 and rituximab and hyaluronidase human SC over 5 minutes every 60 days for up to 1 year in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 90 days for up to 5 years.
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Pathologically confirmed relapsed or primary refractory mantle cell lymphoma with concurrent or prior tissue sample immunohistochemistry (IHC) positive for cyclin D1 or that is positive for fluorescence in situ hybridization (FISH) or cytogenetics for t(11;14)
Negative serum pregnancy test done =\< 7 days prior to registration, for women of childbearing potential only
NOTE: A female of childbearing potential is a sexually mature female who:
For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use a contraceptive method with a failure rate of \< 1% per year during the treatment period and for at least 30 days after the last dose of venetoclax or 18 months after the last dose of rituximab and hyaluronidase human, whichever is longer. For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and agreement to refrain from donating sperm, as defined below:
Exclusion Criteria:
Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:
Treatment with the following agents =\< 7 days prior to registration
Active hepatitis B or hepatitis C infection
INDUCTION: Patients receive rituximab IV on day 1 of cycle 1 and rituximab and hyaluronidase human SC over 5 minutes on day 1 of cycles 2-6. Patients also receive polatuzumab vedotin IV over 30-90 minutes on day 1 and venetoclax PO daily on days 1-21. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE: Patients receive venetoclax PO daily on days 1-21 and rituximab and hyaluronidase human SC over 5 minutes every 60 days for up to 1 year in the absence of disease progression or unacceptable toxicity.
Drug: Polatuzumab Vedotin · Biological: Rituximab · Biological: Rituximab and Hyaluronidase Human · Drug: Venetoclax
Given IV
Also known as: ADC DCDS4501A, Antibody-Drug Conjugate DCDS4501A, DCDS4501A, FCU 2711, polatuzumab vedotin-piiq, Polivy, RG7596, Ro 5541077-000
Given IV
Also known as: ABP 798, BI 695500, C2B8 Monoclonal Antibody, Chimeric Anti-CD20 Antibody, CT-P10, IDEC-102, IDEC-C2B8, IDEC-C2B8 Monoclonal Antibody, MabThera, Monoclonal Antibody IDEC-C2B8, PF-05280586, Riabni, Rituxan, Rituximab ABBS, Rituximab ARRX, Rituximab Biosimilar ABP 798, Rituximab Biosimilar BI 695500, Rituximab Biosimilar CT-P10, Rituximab Biosimilar GB241, Rituximab Biosimilar IBI301, Rituximab Biosimilar JHL1101, Rituximab Biosimilar PF-05280586, Rituximab Biosimilar RTXM83, Rituximab Biosimilar SAIT101, Rituximab Biosimilar SIBP-02, rituximab biosimilar TQB2303, Rituximab PVVR, rituximab-abbs, Rituximab-arrx, Rituximab-pvvr, RTXM83, Ruxience, Truxima
Given SC
Also known as: Rituxan Hycela, Rituximab Plus Hyaluronidase, Rituximab/Hyaluronidase, Rituximab/Hyaluronidase Human
Given PO
Also known as: ABT-0199, ABT-199, ABT199, GDC-0199, RG7601, Venclexta, Venclyxto
Number of Patients Experiencing a Complete Response (CR)
Objective status of CR measured by positron emission tomography (PET)-computed tomography (CT) scans according to Lugano 2014.
Time frame: 3 months
Overall Response Rate (ORR)
The ORR at the end of induction will be estimated by the total number of patients who achieve a complete response (CR) or partial response (PR) by PET-CT scans according to Lugano 2014 divided by the total number of evaluable patients. The ORR between ibrutinib-naive and ibrutinib-pretreated patients will be compared using Fisher's exact test.
Time frame: 3 months
Best Response Rate to Maintenance Therapy
CR, PR, and stable disease (SD) rates for patients who continue to maintenance will be estimated by number of patients who continue on maintenance therapy and achieve CR, PR or SD, respectively, at the end of maintenance divided by the total number of evaluable patients who continue to maintenance.
Time frame: At the end of maintenance therapy
Progression Free Survival (PFS)
The distribution of PFS will be estimated using the method of Kaplan-Meier. The PFS between ibrutinib-naive and ibrutinib-pretreated patients will be compared using log-rank test.
Time frame: 10 months
Overall Survival (OS)
The distribution of OS will be estimated using the method of Kaplan-Meier. The OS between ibrutinib-naive and ibrutinib-pretreated patients will be compared using log-rank test.
Time frame: 15 months
Count of Patients Experiencing Grade 3+ Adverse Events (AEs)
All AEs occurring on or after first study treatment will be summarized by National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 grade.
Time frame: 15 months
Minimal Residual Disease (MRD) Analysis
MRD status for both responders and non-responders at each time point will be reported descriptively, and explored for correlation with clinical factors and patient outcomes such as PFS and OS.
Time frame: Up to the end of maintenance therapy
T Cell and Cytokine Subset Analysis
Systemic immune profiles and T cell activation will be investigated using multi-parameter flow cytometry, and cytokine analysis in the peripheral blood of patients.
Time frame: Up to the end of maintenance therapy
High Risk Cytogenetic Alterations
Will be summarized using frequency and percentages.
Time frame: Up to the end of maintenance therapy
Risk Stratification Scores
Will be summarized using frequency and percentages.
Time frame: Up to the end of maintenance therapy
| Milestone | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Started | 3 |
| Completed | 0 |
| Not completed | 3 |
| Withdrew: Physician decision | 1 |
| Withdrew: Adverse event | 2 |
| Milestone | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Started | 0 |
| Completed | 0 |
| Not completed | 0 |
Objective status of CR measured by positron emission tomography (PET)-computed tomography (CT) scans according to Lugano 2014.
| Participants | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Number of Patients Experiencing a Complete Response (CR) | 0 |
The ORR at the end of induction will be estimated by the total number of patients who achieve a complete response (CR) or partial response (PR) by PET-CT scans according to Lugano 2014 divided by the total number of evaluable patients. The ORR between ibrutinib-naive and ibrutinib-pretreated patients will be compared using Fisher's exact test.
| Participants | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Overall Response Rate (ORR) | 0 |
CR, PR, and stable disease (SD) rates for patients who continue to maintenance will be estimated by number of patients who continue on maintenance therapy and achieve CR, PR or SD, respectively, at the end of maintenance divided by the total number of evaluable patients who continue to maintenance.
No measurements were reported for this outcome.
The distribution of PFS will be estimated using the method of Kaplan-Meier. The PFS between ibrutinib-naive and ibrutinib-pretreated patients will be compared using log-rank test.
| months | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Progression Free Survival (PFS) | 5.5 (1.1 to NA) |
The distribution of OS will be estimated using the method of Kaplan-Meier. The OS between ibrutinib-naive and ibrutinib-pretreated patients will be compared using log-rank test.
| months | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Overall Survival (OS) | NA (1.1 to NA) |
All AEs occurring on or after first study treatment will be summarized by National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 grade.
| Participants | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Count of Patients Experiencing Grade 3+ Adverse Events (AEs) | 3 |
MRD status for both responders and non-responders at each time point will be reported descriptively, and explored for correlation with clinical factors and patient outcomes such as PFS and OS.
Results for this outcome have not been posted.
Systemic immune profiles and T cell activation will be investigated using multi-parameter flow cytometry, and cytokine analysis in the peripheral blood of patients.
Results for this outcome have not been posted.
Will be summarized using frequency and percentages.
Results for this outcome have not been posted.
Will be summarized using frequency and percentages.
Results for this outcome have not been posted.
Collected over 15 months. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) | 1/3 (33.3%) | 2/3 (66.7%) | 3/3 (100%) |
| Event | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Neutrophil count decreasedInvestigations | 1/3 |
| White blood cell decreasedInvestigations | 1/3 |
| HypoxiaRespiratory, thoracic and mediastinal disorders | 1/3 |
| AnemiaBlood and lymphatic system disorders | 1/3 |
| Disease ProgressionGeneral disorders | 1/3 |
| DyspneaRespiratory, thoracic and mediastinal disorders | 1/3 |
| Platelet count decreasedInvestigations | 1/3 |
| Tumor lysis syndromeMetabolism and nutrition disorders | 1/3 |
| Lung infectionInfections and infestations | 1/3 |
| Respiratory failureRespiratory, thoracic and mediastinal disorders | 1/3 |
| Event | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| AnemiaBlood and lymphatic system disorders | 2/3 |
| Blood lactate dehydrogenase increasedInvestigations | 2/3 |
| CoughRespiratory, thoracic and mediastinal disorders | 2/3 |
| Lymphocyte count decreasedInvestigations | 2/3 |
| Neutrophil count decreasedInvestigations | 2/3 |
| Peripheral sensory neuropathyNervous system disorders | 2/3 |
| Platelet count decreasedInvestigations | 2/3 |
| White blood cell decreasedInvestigations | 2/3 |
| Abdominal painGastrointestinal disorders | 1/3 |
| Alanine aminotransferase increasedInvestigations | 1/3 |
| Age, Continuous(years) | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Mean | 62.1 ± 19.89 |
| Sex: Female, Male(Participants) | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Female | 2 |
| Male | 1 |
| Ethnicity (NIH/OMB)(Participants) | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| Hispanic or Latino | 1 |
| Not Hispanic or Latino | 2 |
| Unknown or Not Reported | 0 |
| Race (NIH/OMB)(Participants) | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 0 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 0 |
| White | 2 |
| More than one race | 0 |
| Unknown or Not Reported | 1 |
| Region of Enrollment(participants) | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| United States | 3 |
| ECOG Performance Status(Participants) | Treatment (Rituximab, Polatuzumab Vedotin, Venetoclax) |
|---|---|
| <=1 | 2 |
| >=2 | 1 |
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