ClinicalTrials.gg
RecruitingNCT05848765REFRACTUpdated May 5, 2026

Relapsed Follicular Lymphoma Randomised Trial Against Standard ChemoTherapy

A Phase 2 interventional study of Epcoritamab and Lenalidomide in Relapsed Follicular Lymphoma and Refractory Follicular Lymphoma, sponsored by University of Birmingham. Recruiting at 25 sites in United Kingdom. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-05-05.

Sponsored by University of Birmingham · Phase 2, Interventional, and Treatment

From the registry’s dates

  • Started Sep 2023; still recruiting 3 years 2 months later.

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Phase
Phase 2
Study type
Interventional
Enrollment
284
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-14

Among 13 studies testing epcoritamab in Lymphoma, Follicular — 7 open to participants now, 12 under way, 2 of them phase 3. epcoritamab · Lymphoma, Follicular.

Planned enrollment
4th of 13
284 · median 78
Started
2023
with 2 others
Phase 2
9 of 13
7 open now
Primary completion
2029-05
later than 7 of 11 live
Registered
5th of 13
by date
Lead sponsor
1 of 13
University of Birmingham

Among the 13 studies testing epcoritamab in Lymphoma, Follicular, this one is the 4th largest by planned enrollment, is one of 3 that started in 2023, is one of 9 in phase 2, reaches primary completion later than 7 of the 11 other live ones, and was the 5th registered.

Lymphoma, Follicular

1,891 studies on the registry are indexed under Lymphoma, Follicular; 289 are open to participants now.

Browse Lymphoma, Follicular studies →

Open to participants now

7 of the 13 studies testing epcoritamab in Lymphoma, Follicular are open now, in 4 countries. Recruiting first, the newest first:

1 more — sign in →

By country, each count listing its studies:

All 7 open studies →

About epcoritamab

epcoritamab: first FDA approval 2023 (EPKINLY), first EMA approval 2023. What it is approved for, and how studies give it, is on its page →

Who these studies take

Of the 225 Lymphoma, Follicular studies recruiting now, 158 (70%) set no upper age limit and 39 (17%) stop at 75 or younger; 33 take children under 18; 24 take healthy volunteers.

This study: 18 Years and older · all sexes · no healthy volunteers.

The full table on the hub →

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Watch this landscapeDownload CSVNarrow it in search →With an account: a weekly mail of what changed among 13 studies testing epcoritamab in Lymphoma, Follicular, or all of them as a file.
02

Study summary

The aim of the REFRACT clinical trial is to find new therapies with improved outcomes compared to the current standard treatment available, in patients with relapsed or refractory follicular lymphoma. This will be done by comparing patients who have received a new treatment against patients who receive standard treatment based on their response to the treatment received.

Read the detailed description

In the REFRACT trial patients with relapsed or refractory follicular lymphoma (rrFL) will be randomised (randomly allocated) to receive a new treatment (experimental treatment) or standard treatment which will be chosen by their doctor prior to entering the trial (called investigator choice standard therapy (ICT)). There are 3 treatment rounds which will happen one after another, testing 3 different experimental treatments. The experimental treatment in each round will be compared to ICT. ICT will be a choice of 1 of 5 standard treatment options including RCHOP, RCVP, lenalidomide and rituximab, bendamustine and rituximab or obinutuzumab and bendamustine. Patients in Round 1 (R1) will be randomised using a 1:1 allocation ratio (meaning patients have a 50/50 chance of receiving the experimental treatment). In Round 1 the experimental treatment is epcoritamab combined with lenalidomide. Patients randomised to epcoritamab and lenalidomide will receive up to 12 28-day cycles of therapy; epcoritamab will be delivered as a subcutaneous injection weekly for cycles 1 and 2 and on day 1 of cycles 3-12. Lenalidomide will be taken orally on days 1-21 of each cycle. Patients in Rounds 2 (R2) and 3 (R3) (experimental treatments yet to be determined) will be randomised using a 1:4 allocation ratio in favour of the experimental treatment (meaning patients are more likely to receive the experimental treatment). The study will recruit 284 patients with rrFL over 5 years. The aim is to identify new therapies which have better outcomes compared to ICT based on patients response to treatment (tested by PET scan) after 24 weeks of therapy. Following treatment patients will be followed up yearly until the end of the trial (up to 10 years).

03

Conditions studied

  • Relapsed Follicular Lymphoma
  • Refractory Follicular Lymphoma

Keywords

  • Epcoritamab
  • Lymphoma
04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. proven CD20 positive, grade 1-3a follicular lymphoma (biopsy within 3 months of trial entry)
  2. Aged 18 years or over
  3. Advanced disease that in the opinion of the treating physician requires treatment
  4. Patient suitable for standard available therapy at the Investigator's discretion
  5. Prior therapy with at least one line of immunochemotherapy. Previous radiotherapy at any time is permitted and will not count as a . Previous rituximab monotherapy is also permitted as long as patients have at any time also received at least one line of immunochemotherapy
  6. Assessable disease by PET-CT (at least one involved node with long diameter >1.5cm, or extranodal lesion >1cm )
  7. performance status of 0, 1 or 2 at trial entry
  8. Adequate organ function defined as; i. ≥ 1.0 x 109/L (growth factor use is permitted) ii. count ≥ 75 x 109/L, or ≥ 50 x 109/L if bone marrow infiltration or splenomegaly iii. and AST level ≤3 x iv. Direct level ≤ 2 x ULN, unless due to Gilbert's syndrome v. ≥ 50mL/min (by Cockcroft-Gault formula) vi. PT, and aPTT ≤ 1.5 x ULN, unless receiving anticoagulation vii. within normal limits by MUGA or echocardiography
  9. Able to provide written
  10. Women of (or their partners) must use an effective form of

Exclusion criteria

Exclusion Criteria:

  1. Current (or within 1 year) transformation to high grade lymphoma, including grade 3b follicular lymphoma (patients with historical high-grade transformation over 1 year ago are eligible)
  2. Non-Fluorodeoxyglucose (FDG) avid disease
  3. Prior allogenic stem cell transplantation (SCT) or solid organ transplant
  4. Prior treatment with lenalidomide
  5. Treatment with CAR-T therapy within 100 days of starting trial treatment
  6. SCT or maintenance therapy planned within 24 weeks of starting treatment (patients planning SCT/maintenance after at least 24 weeks of treatment are eligible)
  7. Immunochemotherapy with a platinum-containing regimen planned
  8. Known serological positivity for or uncontrolled
  9. surface antigen (HBsAg) positive and/or detectable viral DNA. Patients positive for Hepatitis B core antibody (anti-HBc) but viral DNA negative are eligible
  10. Other within 2 years of enrolment, excepting cervical carcinoma stage 1B or less, non-invasive basal cell or squamous cell skin carcinoma, non-invasive, superficial bladder cancer, prostate cancer with a current PSA level \<0.1ng/mL, any curable cancer with a CR of > 2 years duration
  11. Active systemic infection requiring treatment
  12. Current or prior CNS involvement with lymphoma
  13. History of allergy or anaphylaxis to anti-CD20 monoclonal antibody therapy
  14. Known to any of the experimental arm IMPs. Patients with a known hypersensitivity to a control arm regimen may still be eligible if they have no hypersensitivity to other potential control arm IMPs.
  15. Serious medical or psychiatric illness likely to interfere with participation in this clinical study
  16. Recent cancer treatment (chemotherapy, immunotherapy, biological therapy) within 4 weeks of starting trial treatment; systemic treatment (prednisolone > 10mg daily (or equivalent)) within 7 days of cycle 1 day 1 dosing
  17. Unwilling to use appropriate methods whilst on study treatment and for 12 months following end of treatment (or 18 months for female patients whose ICT regimen contains obinutuzumab)
  18. Women who are pregnant or breastfeeding
  19. Prior treatment with the experimental therapy under investigation
  20. Major surgery within 30 days of starting treatment
  21. Severe arrhythmias, heart failure, previous myocardial infarction, acute inflammatory heart disease for ICT regimen containing doxorubicin, or severe heart failure ( Class IV) or severe, uncontrolled cardiac disease for ICT regimen containing rituximab
Terms in these criteria, in plain language(22)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

Relapsed and refractory

Relapsed: the illness came back after treatment had worked. Refractory: it did not respond to treatment, or stopped responding while still on it.

Line of therapy

A line of therapy is one course of treatment, which may combine several drugs. First-line is the first course given; second-line follows when that stops working or is not tolerated.

“Two prior lines” means two courses that count separately under the study’s rules — not simply two drugs. Ask the study team if you are unsure how yours are counted.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

INR, PT and aPTT (clotting tests)

Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.

Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Sequential assignment
Masking
None (open label)
Enrollment
284 participants (estimated)

Study arms

  • Experimental
    Round 1: Epcoritamab and lenalidomide

    Epcoritamab (weekly for cycles 1 and 2 and on day 1 of cycles 3-12 for up to 12 cycles) and lenalidomide (daily for days 1-21 of each cycle for up for 12 cycles), cycles will be 28 day cycles.

    Drug: Epcoritamab · Drug: Lenalidomide

  • Experimental
    Round 2

    Investigation agent 2

    Drug: Investigation agent 2

  • Experimental
    Round 3

    Investigation agent 3

    Drug: Investigation agent 3

  • Active comparator
    All rounds: Investigator Choice Therapy

    Choice of therapy to be selected by the Investigator for each patient prior to randomisation. The Investigator will choose between; RCHOP, RCVP, rituximab and bendamustine, rituximab and lenalidomide or bendamustine and obinutuzumab.

    Drug: Lenalidomide · Drug: Rituximab · Drug: Obinutuzumab · Drug: Bendamustine · Drug: Vincristine · Drug: Doxorubicin · Drug: Cyclophosphamide · Drug: Prednisone

Interventions

  • Bispecific antibody

  • Immunomodulatory agent

  • Monoclonal antibody

  • Monoclonal antibody

  • Alkylating agent (chemotherapy drug)

  • Antineoplastic, Vinca Alkaloid

  • Anthracycline

  • Alkylating agent (chemotherapy drug)

  • Corticosteroid

  • DrugInvestigation agent 2

    The drug used in round 2 is yet to be confirmed, round 2 is estimated to open in Q4 2025 and the record will be updated when the drug has been confirmed

  • DrugInvestigation agent 3

    The drug used in round 3 is yet to be confirmed, round 3 is estimated to open in Q3 2027 and the record will be updated when the drug has been confirmed

06

What researchers measure

Primary outcomes

  1. Complete metabolic response (CMR)

    CMR will be assessed by PET-CT using the Deauville 5-point scale and Lugano 2014 criteria. Patients who die from any cause or relapse/progress prior to this time-point will be considered non-responders. Patients who don't have a PET-CT scan within the protocol defined window or withdraw from the trial prior to this time-point will be considered non outcome evaluable. Patients who undergo stem-cell transplant (SCT) within 24 weeks of randomisation, patients who fail to start treatment and patients whose ineligibility is deemed to impact upon response to treatment will be replaced and hence not included in the analysis of this outcome

    Time frame: 24 weeks

Secondary outcomes

  1. Overall metabolic response

    Complete metabolic response (CMR) and partial metabolic response (PMR) will be assessed by PET-CT. Patients who die from any cause or relapse/progress prior to this time-point will be considered non-responders. Patients who undergo stem-cell transplant (SCT) within 24 weeks of randomisation, patients who fail to start treatment and patients whose ineligibility is deemed to impact upon response to treatment will be replaced and hence not included in the analysis of this outcome

    Time frame: 24 weeks

  2. Progression free survival (PFS)

    The time from randomisation to the date of first disease progression or death. Patients who are alive and relapse/progression at the time of analysis will be censored at their date last seen

    Time frame: 10 years

  3. Overall survival (OS)

    The time from randomisation to the date of death from any cause. Patients who are alive at the time of analysis will be censored at their date last seen

    Time frame: 10 years

  4. Duration of response (DoR)

    The time from complete and partial metabolic response by PET-CT to relapse/progression or death from any cause. Patients who are alive and relapse/progression free at the time of analysis will be censored at their date last seen

    Time frame: 10 years

  5. Duration of complete response (DoCR)

    The time from complete metabolic response by PET-CT to relapse/progression or death from any cause. Patients who are alive and relapse/progression free at the time of analysis will be censored at their date last seen

    Time frame: 10 years

  6. Time to next treatment (TTNT)

    The time from randomisation to the start date of next treatment for lymphoma. Patients who are responding (CMR or PMR) who receive consolidation radiotherapy will not be considered an event and will be censored at their date last seen if no other treatment for lymphoma is reported. Patients who die without having started next lymphoma treatment will be considered a competing risk at their date of death, and patients who are alive and have not started next lymphoma treatment at the time of analysis will be censored at their date last seen

    Time frame: 10 years

  7. Adverse events (AEs)

    Collected and reported in accordance with CTCAE version 5 defined as the number of patients who experience one or more grade 3 or 4 adverse events or serious adverse events of any grade

    Time frame: Collected from start of treatment until 60 days after treatment

  8. Quality of Life (QoL)

    Measured using the EQ-5D-5L and FACT-Lym

    Time frame: Collected pre-treatment, day 1 of cycle 3 (28 day cycles), 24 weeks from treatment start and then every 24 weeks in non-progressed patients until the end of the study (10 years)

  9. Quality of Life (QoL)

    Measured using the FACT-Lym

    Time frame: Collected pre-treatment, day 1 of cycle 3 (28 day cycles), 24 weeks from treatment start and then every 24 weeks in non-progressed patients until the end of the study (10 years)

07

Study locations

2 of 25 sites recruiting
08

References and documents

Publications

  • Gaskell C, Linton K, Bishton M, McIlroy G, Lax S, Fox S, Hopkins L, Collings R, Rhodes M, Seale T, Jackson A. The REFRACT trial: implementation of Bayesian power priors in a randomised, sequential phase II adaptive platform trial. BMC Med Res Methodol. 2025 May 3;25(1):121. doi: 10.1186/s12874-025-02575-5. PubMed 40319227 ↗
  • McIlroy G, Lax S, Gaskell C, Jackson A, Rhodes M, Seale T, Fox S, Hopkins L, Okosun J, Barrington SF, Ringshausen I, Ramsay AG, Calaminici M, Linton K, Bishton M. Investigator choice of standard therapy versus sequential novel therapy arms in the treatment of relapsed follicular lymphoma (REFRACT): study protocol for a multi-centre, open-label, randomised, phase II platform trial. BMC Cancer. 2024 Mar 25;24(1):370. doi: 10.1186/s12885-024-12112-0. PubMed 38528445 ↗

Individual participant data

Plan to share: No

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started Sep 2023 (actual). Primary completion is estimated for May 2029, 68 months after the start.

Of 151 non-industry phase 2 interventional studies under Lymphoma, Follicular, half reached primary completion within 67 months of starting (the median), counting those still running; a quarter within 40 and three quarters within 110. This study's planned 68 months is close to that.

Counting every sponsor, half of 199 studies reached it within 57 months; a quarter within 31 and three quarters within 97.

How these figures are worked out, and which studies are left out of them.

Registered
Apr 18, 2023
First posted
May 8, 2023
StartActual
Sep 4, 2023
Primary completionEst.
May 31, 2029
CompletionEst.
Nov 30, 2031
Last update
May 5, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on May 5, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT05848765
Collaborators
Cancer Research UK, Genmab
Responsible party
Sponsor
First posted
May 8, 2023
Start date
Sep 4, 2023
Primary completion
May 31, 2029 (estimated)
Completion
Nov 30, 2031 (estimated)
Last update
May 5, 2026

Study contacts

Trial Coordinator
Contact
refract@trials.bham.ac.uk
0121 371 7861

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drugs tested here: Epcoritamab · Lenalidomide

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