Active, not recruiting
Phase 1/2
An Open-Label Phase lB/II Study of Glofitamab and Atezolizumab or Polatuzumab Vedotin in Adult Patients With Relapsed/Refractory B-Cell Non-Hodgkin's Lymphoma
Condition(s) studied
Non-Hodgkins Lymphoma
Investigational drug(s) / intervention(s)
Glofitamab: Glofitamab will be administered through IV infusion every 3 weeks (Q3W) beginning Cycle 1, Day 1, for up to 17 cycles (Cycle = 21 days). Step-up dosing, in which an initial lower dose will be followed by a higher dose 1 week later, will be considered for the initial treatment phase and for Cycle 9 of the re-treatment phase.
Atezolizumab: Atezolizumab will be administered in combination with Glofitamab through IV infusion Q3W from Cycle 2, Day 1, for up to 16 cycles (Cycle = 21 days).
Obinutuzumab: Obinutuzumab will be administered once, through IV infusion, at a fixed dose 7 days before the first dose of Glofitamab.
Tocilizumab: Tocilizumab will be administered as necessary to treat cytokine release syndrome (CRS).
Polatuzumab Vedotin: Polatuzumab vedotin will be administered in combination with Glofitamab (on different days) Q3W from Cycle 1, Day 2, for up to 12 cycles (Cycle = 21 days).
89Zr-Df-IAB22M2C: Participants will receive 89Zr-Df-IAB22M2C (Cycle 1 only) prior to obinutuzumab pre-treatment and again on Day 10 after dosing with glofitamab, followed by PET/CT.
Study summary
This is an open-label, single arm, multicenter, dose finding, Phase Ib study in order to assess the maximum tolerated dose (MTD) and/or recommended Phase II dose (RP2D) for this combination treatment and to evaluate the general safety, tolerability, pharmacokinetic (PK), pharmacodynamic, and preliminary anti-tumor activity of this combination treatment in adult patients.
This study includes an additional open-label imaging feasibility sub-study using a tracer in adult participants with relpased/refractory B-cell non-Hodgkin's lymphoma to image CD8+T-cells at baseline and after treatment with glofitamab, including pre-treatment with obinutuzumab.
Eligibility
Main Inclusion Criteria
* Histologically-confirmed hematologic malignancy that is expected to express CD20 (Relapsed after or refractory to respond to at least one prior treatment regimen; no available treatment options that are expected to prolong survival or patients refusing chemotherapy or autologous stem cell transplant (SCT))
* Dose-escalation: Grades 1-3b relapsed or refractory (R/R) follicular lymphoma (FL) or marginal zone lymphoma (MZL) (nodal; extra-nodal; or splenic), diffuse large B-cell lymphoma (DLBCL), primary mediastinal large B-cell lymphoma (PMBCL), high-grade B-cell lymphoma (HGBCL) with MYC and BCL2 and/or BCL6 rearrangements (double-hit lymphoma), HGBCL not otherwise specified (NOS), DLBCL arising from FL (transformed FL)
* Dose-expansion: R/R LBCL, including DLBCL NOS, DLBCL arising from FL (transformed FL), PMBCL, HGBCL with MYC and BCL2 and/or BCL6 rearrangements (i.e., double-hit and triple-hit lymphomas), and HGBCL NOS
* At least one measurable target lesion
* Fresh pre-treatment biopsy, but if this cannot be taken, a previous archived biopsy from metastatic lesion can be taken as replacement if it is not older than 6 months and not confounded by major events (progression, treatment)
* Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
* Adequate organ function (liver, hematological, renal)
* Negative test results for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV)
Inclusion Criteria Specific to Imaging Substudy
* At least two measurable target lesions
* Able to provide two fresh tumor biopsies (baseline and on-treatment)
Main Exclusion Criteria
* Participants with Chronic Lymphocytic Leukemia (CLL), acute lymphoblastic leukemia (ALL), lymphoblastic lymphoma, Richter's transformation, CD20-positive ALL, Burkitt lymphoma, or lymphoplasmacytic lymphoma
* Current \> Grade 1 peripheral neuropathy (only for participants being treated in the polatuzumab vedotin arm)
* Patients with known active infection, or reactivation of a latent infection within 4 weeks prior to Obinutuzumab (Gpt) infusion
* Patient with history of confirmed progressive multifocal leukoencephalopathy (PML)
* History of leptomeningeal disease
* Current or past history of central nervous system (CNS) lymphoma
* Current or past history of CNS disease
* Major surgery or significant traumatic injury \</=28 days prior to Gpt infusion
* Significant cardiovascular disease or significant pulmonary disease
* Active or history of autoimmune disease or immune deficiency (with exceptions, e.g. hypothyroidism and Diabetes mellitus Type 1)
* History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g. bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography (CT) scan
* Treatment with any other standard anti-cancer radiotherapy / chemotherapy including investigational therapy within 4 weeks prior to Gpt infusion
* Prior solid organ transplantation
* Prior allogenic stem cell transplant (SCT)
* Autologous SCT within 100 days prior to Gpt infusion
* Documented refractoriness to an obinutuzumab-monotherapy regimen
* Prior treatment with anti-cancer/lymphoma therapies and systemic immunotherapeutic/immunostimulating agents within 4 weeks or 5 half-lives of the drug, whichever is shorter, prior to Gpt infusion
* Any history of immune related \>/= Grade 3 adverse events (AE) with the exception of endocrinopathy managed with replacement therapy
* Ongoing corticosteroid use \>25 milligrams/day of prednisone or equivalent within 4 weeks prior to and during study treatment
* Treatment with systemic immunosuppressive medication
* Administration of a live, attenuated vaccine within 4 weeks prior to Gpt infusion or anticipation that such a live attenuated vaccine will be required during the study or within 5 months after last dose of study treatment
Exclusion Criteria Specific to Imaging Substudy
* Circulating lymphoma cells, defined by out of range (high) absolute lymphocyte count and/or the presence of abnormal/malignant cells in the peripheral blood differential signifying circulating lymphoma cell
* Participants who have had splenectomy or functional asplenia that could compromise protocol objectives
Primary outcome measure(s)
- Best Objective Response Rate (ORR) as Measured by Independent Review Committee (IRC) — Baseline until the end of treatment (13 to 14 months), then ever 3 months until end of study visit (to occur within 4 weeks of disease progression)
- Dose Limiting Toxicities (DLTs) — Atezolizumab Arm: During DLT period of 21 days (or up to 42 days in the case of cycle delay), starting on Day 1, Cycle 2; Polatuzumab Vedotin Arm: During 5-week DLT period starting Cycle 1, Day 8
Trial sites (19)
| Facility | City | Region | Status |
| UZ Gent |
Ghent |
Belgium |
|
| Aarhus Universitetshospital Skejby |
Aarhus N |
Denmark |
|
| Rigshospitalet |
København Ø |
Denmark |
|
| Odense Universitetshospital |
Odense C |
Denmark |
|
| Hadassah Ein Karem Hospital |
Jerusalem |
Israel |
|
| Rabin Medical Center-Beilinson Campus |
Petah Tikva |
Israel |
|
| Chaim Sheba Medical Center |
Ramat Gan |
Israel |
|
| Istituto Nazionale Tumori Irccs Fondazione g. Pascale |
Naples |
Campania |
|
| Policlinico S.Orsola-Malpighi |
Bologna |
Emilia-Romagna |
|
| Asst Papa Giovanni Xxiii |
Bergamo |
Lombardy |
|
| Fond. IRCCS Istituto Nazionale Tumori |
Milan |
Lombardy |
|
| Hospital Universitari Vall d'Hebron |
Barcelona |
Spain |
|
| Hospital Duran i Reynals |
Barcelona |
Spain |
|
| START Madrid-FJD, Hospital Fundacion Jimenez Diaz |
Madrid |
Spain |
|
| Hospital Clinico Universitario Virgen de la Victoria |
Málaga |
Spain |
|
| Hospital Clinico Universitario de Valencia |
Valencia |
Spain |
|
| The HOPE Clinical Trials Unit |
Leicester |
United Kingdom |
|
| University College London Hospitals NHS Foundation Trust |
London |
United Kingdom |
|
| The Newcastle upon Tyne Hospitals NHS Foundation Trust |
Newcastle upon Tyne |
United Kingdom |
|
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