Active, not recruiting
Phase 2
Study of Iopofosine I-131 (CLR 131) in Select B-Cell Malignancies (CLOVER-1) With Expansion in Waldenstrom
Condition(s) studied
Waldenstrom MacroglobulinemiaMultiple MyelomaChronic Lymphocytic LeukemiaSmall Lymphocytic LymphomaLymphoplasmacytic LymphomaMarginal Zone LymphomaMantle Cell LymphomaDiffuse Large B Cell LymphomaCentral Nervous System Lymphoma
Investigational drug(s) / intervention(s)
Iopofosine I 131 single doseIopofosine I 131 multiple doseIopofosine I 131 fractionated dose
Iopofosine I 131 single dose: Radiopharmaceutical
Iopofosine I 131 multiple dose: Radiopharmaceutical
Iopofosine I 131 fractionated dose: Radiopharmaceutical
Study summary
Part A of this study evaluates iopofosine I 131 (CLR 131) in patients with select B-cell malignancies (multiple myeloma( MM), indolent chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), lymphoplasmacytic lymphoma (LPL)/Waldenstrom Macroglobulinemia (WM), marginal zone lymphoma (MZL), mantle cell lymphoma (MCL), diffuse large B-cell lymphoma (DLBCL), and central nervous system lymphoma (CNSL) who have been previously treated with standard therapy for their underlying malignancy. Part B (CLOVER-WaM) is a pivotal efficacy study evaluating IV administration of iopofosine I 131 in patients with WM that have received at least two prior lines of therapy.
Eligibility
\[CLOVER-1\] Inclusion Criteria: All Patients
* Histologically or cytologically confirmed MM; Patients with primary or secondary CNSL may be enrolled.
* ECOG performance status of 0 to 2
* 18 years of age or older
* Life expectancy of at least 6 months
* Platelets ≥ 75,000/µL (if full-dose anticoagulation therapy is used, platelets ≥ 100,000/µL are required)
* WBC count ≥ 3000/µL
* Absolute neutrophil count ≥ 1500/µL
* Hemoglobin ≥ 9 g/dL (last transfusion, if any, must be at least 1 week prior to study registration, and no transfusions are allowed between registration and dosing)
* Estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2
* Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) ≤ 2.5 × upper limit of normal (ULN)
* Bilirubin \< 1.5 × ULN
* International normalized ratio (INR) \< 2.5
* If patient is on full-dose anticoagulation therapy, the anticoagulation therapy must be reversible and reversal of the anticoagulation therapy must not be life-threatening, as judged by the Investigator
* Patients who have undergone stem cell transplant must be at least 100 days from transplant
Patients with Multiple Myeloma
* At least 5 prior regimens, which must include at least 1 approved proteasome inhibitor (bortezomib, carfilzomib, or ixazomib), at least 1 approved immunomodulatory agent (thalidomide, lenalidomide, or pomalidomide), and at least 1 approved monoclonal antibody (e.g., daratumumab or elotuzumab) with or without maintenance therapy, unless patients are intolerable to such agents or ineligible to receive such agents.
* At least triple-class refractory (refractory to a proteasome inhibitor, immunomodulatory agent, and a monoclonal antibody)
* Progressive disease defined by any of the following:
* 25% increase in serum M-protein from the lowest response value during (or after) last therapy and/or absolute increase in serum M-protein of ≥ 0.5 g/dL
* 25% increase in urine M-protein from the lowest response value during (or after) last therapy and/or absolute increase in urine M-protein of ≥ 200 mg/24 h
* 25% increase in bone marrow plasma cell percentage from the lowest response value during (or after) last therapy. Absolute bone marrow plasma cell percentage must be ≥ 10% unless prior CR when absolute bone marrow plasma cell percentage must be ≥ 5%.
* 25% increase in serum FLC level from the lowest response value during (or after) last therapy; the absolute increase must be \> 10 mg/dL
* New onset hypercalcemia \> 11.5 mg/dL
* Failure to obtain a partial response or better to current treatment, or cannot further improve their response to current treatment
* Appearance of new extramedullary disease
* Measurable disease defined by any of the following:
* Serum M-protein \> 0.5 g/dL
* Urine M-protein \> 200 mg/24 h
* Serum FLC assay: Involved FLC level ≥ 10 mg/dL provided serum FLC ratio is abnormal.
\[CLOSED\] Patients with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Lymphoplasmacytic Lymphoma/Waldenstom Macroglobulinemia, or Marginal Zone Lymphoma
* Prior treatment with at least 2 prior regimens, which may include chemotherapy, an approved anti-CD20 antibody with or without maintenance therapy, and an approved targeted agent, unless patients are ineligible to receive such agents
* Patients with Helicobacter pylori+ mucosa-associated lymphoid tissue lymphoma must have received 1 prior antibiotic regimen for H pylori
* At least 1 measurable nodal lesion with longest diameter \> 15 mm or 1 measurable extranodal lesion (eg, hepatic nodule) with longest diameter \> 10 mm. Additional parameters (e.g., measurable IgM for patients with Lymphoplasmacytic Lymphoma) may be allowed if they meet current NCCN guidelines for symptomatic disease. Patients with uptake by FDG-PET scan may be allowed with prior approval of Sponsor.
\[CLOSED\] Patients with Mantle Cell Lymphoma
* Prior treatment with at least 1 prior regimen
* At least 1 measurable nodal lesion with longest diameter \> 15 mm or 1 measurable extranodal lesion (eg, hepatic nodule) with longest diameter \> 10 mm. Patients with uptake by FDG-PET scan may be allowed with prior approval of Sponsor.
\[CLOSED\] Patients with Diffuse Large B-Cell Lymphoma
* Relapsed or refractory to combination chemotherapy for DLBCL that contains rituximab and an anthracycline; or is intolerable to such agents. Relapsed disease is defined as either recurrence of disease after a CR or PD after achieving a partial response (PR) or SD. Refractory disease is defined as failure to achieve at least SD with any 1 line of therapy or with PD ≤ 3 months of the most recent chemotherapy regimen.
* At least 1 measurable nodal lesion with longest diameter \> 15 mm or 1 measurable extranodal lesion (eg, hepatic nodule) with longest diameter \> 10 mm. Patients with uptake by FDG-PET scan may be allowed with prior approval of Sponsor.
Patients with CNS Lymphoma
* Must have biopsy-proven disease and must have received at least one prior intervention for their disease.
* Must be at least two weeks from CNS biopsy before administration of iopofosine I 131.
* Must have at least one lesion with enhancement on brain imaging.
* Stable (or decreasing) dose of corticosteroids or anti-convulsant medication for at least 7 days prior to dosing
\[CLOVER-1\] Exclusion Criteria:
* Ongoing Grade 2 or greater toxicities due to previous therapies. Stable, tolerable Grade 2 AEs (eg, neuropathy) may be allowed.
* Prior external-beam RT resulting in greater than 20% of total bone marrow receiving greater than 20 Gy.
* Prior total body or hemi-body irradiation. Patients who have received prior low-dose total body or hemi-body irradiation may be allowed on a case-by-case basis after discussion with Sponsor (considerations may include factors such as time since irradiation, total lifetime accumulated dose, etc.)
* Extradural tumor in contact with the spinal cord or tumor located where swelling in response to therapy may impinge upon the spinal cord
* For patients with CLL/SLL, LPL, or MZL, transformation to a more aggressive form of NHL
* Ongoing chronic immunosuppressive therapy
* Clinically significant bleeding event within prior 6 months
* Ongoing anti-platelet therapy (except low-dose aspirin \[eg, 81 mg daily\] for cardioprotection)
* Anti-cancer therapy within two weeks of initial iopofosine I 131 infusion. Low dose dexamethasone for symptom management is allowed
* Radiation therapy, chemotherapy, immunotherapy, or investigational therapy within 2 weeks of eligibility-defining bone marrow biopsy.
* For patients with primary or secondary CNSL, active bleeding in the tumor bed and/or uncontrolled seizure activity
\[CLOVER-WaM\] Inclusion Criteria
* Histologically or cytologically confirmed WM. Patients with a diagnosis of LPL may be enrolled with prior Sponsor approval.
* Patient has an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 to 2 (Appendix C)
* Patient is 18 years of age or older
* Life expectancy of at least 6 months
* Received at least two prior lines of therapy for WM
* Measurable IgM (above upper limit of normal) OR at least one measurable nodal lesion with longest diameter \> 15 mm or one measurable extranodal lesion (e.g., hepatic nodule) with longest diameter \> 10 mm
\[CLOVER-WaM\] Exclusion Criteria
* Ongoing Grade 2 or greater toxicities due to previous therapies, excluding alopecia.
* Prior external-beam RT resulting in greater than 20% of total bone marrow receiving greater than 20 Gy.
* Prior total body or hemi-body irradiation. Patients who have received prior low-dose total body or hemi-body irradiation may be allowed on a case-by-case basis after discussion with Sponsor (considerations may include factors such as time since irradiation, total lifetime accumulated dose, etc.)
* Patients with second malignancies in addition to WM, if the second malignancy has required therapy in the last 2 years or is not in remission; exceptions to this criterion include successfully treated non-metastatic basal cell or squamous cell skin carcinoma, or prostate cancer that does not require therapy
* Anti-cancer therapy within two weeks of initial iopofosine I 131 infusion.
* Need for acute treatment of WM (e.g., those with hyperviscosity)
Primary outcome measure(s)
- Part A [CLOVER-1] Clinical benefit rate — 84 days
Response assessment per International Uniform Response Criteria for Multiple Myeloma; Lugano Criteria for lymphoma; International Workshop on Chronic Lymphocytic Leukemia for CLL; VIth Waldenstrom's Macroglobulinemia Criteria for Response Assessment; or 2005 Response Criteria for CNS Lymphoma
- Part B [CLOVER-WaM] Major Response Rate — 12 months
Response assessment per criteria modified from VIth Waldenstrom's Macroglobulinemia Criteria for Response Assessment
Trial sites (52)
| Facility | City | Region | Status |
| Cellectar Biosciences site |
Los Angeles |
California |
|
| Cellectar Biosciences site |
Redlands |
California |
|
| Cellectar Biosciences site |
Washington D.C. |
District of Columbia |
|
| Cellectar Biosciences site |
Jacksonville |
Florida |
|
| Cellectar Biosciences site |
Miami |
Florida |
|
| Cellectar Biosciences site |
Tampa |
Florida |
|
| Cellectar Biosciences |
Atlanta |
Georgia |
|
| Cellectar Biosciences site |
Maywood |
Illinois |
|
| Cellectar Biosciences site |
Warrenville |
Illinois |
|
| Cellectar Biosciences site |
Westwood |
Kansas |
|
| Cellectar Biosciences site |
New Orleans |
Louisiana |
|
| Cellectar Biosciences site |
Baltimore |
Maryland |
|
| Cellectar Biosciences |
Bethesda |
Maryland |
|
| Cellectar Biosciences site |
Boston |
Massachusetts |
|
| Cellectar Biosciences |
North Bergen |
New Jersey |
|
| Cellectar Biosciences site |
Buffalo |
New York |
|
| Cellectar Biosciences site |
New York |
New York |
|
| Cellectar Biosciences site |
Rochester |
New York |
|
| Cellectar Biosciences site |
Durham |
North Carolina |
|
| Cellectar Biosciences |
Canton |
Ohio |
|
| Cellectar Biosciences site |
Cincinnati |
Ohio |
|
| Cellectar Biosciences Site |
Charleston |
South Carolina |
|
| Cellectar Biosciences |
Greenville |
South Carolina |
|
| Cellectar Biosciences site |
Knoxville |
Tennessee |
|
| Cellectar Biosciences site |
Dallas |
Texas |
|
| Cellectar Biosciences site |
Dallas |
Texas |
|
| Cellectar Biosciences site |
Houston |
Texas |
|
| Cellectar Biosciences site |
Seattle |
Washington |
|
| Cellectar Biosciences site |
Madison |
Wisconsin |
|
| Cellectar Biosciences site |
Concord |
New South Wales |
|
| Cellectar Biosciences |
Adelaide |
South Australia |
|
| Cellectar Biosciences |
Salvador |
Estado de Bahia |
|
| Cellectar Biosciences |
Curitiba |
Paraná |
|
| Cellectar Biosciences |
Porto Alegre |
RioGrande Do Sul |
|
| Cellectar Biosciences |
Blumenau |
Santa Catarina |
|
| Cellectar Biosciences Site |
Hradec Králové |
Czechia |
|
| Cellectar Biosciences |
Helsinki |
Finland |
|
| Cellectar Biosciences |
Pessac |
France |
|
| Cellectar Biosciences |
Poitiers |
France |
|
| Cellectar Biosciences site |
Athens |
Greece |
|
+ 12 more sites — see the full list on the official registry below.
Other trials for the same condition