A Phase 2 Study of Venetoclax + Obinutuzumab Followed by Epcoritamab in Previously Untreated Chronic Lymphocytic Leukemia/ Small Lymphocytic Lymphoma (LonGEVity)
Summary
This phase II trial tests the effect of venetoclax and obinutuzumab followed by epcoritamab in treating patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) that have not previously received treatment. Venetoclax is in a class of medications called B-cell lymphoma-2 (BCL-2) inhibitors. It may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Obinutuzumab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. A monoclonal antibody is a type of protein that can bind to certain targets in the body, such as molecules that cause the body to make an immune response (antigens). Epcoritamab, a bispecific monoclonal antibody, binds to a protein called CD3, which is found on T cells (a type of white blood cell). It also binds to a protein called CD20, which is found on B cells (another type of white blood cell) and some lymphoma cells. This may help the immune system kill cancer cells. The combination of venetoclax and obinutuzumab is a standard treatment for CLL/SLL and has been found to be safe and effective. Adding epcoritamab to standard treatment with venetoclax and obinutuzumab may lead to deeper and longer-lasting responses in patients with untreated CLL/SLL.
Detailed description
PRIMARY OBJECTIVE: I. Evaluate the efficacy of venetoclax and obinutuzumab followed by venetoclax and epcoritamab in patients with newly diagnosed CLL/SLL, as assessed by the minimal residual disease (MRD)-negative complete response (CR) rate at 12 cycles of therapy. SECONDARY OBJECTIVES: I. Evaluate the safety and tolerability of venetoclax and obinutuzumab followed by venetoclax and epcoritamab in patients with newly diagnosed CLL/SLL. II. Evaluate the overall response rate (ORR), progression-free survival (PFS), duration of response (DOR) and overall survival (OS) in patients with newly diagnosed CLL/SLL who received venetoclax and obinutuzumab followed by venetoclax and epcoritamab. EXPLORATORY OBJECTIVES: I. Examine T cell and natural killer (NK) cell immune function in patients with newly diagnosed CLL/SLL treated with venetoclax and obinutuzumab followed by venetoclax and epcoritamab. II. Examine the association between established biomarkers (chromosomal abnormalities, immunoglobulin heavy chain \[IGHV\] mutational status, TP53 mutational status) and clinical outcomes (ORR, PFS). OUTLINE: Patients receive obinutuzumab intravenously (IV) on days 1, 2, 8 and 15 of cycle 1 and on day 1 of cycles 2-6, venetoclax orally (PO) once daily (QD) on days 22-28 of cycle 1 and on days 1-28 of cycles thereafter, as well as epcoritamab subcutaneously (SC) on days 1, 8, 15, and 22 of cycles 7-9 and on day 1 of cycles thereafter. Cycles repeat every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity. After completion of 12 cycles, patients who are MRD positive and have CR, partial response (PR), or stable disease (SD) continue receiving epcoritamab SC on day 1 of each cycle. Cycles of epcoritamab repeat every 28 days for 6 cycles in the absence of disease progression or unacceptable toxicity. All patients also undergo blood sample collection and computed tomography (CT) or magnetic resonance imaging (MRI) throughout the study. Additionally, patients may undergo bone marrow aspiration and biopsy throughout the study. After completion of study treatment, patients are followed up at 30 and 60 days, then every 6 months (for patients who have not experienced disease progression) and 12 months (after disease progression) for up to 5 years.
Arms & interventions
- ProcedureBiospecimen Collection
Undergo blood sample collection
- ProcedureBone Marrow Aspiration
Undergo bone marrow aspiration and biopsy
- ProcedureBone Marrow Biopsy
Undergo bone marrow aspiration and biopsy
- ProcedureComputed Tomography
Undergo CT
- OtherElectronic Health Record Review
Ancillary studies
- BiologicalEpcoritamab
Given SC
- ProcedureMagnetic Resonance Imaging
Undergo MRI
- BiologicalObinutuzumab
Given IV
- DrugVenetoclax
Given PO
Outcome measures
Primary
Minimal residual disease (MRD) negative complete response (CR)
MRD status will be assessed using ClonoSEQ® (Adaptive Biotechnologies™) on the blood (sensitivity at 10\^-4 and 10\^-6). The determination of MRD status (i.e. positive versus negative) will be defined as the presence or absence of measurable clonotypes, respectively, at a sensitivity of 10\^-6. Will be estimated along with the 95% exact binomial confidence interval.
Time frame: At beginning of cycle 12 (cycle length = 28 days)
Secondary
Overall response rate
Time frame: After the start of protocol therapy and prior to disease progression and/or start of other anti-lymphoma therapy, assessed up to 5 years
Progression-free survival (PFS)
Time frame: From start of protocol treatment to time of disease relapse/progression or death due to any cause, whichever occurs earlier, assessed up to 5 years
Duration of response (DOR)
Time frame: From the first achievement of PR or CR to time of disease relapse/progression or death, whichever earlier, assessed up to 5 years
Overall survival (OS)
Time frame: From start of protocol treatment to death due to any cause, assessed up to 5 years
Incidence of adverse events
Time frame: Up to 60 days after last dose of study treatment
Eligibility criteria
Study locations (7)
City of Hope Medical Center
Duarte, California, 91010
City of Hope at Irvine Lennar
Irvine, California, 92618
City of Hope at Long Beach Elm
Long Beach, California, 90813
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
City of Hope Atlanta Cancer Center
Newnan, Georgia, 30265
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York, 10016
Medical College of Wisconsin
Milwaukee, Wisconsin, 53226