A Study of Durvalumab in Combination With R-CHOP or Lenalidomide Plus R-CHOP in Previously Untreated High-Risk Diffuse Large B-Cell Lymphoma

NCT ID: NCT03003520

Last Updated: 2023-05-22

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

46 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-02-28

Study Completion Date

2022-04-24

Brief Summary

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This Phase 2, two-arm, open-label study is designed to evaluate the safety, clinical activity, and predictive biomarkers of durvalumab in combination with R-CHOP or R2-CHOP, followed by durvalumab consolidation therapy in previously untreated subjects with high-risk diffuse large B-cell lymphoma (DLBCL). Induction treatment with R-CHOP (± lenalidomide) will last for a total of up to 6 to 8 treatment cycles (21 day cycles), and the total time on study treatment, including durvalumab consolidation, will last up to 12 months.

On 05-Sep-2017, the US FDA has issued a Partial Clinical Hold on this study resulting in the discontinuation of enrollment into Arm B (Durvalumab + Lenalidomide + R-CHOP). After the US FDA Partial Clinical Hold, new eligible participants have been enrolled in Arm A (Durvalumab + R-CHOP).

Detailed Description

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This research study is conducted in participants with previously untreated, high-risk diffuse large B-cell lymphoma (DLBCL). Patients with high-risk DLBCL typically have insufficient therapeutic outcomes. Therefore, the addition of novel agents to the currently used induction therapy (R-CHOP) is a rational approach to improve therapeutic outcomes in this disease setting.

Based on pre-clinical and clinical observations, it is hypothesized that durvalumab will have activity in DLBCL because the PD 1/PD L1 pathway is involved in the pathophysiology of DLBCL. In particular, the addition of durvalumab may augment the anti-tumor activity of R-CHOP against high-risk DLBCL sub-types.

The safety of durvalumab has already been explored. However, as there is limited clinical experience with durvalumab in DLBCL, the study is divided into two stages:

* A Safety Run-in Stage to evaluate the safety of the treatment combinations until at least 10 subjects are included in each of the two treatment arms
* An Expansion Stage to analyze the clinical activity of the treatment combinations

Results posted following Primary Outcome Completion date are based on a database cut-off of August 2, 2018.

Conditions

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Lymphoma, Large B-Cell, Diffuse

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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DUR + R-CHOP

On Day 1 of each 21-day cycle, participants received durvalumab 1125 mg intravenously (IV) followed by R-CHOP (IV rituximab 375 mg/m\^2, doxorubicin 50 mg/m\^2, vincristine 1.4 mg/m\^2 (maximum dose of 2.0 mg total), and cyclophosphamide 750 mg/m\^2); Participants also were administered daily oral or IV prednisone/prednisolone 100 mg from Day 1 to 5. Induction treatment continued for a total of 6-8 cycles.

Participants who achieve a complete response or partial response continue with consolidation therapy treatment consisting of durvalumab monotherapy 1500 mg by IV on Day 1 of each 28-day cycle for up to a total of 12 months.

Group Type EXPERIMENTAL

Durvalumab

Intervention Type DRUG

Durvalumab was supplied in single use vials as a liquid solution containing 500 mg (nominal) of durvalumab at a concentration of 50 mg/mL to be infused by intravenous (IV) injection.

Day 1 of each treatment cycle (Induction Period and Consolidation Period) started with the administration of IV durvalumab followed by a 2-hour observation period post infusion.

Rituximab

Intervention Type DRUG

Subsequent to durvalumab infusion, rituximab was administered by IV. Rituximab administration could be split over 2 consecutive days according to local clinical practice. Rapid infusion of rituximab was not allowed in this clinical study.

Doxorubicin

Intervention Type DRUG

A component of the CHOP therapy administered by IV. CHOP therapy was administered following rituximab.

Vincristine

Intervention Type DRUG

A component of the CHOP therapy administered by IV. CHOP therapy was administered following rituximab.

Cyclophosphamide

Intervention Type DRUG

A component of the CHOP therapy administered by IV. CHOP therapy was administered following rituximab.

Prednisone

Intervention Type DRUG

Prednisone was administered as an IV infusion or by mouth (PO) on Day 1, followed by PO administration on Days 2-5 of each cycle.

Prednisone could be given prior to other drugs of the CHOP therapy. It was administered after lenalidomide dosing in the R2-CHOP treatment arm.

DUR + R2-CHOP

Participants start the study on durvalumab in combination with R-CHOP (as described in Arm DUR + R-CHOP). Based on their DLBCL Cell-of-Origin subtype (test typically done between cycles 1 and 2), participants with ABC subtype continue the study taking durvalumab in combination with R2-CHOP. On Day 1 of each 21-day cycle, participants received durvalumab 1125 mg intravenously (IV) followed by R-CHOP. Participants were also administered daily oral or IV prednisone/prednisolone 100 mg from Day 1 to 5. In addition, a daily oral lenalidomide 15 mg was administered from Day 1 to 14 of each 21-day cycle. Induction treatment continued for a total of 6-8 cycles.

Participants who achieve a complete response or partial response continue with consolidation therapy treatment consisting of durvalumab monotherapy 1500 mg by IV on Day 1 of each 28-day cycle for up to a total of 12 months.

Enrollment into Arm B was discontinued.

Group Type EXPERIMENTAL

Durvalumab

Intervention Type DRUG

Durvalumab was supplied in single use vials as a liquid solution containing 500 mg (nominal) of durvalumab at a concentration of 50 mg/mL to be infused by intravenous (IV) injection.

Day 1 of each treatment cycle (Induction Period and Consolidation Period) started with the administration of IV durvalumab followed by a 2-hour observation period post infusion.

Rituximab

Intervention Type DRUG

Subsequent to durvalumab infusion, rituximab was administered by IV. Rituximab administration could be split over 2 consecutive days according to local clinical practice. Rapid infusion of rituximab was not allowed in this clinical study.

Doxorubicin

Intervention Type DRUG

A component of the CHOP therapy administered by IV. CHOP therapy was administered following rituximab.

Vincristine

Intervention Type DRUG

A component of the CHOP therapy administered by IV. CHOP therapy was administered following rituximab.

Cyclophosphamide

Intervention Type DRUG

A component of the CHOP therapy administered by IV. CHOP therapy was administered following rituximab.

Prednisone

Intervention Type DRUG

Prednisone was administered as an IV infusion or by mouth (PO) on Day 1, followed by PO administration on Days 2-5 of each cycle.

Prednisone could be given prior to other drugs of the CHOP therapy. It was administered after lenalidomide dosing in the R2-CHOP treatment arm.

Lenalidomide

Intervention Type DRUG

Lenalidomide was administered orally in capsule form on Days 1-14 of the DUR+R2-CHOP treatment arm only.

Interventions

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Durvalumab

Durvalumab was supplied in single use vials as a liquid solution containing 500 mg (nominal) of durvalumab at a concentration of 50 mg/mL to be infused by intravenous (IV) injection.

Day 1 of each treatment cycle (Induction Period and Consolidation Period) started with the administration of IV durvalumab followed by a 2-hour observation period post infusion.

Intervention Type DRUG

Rituximab

Subsequent to durvalumab infusion, rituximab was administered by IV. Rituximab administration could be split over 2 consecutive days according to local clinical practice. Rapid infusion of rituximab was not allowed in this clinical study.

Intervention Type DRUG

Doxorubicin

A component of the CHOP therapy administered by IV. CHOP therapy was administered following rituximab.

Intervention Type DRUG

Vincristine

A component of the CHOP therapy administered by IV. CHOP therapy was administered following rituximab.

Intervention Type DRUG

Cyclophosphamide

A component of the CHOP therapy administered by IV. CHOP therapy was administered following rituximab.

Intervention Type DRUG

Prednisone

Prednisone was administered as an IV infusion or by mouth (PO) on Day 1, followed by PO administration on Days 2-5 of each cycle.

Prednisone could be given prior to other drugs of the CHOP therapy. It was administered after lenalidomide dosing in the R2-CHOP treatment arm.

Intervention Type DRUG

Lenalidomide

Lenalidomide was administered orally in capsule form on Days 1-14 of the DUR+R2-CHOP treatment arm only.

Intervention Type DRUG

Other Intervention Names

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MEDI4736 IMFINZI™ DUR RITUXAN® Adriamycin leurocristine Oncovin cytophosphane Cytoxan corticosteroid prednisolone Revlimid®

Eligibility Criteria

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Inclusion Criteria

1. CD20+Diffuse Large B-Cell Lymphoma.
2. Ann Arbor stage 3 or 4 or stage 2 with bulky disease
3. High or high-intermediate disease risk.
4. No prior anti-lymphoma treatment.
5. Subject is willing and able to undergo biopsy.
6. Investigator considers R-CHOP immunochemotherapy appropriate.
7. Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.
8. Adequate hematology laboratory results (absolute neutrophil count ≥ 1.5 \* 10\^9/L, platelet count ≥ 75 \* 10\^9/L, hemoglobin ≥ 10.0 g/dL).
9. Adequate biochemistry laboratory results (aspartate aminotransferase (AST/SGOT) and alanine aminotransferase (ALT/SGPT) ≤ 3.0 \* upper limit of normal; bilirubin ≤ 2.0 mg/dL; creatinine clearance of ≥ 40 mL/min).
10. Bi-dimensionally measurable disease (\> 2.0 cm).
11. Subject is using effective contraception.

Exclusion Criteria

1. Diagnosis of lymphoma other than Diffuse Large B-Cell Lymphoma.
2. Composite lymphoma or transformed lymphoma.
3. Primary or secondary Central Nervous System involvement by lymphoma.
4. Seropositive or active viral infection with hepatitis B virus, human immunodeficiency virus or hepatitis C virus.
5. History of other malignancies, unless disease-free for ≥ 5 years.
6. Left ventricular ejection fraction \< 50%.
7. Peripheral neuropathy ≥ Grade 2.
8. Prior use of lenalidomide, or monoclonal antibodies against CTLA-4, PD-1, or PD-L1.
9. High risk of developing thromboembolic events, who are unwilling to take venous thromboembolism prophylaxis.
10. Active or prior documented autoimmune or inflammatory disorders within the past 3 years.
11. Current or prior use of immunosuppressive medication within 28 days before start of treatment.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Celgene

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Bristol-Myers Squibb

Role: STUDY_DIRECTOR

Bristol-Myers Squibb

Locations

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Banner MD Anderson Cancer Center

Gilbert, Arizona, United States

Site Status

Parkview Research Center

Fort Wayne, Indiana, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

Roswell Park Cancer Institute

Buffalo, New York, United States

Site Status

University of Rochester Medical Center

Rochester, New York, United States

Site Status

Mid Ohio Oncology Hematology Inc

Columbus, Ohio, United States

Site Status

Swedish Cancer Institute

Seattle, Washington, United States

Site Status

Innsbruck Medical University Department of Internal Medicine

Innsbruck, , Austria

Site Status

Landeskrankenhaus Salzburg

Salzburg, , Austria

Site Status

Hanusch Krankenhaus

Vienna, , Austria

Site Status

Local Institution - 101

Vienna, , Austria

Site Status

Medical University of Vienna Internalmedicine 1, Hematology

Vienna, , Austria

Site Status

Aarhus Sygehus

Arhus C, , Denmark

Site Status

Rigshospitalet, Kobenhavns Universitet - Centre for Clinical Intervention Research - The Copenhagen

Copenhagen, , Denmark

Site Status

Odense Universitetshospital

Odense C, , Denmark

Site Status

(North Estonia Medical Centre) - Onkoloogia-ja Hematoloogiakliinik

Tallinn, , Estonia

Site Status

Tartu University Hospital

Tartu, , Estonia

Site Status

University Hospital Birmingham

Birmingham, , United Kingdom

Site Status

Royal Marsden Hospital

London, , United Kingdom

Site Status

Oxford University Hospitals NHS Trust- Churchill Hospital-Oxford Centre for Respiratory Medicine

Oxford, , United Kingdom

Site Status

Countries

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United States Austria Denmark Estonia United Kingdom

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

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Other Identifiers

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2015-005173-20

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

MEDI4736-DLBCL-001

Identifier Type: -

Identifier Source: org_study_id

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