Study of Ibrutinib Combined With Venetoclax in Subjects With Mantle Cell Lymphoma (MCL)

NCT ID: NCT03112174

Last Updated: 2025-07-22

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

366 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-06-19

Study Completion Date

2024-06-27

Brief Summary

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This Phase 3 multinational, randomized, double-blind study is designed to compare the efficacy and safety of the combination of ibrutinib and venetoclax vs. ibrutinib and placebo in subjects with MCL.

Detailed Description

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Conditions

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Mantle-Cell Lymphoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Safety Run-in

Participants with a low or high risk of TLS enroll into the open-label Safety Run-in Period to receive concurrent ibrutinib at 560 mg once daily and venetoclax starting at 20 mg, and gradually ramp up to a target dose of 400 mg once daily over a 5-week period.

Group Type EXPERIMENTAL

Ibrutinib

Intervention Type DRUG

Administered orally once daily

Venetoclax

Intervention Type DRUG

Administered orally once daily

Randomization Phase: Ibrutinb + Venetoclax

Participants randomized to ibrutinib and venetoclax for approximately 104 weeks, followed by ibrutinib monotherapy until disease progression (PD), unacceptable toxicity or withdrawal of consent. Venetoclax is discontinued after 104 weeks of treatment, regardless of response assessment.

Group Type EXPERIMENTAL

Ibrutinib

Intervention Type DRUG

Administered orally once daily

Venetoclax

Intervention Type DRUG

Administered orally once daily

Randomization Phase: Ibrutinib + Placebo

Participants randomized to ibrutinib and placebo for approximately 104 weeks, followed by ibrutinib monotherapy until PD, unacceptable toxicity or withdrawal of consent. Placebo is discontinued after 104 weeks of treatment, regardless of response assessment.

Group Type PLACEBO_COMPARATOR

Ibrutinib

Intervention Type DRUG

Administered orally once daily

Placebo Oral tablet to match Venetoclax

Intervention Type DRUG

Administered orally once daily

Treatment-naive Open-label Arm

Participants are treated with ibrutinib 560 mg and venetoclax 400 mg, administered using the 5-week ramp-up schedule.

Group Type EXPERIMENTAL

Ibrutinib

Intervention Type DRUG

Administered orally once daily

Venetoclax

Intervention Type DRUG

Administered orally once daily

Interventions

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Ibrutinib

Administered orally once daily

Intervention Type DRUG

Venetoclax

Administered orally once daily

Intervention Type DRUG

Placebo Oral tablet to match Venetoclax

Administered orally once daily

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Pathologically confirmed MCL (in tumor tissue), with documentation of either overexpression of cyclin D1 in association with other relevant markers (eg, CD19, CD20, PAX5, CD5) or evidence of t(11;14) as assessed by cytogenetics, fluorescent in situ hybridization (FISH), or polymerase chain reaction (PCR).
* At least 1 measurable site of disease on cross-sectional imaging (CT).
* At least 1, but no more than 5, prior treatment regimens for MCL.
* Failure to achieve at least partial response (PR) with, or documented disease progression after, the most recent treatment regimen.
* Subjects must have adequate fresh or paraffin embedded tissue.
* Adequate hematologic, hepatic and renal function.
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) of \<= 2.


* Pathologically confirmed treatment-naive MCL (tumor tissue), with documentation of either overexpression of cyclin D1 in association with other relevant markers (eg, CD19, CD20, PAX5, CD5) or evidence of t(11;14), as assessed by cytogenetics, fluorescent in situ hybridization (FISH), or polymerase chain reaction (PCR).
* Men and women ≥18 years of age with a TP53 mutation.
* At least 1 measurable site of disease by CT.
* Must have adequate fresh or paraffin-embedded tissue.
* Eastern Cooperative Oncology Group (ECOG) performance status score 0 to \<= 2.
* Adequate hematologic, hepatic, and renal function.

Exclusion Criteria

* History or current evidence of central nervous system lymphoma.
* Concurrent enrollment in another therapeutic investigational study or prior therapy with ibrutinib or other BTK inhibitors.
* Prior treatment with venetoclax or other BCL2 inhibitors.
* Anticancer therapy including chemotherapy, radiotherapy, small molecule and investigational agents \<= 21 days prior to receiving the first dose of study drug.
* Treatment with any of the following within 7 days prior to the first dose of study drug: moderate to strong cytochrome P450 3A (CYP3A) inhibitors or strong CYP3A inducers.

Treatment Naïve Arm


* Blastoid variant of MCL
* History or current evidence of CNS lymphoma.
* Concurrent enrollment in another therapeutic investigational study or prior therapy including ibrutinib or other BTK inhibitors.
* Prior treatment with venetoclax or other BCL2 inhibitors.
* Vaccinated with live, attenuated vaccines within 4 weeks of the first dose of study drug.
* Clinically significant infection requiring IV systemic treatment that was completed \<=14 days before the first dose of study drug.
* Any uncontrolled active systemic infection.
* Known bleeding disorders (eg, von Willebrand's disease or hemophilia).
* History of stroke or intracranial hemorrhage within 6 months prior to enrollment.
* History of HIV or active HCV or HBV.
* Major surgery within 4 weeks of the first dose of study drug.
* Any life-threatening illness, medical condition, or organ system dysfunction that, in the investigator's opinion, could compromise the participant's safety or put the study outcomes at undue risk.
* Currently active, clinically significant cardiovascular disease; or a history of myocardial infarction, unstable angina, or acute coronary syndrome within 6 months prior to randomization.
* Unable to swallow capsules or tablets, or malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel, symptomatic inflammatory bowel disease or ulcerative colitis, or partial or complete bowel obstruction.
* Treatment with any of the following within 7 days prior to the first dose of study drug: Moderate or strong cytochrome P450 3A (CYP3A) inhibitors or moderate or strong CYP3A inducers.
* Known allergy to xanthine oxidase inhibitors and/or rasburicase for subjects with known risk factors (as defined by high tumor burden and/or diminished renal function, as detailed in "Study Design" section above) for TLS.
* Chronic liver disease with hepatic impairment Child-Pugh class B or C.
* Unwilling or unable to participate in all required study evaluations and procedures.
* Known hypersensitivity to the active ingredient or other components of one or more study drugs.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Janssen Research & Development, LLC

INDUSTRY

Sponsor Role collaborator

Pharmacyclics LLC.

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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The University of Arizona Cancer Centre-North Campus

Tucson, Arizona, United States

Site Status

City of Hope

Duarte, California, United States

Site Status

UCLA Department of Medicine-Hematology/Oncology

Los Angeles, California, United States

Site Status

Orlando Health Inc.

Orlando, Florida, United States

Site Status

The University of Kansas Cancer Center and Medical Pavilion

Westwood, Kansas, United States

Site Status

Norton Cancer Institute

Louisville, Kentucky, United States

Site Status

Barbara Ann Karmanos Cancer institute

Detroit, Michigan, United States

Site Status

Memorial Sloan Kettering Cancer Center

New York, New York, United States

Site Status

Stony Brook University

New York, New York, United States

Site Status

Levine Cancer Institute

Charlotte, North Carolina, United States

Site Status

Tennessee Oncology

Chattanooga, Tennessee, United States

Site Status

University of Tennessee medical Center

Knoxville, Tennessee, United States

Site Status

University of Texas MD Anderson Cancer Center

Houston, Texas, United States

Site Status

Swedish Cancer Institute

Seattle, Washington, United States

Site Status

The Canberra Hospital

Canberra, Australian Capital Territory, Australia

Site Status

Border Medical Oncology Research Unit

Albury, New South Wales, Australia

Site Status

Icon Cancer Care

Auchenflower, Queensland, Australia

Site Status

Austin Health

Heidelberg, Victoria, Australia

Site Status

Peter MacCallum Cancer

Melbourne, Victoria, Australia

Site Status

St.Vincent's Hospital

Melbourne, Victoria, Australia

Site Status

Sir Charles Gairdner Hospital

Nedlands, Western Australia, Australia

Site Status

ZiekenhuisNetwerk Antwerpen (ZNA) Stuivenberg

Antwerp, , Belgium

Site Status

AZ Sint-Jan Brugge-Oostende AV

Bruges, , Belgium

Site Status

Institut Jules Bordet

Brussels, , Belgium

Site Status

CHU UCL Namur asbl- Mont Godinne

Yvoir, , Belgium

Site Status

Tom Baker Cancer Centre

Calgary, Alberta, Canada

Site Status

Cross Cancer Institute

Edmonton, Alberta, Canada

Site Status

BC Cancer-Vancouver Centre

Vancouver, British Columbia, Canada

Site Status

Queen Elizabeth II Health Science Centre

Halifax, Nova Scotia, Canada

Site Status

The Ottawa Hospital

Ottawa, Ontario, Canada

Site Status

Jewish General Hospital

Montreal, Quebec, Canada

Site Status

FN Brno, Interni hematologicka a onkologicka klinika

Brno, , Czechia

Site Status

Fakultni Nemocnice (FN) Hradec Kravlove, a.s. IV. Interni hematologicka klinika

Hradec Králové, , Czechia

Site Status

FN Olomouc

Olomouc, , Czechia

Site Status

FN Ostrava

Ostrava-Poruba, , Czechia

Site Status

Fakultni nemocnice Kralovske Vinohrady

Prague, , Czechia

Site Status

Vseobecna fakultni nemocnice v Praze, l. interni klinika-klinika hematologie

Prague, , Czechia

Site Status

CHU CAEN-Hôpital de la Côte de Nacre

Caen, Calvados, France

Site Status

Institut Bergonié

Bordeaux, , France

Site Status

CHU Clermont Ferrand - Hôpital d'Estaing

Clermont-Ferrand, , France

Site Status

Institut Paoli Calmettes, Service Hematologie

Marseille, , France

Site Status

Centre Antoine Lacassagne

Nice, , France

Site Status

Hôpital Saint-Louis

Paris, , France

Site Status

Centre Hospitalier Lyon Sud

Pierre-Bénite, , France

Site Status

CHU de Tours

Tours, , France

Site Status

Kliniken Ostalb Stauferklinikum Schwab. Gmund

Mutlangen, Baden-Wuttemberg, Germany

Site Status

Universitaetsklinikum Ulm

Ulm, Baden-Wuttemberg, Germany

Site Status

Klinikum der Universitaet Muenchen Campus Grosshadern

Munich, Bavaria, Germany

Site Status

Universitatsklinikum Koln

Kerpen, Koln, Germany

Site Status

Universitaetsmedizin der Johannes Gutenberg, Langenbeckstrasse 1

Langen, Mainz, Germany

Site Status

Gemeinschaftpraxis Haematologie und Onkologie

Dresden, Saxony, Germany

Site Status

Vivantes Klinikum Am Urban

Berlin, , Germany

Site Status

Charite- Universitatsmedizin Berlin, Campus Benjamin Franklin

Berlin, , Germany

Site Status

Universitatsklinikum Essen, Klinik fur Hamatologie

Essen, , Germany

Site Status

Universitatsklinikum des Saarlandes, Klinik fur Innere Medizin I

Homburg/Saar, , Germany

Site Status

University Hospital of Alexandroupolis

Alexandroupoli, , Greece

Site Status

251 Air Force General Hospital

Athens, , Greece

Site Status

General Hospital of Athens Laiko

Athens, , Greece

Site Status

General Hospital of Athens "Alexandra"

Athens, , Greece

Site Status

University General Hospital of Ioannina

Ioannina, , Greece

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University General Hospital of Larissa

Larissa, , Greece

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University Hospital of Patras

Pátrai, , Greece

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Orszagos Onkologiai Intezet

Budapest, , Hungary

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Semmelweis Egyetem

Budapest, , Hungary

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Debreceni Egyetem Klinikai Kozpont, Belgyogyaszati Klinika

Debrecen, , Hungary

Site Status

Petz Aladar Megyei Oktato Korhaz, II. Belgyogyaszat-Hematologia

Győr, , Hungary

Site Status

Somogy Megyei Kaposi Mor Oktato Korhaz

Kaposvár, , Hungary

Site Status

Szegedi Tudományegyetem Szent-Györgyi Albert Klinikai Központ

Szeged, , Hungary

Site Status

Markusovszky Egyetemi Oktatokorhaz, Haematologiai es Haemoszatazeologiai Osztaly

Szombathely, , Hungary

Site Status

Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo di Alessandria

Alessandria, Alessandria/Piemonte, Italy

Site Status

Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII (Presidio Papa Giovanni XXIII)

Bergamo, Bergamo/Lombardia, Italy

Site Status

Azienda Ospedaliera Universitaria di Bologna Policlinico Saint Orsola Malpighi

Bologna, Bologna/Emilia-Romagna, Italy

Site Status

ASST degli Spedali Civili di Brescia

Brescia, Brescia/Lombardia, Italy

Site Status

Azienda Ospedaliera S. Croce e Carle Cuneo

Cuneo, Cuneo/Piemonte, Italy

Site Status

Istituto Scientifico Romagnolo Per Lo Studio e La Cura Dei Tumori

Meldola, Forli-Cesena/Emilia-Rom, Italy

Site Status

IRCCS Ospedale S. Raffaele di Milano

Milan, Milano/Lombardia, Italy

Site Status

Asst Grande Ospedale Metropolitano Niguarda

Milan, Milano/Lombardia, Italy

Site Status

Fondazione IRCCS Policlinico San Matteo

Pavia, Pavia/Lombardia, Italy

Site Status

Azienda Ospedaliero Universitaria Molinette San Giovanni Battista di Torino

Torino, Torino/Piemonte, Italy

Site Status

Azienda Ospedaliero-Universitaria Santa Maria della Misericordia

Udine, Udine/Friuli-Venezia Giulia, Italy

Site Status

Universitair Medisch Centrum Groningen

Groningen, , Netherlands

Site Status

Spaarne Gasthuis

Hoofddorp, , Netherlands

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Leiden University Medical Center

Leiden, , Netherlands

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Erasmus MC

Rotterdam, , Netherlands

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Franciscus Vlietland

Schiedam, , Netherlands

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Szpital Uniwersytecki nr 2 im. dr J. Biziela w Bydgoszcz

Bydgoszcz, , Poland

Site Status

Samodzielny Publiczny Zaklad Opieki Zdrowotnej Zespol Szpitali Miejskich, Oddzial Hematologiczny

Chorzów, , Poland

Site Status

Malopolskie Centrum Medyczne s c

Krakow, , Poland

Site Status

Wojewodzkie Wielospecjalistyczne Centrum Onkologii i Traumatologii im. Kopernika w Lodzi

Lodz, , Poland

Site Status

Instytut Hematologii i Transfuzjologii

Warsaw, , Poland

Site Status

Uniwersytecki Szpital Kliniczny im. J. Mikulicza-Radeckiego we Wroclawiu, PZOZ

Wroclaw, , Poland

Site Status

Gachon University Gil Medical Center

Incheon, , South Korea

Site Status

Seoul National University Hospital

Seoul, , South Korea

Site Status

Severance Hospital, Yonsei University Health System

Seoul, , South Korea

Site Status

Samsung Medical Center

Seoul, , South Korea

Site Status

The Catholic University of Korea, Seoul St. Mary's Hospital

Seoul, , South Korea

Site Status

Hospital Universitari Germans Trias I Pujol

Badalona, Barcelona, Spain

Site Status

ICO l'Hospitalet- Hospital Duran i Reynals

L'Hospitalet de Llobregat, Barcelona, Spain

Site Status

Clinica Universidad de Navarra

Pamplona, Navarre, Spain

Site Status

Hospital Universitario de Cabuenes

Gijón, Principality of Asturias, Spain

Site Status

Hospital de la Santa Creu i Sant Pau

Barcelona, , Spain

Site Status

Hospital Universitario Ramon y Cajal

Madrid, , Spain

Site Status

Fundacion Jimenez Diaz

Madrid, , Spain

Site Status

Ondokuz Mayiz universitesi Tip Fakultesi

Kurupelit, Samsun, Turkey (Türkiye)

Site Status

Gazi Universitesi Tip Fakultesi, Besevler

Ankara, , Turkey (Türkiye)

Site Status

Dokuz Eylul Universitesi Tip Fakultesi

Izmir, , Turkey (Türkiye)

Site Status

Namik Kemal Universitesi Saglik Uyg. ve.Ars. Hastanesi

Tekirdağ, , Turkey (Türkiye)

Site Status

Communal Nonprofit enterprise Cherkasy Regional Oncology Dispensary ofCherkasy Oblast Council,Regional Treatment and Diagnostic Hematological Center

Cherkasy, , Ukraine

Site Status

Communal Non-profit Enterprise Regional Center of Oncology, Department of Hematology

Kharkiv, , Ukraine

Site Status

National Inst. of Cancer, Scientific and Research Dept of Chemotherapy of Hemoblastosis and Adjuvant Treatment Methods, Dept of Oncohematology with Sector of Adjuvant treatment methods

Kyiv, , Ukraine

Site Status

SI national Scientific Center of Radiation Medicine of NAMS of Ukraine, Dep. of Radiation Oncohematology and Stem Cell Transplantation Unit

Kyiv, , Ukraine

Site Status

Andrii Novak Transcarpathian Regional Clinical Hospital, Department of Hematology

Uzhhorod, , Ukraine

Site Status

Communal Institution O.F. Herbachevskyi Regional Clinical Hospital of Zhytomyr Regional Council Dept of Hematology with beds of Intensive Therapy

Zhytomyr, , Ukraine

Site Status

Barts Health NHS Trust

London, Greater London, United Kingdom

Site Status

The Christie NHS Foundation Trust

Manchester, Greater Manchester, United Kingdom

Site Status

Nottingham University Hospitals NHS Trust

Nottingham, Nottinghamshire, United Kingdom

Site Status

The Churchill Hospital

Oxford, Oxfordshire, United Kingdom

Site Status

The Royal Marsden NHS Foundation Trust

Sutton, Surrey, United Kingdom

Site Status

St James University Hospital

Leeds, West Yorkshire, United Kingdom

Site Status

University College London Hospitals NHS Foundation Trust

London, , United Kingdom

Site Status

Countries

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United States Australia Belgium Canada Czechia France Germany Greece Hungary Italy Netherlands Poland South Korea Spain Turkey (Türkiye) Ukraine United Kingdom

References

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Wang M, Jurczak W, Trneny M, Belada D, Wrobel T, Ghosh N, Keating MM, van Meerten T, Alvarez RF, von Keudell G, Thieblemont C, Peyrade F, Andre M, Hoffmann M, Szafer-Glusman E, Lin J, Dean JP, Neuenburg JK, Tam CS. Ibrutinib plus venetoclax in relapsed or refractory mantle cell lymphoma (SYMPATICO): a multicentre, randomised, double-blind, placebo-controlled, phase 3 study. Lancet Oncol. 2025 Feb;26(2):200-213. doi: 10.1016/S1470-2045(24)00682-X.

Reference Type DERIVED
PMID: 39914418 (View on PubMed)

Wang M, Ramchandren R, Chen R, Karlin L, Chong G, Jurczak W, Wu KL, Bishton M, Collins GP, Eliadis P, Peyrade F, Lee Y, Eckert K, Neuenburg JK, Tam CS. Concurrent ibrutinib plus venetoclax in relapsed/refractory mantle cell lymphoma: the safety run-in of the phase 3 SYMPATICO study. J Hematol Oncol. 2021 Oct 30;14(1):179. doi: 10.1186/s13045-021-01188-x.

Reference Type DERIVED
PMID: 34717692 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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2017-000129-12

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

PCYC-1143-CA

Identifier Type: -

Identifier Source: org_study_id

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