A Prospective, Multicenter, Phase-II Trial of Ibrutinib Plus Venetoclax in Patients With Creatinine Clearance >= 30 ml/Min Who Have Relapsed or Refractory Chronic Lymphocytic Leukemia (RR-CLL) With or Without TP53 Aberrations

NCT ID: NCT03226301

Last Updated: 2022-08-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE2

Total Enrollment

230 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-06-23

Study Completion Date

2026-06-21

Brief Summary

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The aim of the current trial is to evaluate if combination treatment with venetoclax + ibrutinib in patients with relapsed or refractory chronic lymphocytic leukemia (RR CLL) can lead to MRD negativity, which may induce long lasting remissions for MRD-negative patients randomized to stopping treatment after 15 induction cycles.

Detailed Description

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Conditions

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Chronic Lymphocytic Leukemia in Relapse Chronic Lymphocytic Leukemia in Remission

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

All patients receive ibrutinib + venetoclax (with delayed start and ramp up of venetoclax from cycle 3) for the 15 cycles. Patients not achieving MRD negativity after cycle 12 (PB) AND/OR cycle 15 (PB+BM) continue on ibrutinib maintenance (non-randomized group). Patients achieving MRD negativity after cycle 12 (PB) AND cycle 15 (PB+BM) are randomized 1:2 between ibrutinib maintenance (arm A) and stopping treatment (observation, arm B).
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Ibrutinib until progression/relapse

All patients receive ibrutinib + venetoclax (with delayed start and ramp up of venetoclax from cycle 3) for the 15 cycles.

MRDpositive patients (PB and BM) will continue on Ibrutinib maintenance (non-randomized group) until progression/relapse

Group Type EXPERIMENTAL

Ibrutinib + Venetoclax 15 cycles

Intervention Type DRUG

Cycle 1 + 2: 420 mg ibrutinib, day 1-28 \| Cycle 3: 420 mg ibrutinib, day 1-28 \| 20 mg venetoclax, day 1-7 \| 50 mg venetoclax, day 8-14 \| 100 mg venetoclax, day 15-21 \| 200 mg venetoclax, day 22-28 \| Cycle 4-15: 420 mg ibrutinib, day 1-28 + 400mg venetoclax, day 1-28

Ibrutinib until progression/relapse

Intervention Type DRUG

420mg ibrutinib daily until progression/relapse

Arm A

All patients receive ibrutinib + venetoclax (with delayed start and ramp up of venetoclax from cycle 3) for the 15 cycles.

MRD negative patients (PB and BM) will be randomized to Arm A or Arm B. Arm A: Ibrutinib until progression/relapse (Continuous ibrutinib treatment until toxicity or progression)

Group Type EXPERIMENTAL

Ibrutinib + Venetoclax 15 cycles

Intervention Type DRUG

Cycle 1 + 2: 420 mg ibrutinib, day 1-28 \| Cycle 3: 420 mg ibrutinib, day 1-28 \| 20 mg venetoclax, day 1-7 \| 50 mg venetoclax, day 8-14 \| 100 mg venetoclax, day 15-21 \| 200 mg venetoclax, day 22-28 \| Cycle 4-15: 420 mg ibrutinib, day 1-28 + 400mg venetoclax, day 1-28

Ibrutinib until progression/relapse

Intervention Type DRUG

420mg ibrutinib daily until progression/relapse

Arm B

All patients receive ibrutinib + venetoclax (with delayed start and ramp up of venetoclax from cycle 3) for the 15 cycles.

MRD negative patients (PB and BM) will be randomized to Arm A or Arm B. Arm B: Observation until event.

Patients randomized to Arm B will get reinitiation of therapy during the observation period in case of:

* progression according to IWCLL criteria or
* MRD≥10-3 (PB) and at least one month later MRD ≥10-2 (PB).

Treatment reinitiation will consist of ibrutinib and venetoclax (with ramp up of venetoclax from cycle 1) for 12 cycles

Group Type EXPERIMENTAL

Ibrutinib + Venetoclax 15 cycles

Intervention Type DRUG

Cycle 1 + 2: 420 mg ibrutinib, day 1-28 \| Cycle 3: 420 mg ibrutinib, day 1-28 \| 20 mg venetoclax, day 1-7 \| 50 mg venetoclax, day 8-14 \| 100 mg venetoclax, day 15-21 \| 200 mg venetoclax, day 22-28 \| Cycle 4-15: 420 mg ibrutinib, day 1-28 + 400mg venetoclax, day 1-28

Possible reinitiation treatment: Ibrutinib + Venetoclax 12 cycles

Intervention Type DRUG

Cycle 1: 420 mg ibrutinib \| 20 mg venetoclax, day 1-7 \| 50 mg venetoclax, day 8-14 \| 100 mg venetoclax, day 15-21 \| 200 mg venetoclax, day 22-28 \| cycles 2-12: 420 mg ibrutinib, day 1-28 + 400 mg venetoclax, day 1-28

Interventions

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Ibrutinib + Venetoclax 15 cycles

Cycle 1 + 2: 420 mg ibrutinib, day 1-28 \| Cycle 3: 420 mg ibrutinib, day 1-28 \| 20 mg venetoclax, day 1-7 \| 50 mg venetoclax, day 8-14 \| 100 mg venetoclax, day 15-21 \| 200 mg venetoclax, day 22-28 \| Cycle 4-15: 420 mg ibrutinib, day 1-28 + 400mg venetoclax, day 1-28

Intervention Type DRUG

Ibrutinib until progression/relapse

420mg ibrutinib daily until progression/relapse

Intervention Type DRUG

Possible reinitiation treatment: Ibrutinib + Venetoclax 12 cycles

Cycle 1: 420 mg ibrutinib \| 20 mg venetoclax, day 1-7 \| 50 mg venetoclax, day 8-14 \| 100 mg venetoclax, day 15-21 \| 200 mg venetoclax, day 22-28 \| cycles 2-12: 420 mg ibrutinib, day 1-28 + 400 mg venetoclax, day 1-28

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Documented CLL or SLL requiring treatment according to IWCLL criteria after either being refractory to first line therapy or relapse after initial therapy.

* Age at least 18 years.
* Adequate bone marrow function defined as:

* Absolute neutrophil count (ANC) \>0.75 x 109/L
* Platelet count \>30,000 /μL 30 x 109/L.
* Hemoglobin \>8.0 g/dL (5 mmol/L) Unless directly attributable to CLL infiltration of the bone marrow, proven by bone marrow biopsy
* Creatinine clearance (CrCL) ≥ 30ml/min calculated according to the modified formula of Cockcroft and Gault or directly measured with 24hr urine collection.
* Adequate liver function as indicated

* Serum aspartate transaminase (AST) or alanine transaminase (ALT) ≤ 3.0 x upper limit of normal (ULN)
* Bilirubin ≤1.5 x ULN (unless bilirubin rise is due to Gilbert's syndrome or of nonhepatic origin)
* Prothrombin time (PT)/International normal ratio (INR) \<1.5 x ULN and PTT (activated partial thromboplastin time \[aPTT\]) \<1.5 x ULN (unless abnormalities are related to coagulopathy or bleeding disorder).
* Negative serological testing for hepatitis B (HBsAg negative and anti-HBc negative; patients positive for anti-HBc may be included if PCR for HBV DNA is negative and HBV-DNA PCR is performed every month until 12 months after last dose), negative testing for hepatitis C RNA within 42 days prior to registration.
* WHO/ECOG performance status 0-3 (appendix C), stage 3 only if attributable to CLL.
* Negative pregnancy test at study entry (for women of childbearing potential).
* Male and female subjects of reproductive potential must agree to use both a highly effective method of birth control (e.g. implants, injectables, combined oral contraceptives, some intrauterine devices \[IUDs\], complete abstinence , or sterilized partner) and a barrier method (e.g., condoms, cervical ring, sponge, etc.) during the period of therapy and for 90 days after the last dose of study drug.
* Ability and willingness to provide written informed consent and to adhere to the study visit schedule and other protocol requirements.
* Written informed consent.

Exclusion Criteria

* Any prior therapy with ibrutinib and/or venetoclax.
* Transformation of CLL (Richter's transformation).
* Patients with a history of confirmed progressive multifocal leukoencephalopathy (PML).
* Malignancies other than CLL currently requiring systemic therapies or not being treated in curative intention before or showing signs of progression after curative treatment.
* Known allergy to xanthine oxidase inhibitors and/or rasburicase.
* Known bleeding disorders (e.g., von Willebrand's disease or hemophilia).
* Uncontrolled or active infection.
* Patients requiring treatment with a strong cytochrome P450 (CYP) 3A inhibitor (see appendix K). or anticoagulant therapy with warfarin or phenoprocoumon or other vitamin K antagonists. Please note: Patients being treated with NOACs can be included, but must be properly informed about the potential risk of bleeding under treatment with ibrutinib.
* History of stroke or intracranial hemorrhage within 6 months prior to registration.
* Major surgery within 28 days prior to registration.
* Use of investigational agents which might interfere with the study drug within 28 days prior to registration.
* Vaccination with live vaccines within 28 days prior to registration
* Steroid therapy within 7 days prior to registration, with the exception of inhaled steroids for asthma, topical steroids, steroids up to 25 mg of prednisolone daily to control autoimmune phenomenon's, or replacement/stress corticosteroids.
* Pregnant women and nursing mothers.
* Any psychological, familial, sociological and geographical condition potentially hampering compliance with the study protocol and follow-up schedule.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Nordic CLL Study Group

UNKNOWN

Sponsor Role collaborator

Stichting Hemato-Oncologie voor Volwassenen Nederland

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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BE-Antwerpen-ZNASTUIVENBERG

Antwerp, , Belgium

Site Status

BE-Brugge-AZBRUGGE

Bruges, , Belgium

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BE-Bruxelles-STLUC

Brussels, , Belgium

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BE-Haine-Saint-Paul-JOLIMONT

Haine-Saint-Paul, , Belgium

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BE-Leuven-UZLEUVEN

Leuven, , Belgium

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DK-Aalborg-AALBORGUH

Aalborg, , Denmark

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DK-Copenhagen-RIGSHOSPITALET

Copenhagen, , Denmark

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DK-Herlev-HERLEV

Herlev, , Denmark

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DK-Holstebro-HOLSTEBRO

Holstebro, , Denmark

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DK-Odense-OUH

Odense, , Denmark

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DK-Roskilde-ROSKILDE

Roskilde, , Denmark

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FI-Helsinki-HUS

Helsinki, , Finland

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FI-Jyvaskyla-KSSHP

Jyväskylä, , Finland

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FI-Kuopio-KYS

Kuopio, , Finland

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FI-Tampere-TAYS

Tampere, , Finland

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FI-Turku-TYKS

Turku, , Finland

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NL-Alkmaar-NWZ

Alkmaar, , Netherlands

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NL-Amersfoort-MEANDERMC

Amersfoort, , Netherlands

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NL-Amsterdam-AMC

Amsterdam, , Netherlands

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NL-Amsterdam-AVL

Amsterdam, , Netherlands

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NL-Amsterdam-VUMC

Amsterdam, , Netherlands

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NL-Arnhem-RIJNSTATE

Arnhem, , Netherlands

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NL-Breda-AMPHIA

Breda, , Netherlands

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NL-Delft-RDGG

Delft, , Netherlands

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NL-Dordrecht-ASZ

Dordrecht, , Netherlands

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NL-Enschede-MST

Enschede, , Netherlands

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NL-Gouda-GROENEHART

Gouda, , Netherlands

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NL-Groningen-UMCG

Groningen, , Netherlands

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NL-Heerlen-ATRIUMMC

Heerlen, , Netherlands

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NL-Helmond-ELKERLIEK

Helmond, , Netherlands

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NL-Nieuwegein-ANTONIUS

Nieuwegein, , Netherlands

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NL-Nijmegen-CWZ

Nijmegen, , Netherlands

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NL-Rotterdam-ERASMUSMC

Rotterdam, , Netherlands

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NL-Rotterdam-MAASSTADZIEKENHUIS

Rotterdam, , Netherlands

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NL-Sittard-Geleen-ZUYDERLAND

Sittard, , Netherlands

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NL-Sneek-ANTONIUSSNEEK

Sneek, , Netherlands

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NL-Den Haag-HAGA

The Hague, , Netherlands

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NL-Tilburg-ETZ

Tilburg, , Netherlands

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NL-Uden-BERNHOVEN

Uden, , Netherlands

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NL-Utrecht-UMCUTRECHT

Utrecht, , Netherlands

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NL-Zaandam-ZAANSMC

Zaandam, , Netherlands

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NL-Zwolle-ISALA

Zwolle, , Netherlands

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NO-Lørenskog-AKERSHUS

Lørenskog, , Norway

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NO-Trondheim-STOLAV

Trondheim, , Norway

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SE-Boras-SASBORAS

Borås, , Sweden

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SE-Linköping-REGIONOSTERGOTLAND

Linköping, , Sweden

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SE-Luleå-SUNDERBY

Luleå, , Sweden

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SE-Lund-SUH

Lund, , Sweden

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SE-Uppsala-UPPSALAUH

Uppsala, , Sweden

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Countries

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Belgium Denmark Finland Netherlands Norway Sweden

References

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Niemann CU, Dubois J, Nasserinejad K, da Cunha-Bang C, Kersting S, Enggaard L, Veldhuis GJ, Mous R, Mellink CHM, van der Kevie-Kersemaekers AF, Dobber JA, Poulsen CB, Razawy W, Hollestein R, Frederiksen H, Janssens A, Schjodt I, Dompeling EC, Ranti J, Brieghel C, Mattsson M, Bellido M, Tran HTT, Kater AP, Levin MD. Long-term follow-up of MRD-guided ibrutinib plus venetoclax in relapsed CLL: phase 2 VISION/HO141 trial. Blood Adv. 2025 Aug 12;9(15):3665-3675. doi: 10.1182/bloodadvances.2024015180.

Reference Type DERIVED
PMID: 40249856 (View on PubMed)

Kater AP, Levin MD, Dubois J, Kersting S, Enggaard L, Veldhuis GJ, Mous R, Mellink CHM, van der Kevie-Kersemaekers AF, Dobber JA, Poulsen CB, Frederiksen H, Janssens A, Schjodt I, Dompeling EC, Ranti J, Brieghel C, Mattsson M, Bellido M, Tran HTT, Nasserinejad K, Niemann CU. Minimal residual disease-guided stop and start of venetoclax plus ibrutinib for patients with relapsed or refractory chronic lymphocytic leukaemia (HOVON141/VISION): primary analysis of an open-label, randomised, phase 2 trial. Lancet Oncol. 2022 Jun;23(6):818-828. doi: 10.1016/S1470-2045(22)00220-0.

Reference Type DERIVED
PMID: 35654052 (View on PubMed)

Levin MD, Kater AP, Mattsson M, Kersting S, Ranti J, Thi Tuyet Tran H, Nasserinejad K, Niemann CU. Protocol description of the HOVON 141/VISION trial: a prospective, multicentre, randomised phase II trial of ibrutinib plus venetoclax in patients with creatinine clearance >/=30 mL/min who have relapsed or refractory chronic lymphocytic leukaemia (RR-CLL) with or without TP53 aberrations. BMJ Open. 2020 Oct 15;10(10):e039168. doi: 10.1136/bmjopen-2020-039168.

Reference Type DERIVED
PMID: 33060089 (View on PubMed)

Related Links

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Other Identifiers

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HO141 CLL / VIsion trial

Identifier Type: -

Identifier Source: org_study_id

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