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    Clinical Trial Results:
    A MULTI-CENTER, PHASE IB/II, OPEN LABEL, SINGLE ARM STUDY OF INOTUZUMAB OZOGAMICIN PLUS RITUXIMAB (R-CMC544) ALTERNATING WITH GEMCITABINE-OXALIPLATIN PLUS RITUXIMAB (R-GEMOX) IN PATIENTS AGED FROM 18 TO 80 YEARS WITH CD20 AND CD22 POSITIVE DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) IN RELAPSE AFTER/REFRACTORY TO 1ST OR 2ND LINE TREATMENT, WHO ARE NO CANDIDATES FOR AUTOLOGOUS TRANSPLANT

    Summary
    EudraCT number
    2011-003849-18
    Trial protocol
    BE  
    Global end of trial date
    22 Mar 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Apr 2017
    First version publication date
    13 Apr 2017
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CMC-R-GEMOX
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01562990
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    LYSARC
    Sponsor organisation address
    Secteur Sainte Eugénie - pavillon 6D, Pierre Bénite, France, 69495
    Public contact
    Elise Hutasse, LYSARC, +33 472669333, elise.hutasse@lysarc.org
    Scientific contact
    Elise Hutasse, LYSARC, +33 472669333, elise.hutasse@lysarc.org
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    22 Mar 2016
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    22 Mar 2016
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The primary objective of the phase Ib part of the study is to determine the tolerability, safety and MTD or recommended dose of R-CMC544 alternating with RGEMOX in subjects aged from 18 to 80 years with CD20 and CD22 positive DLBCL in relapse after/refractory to 1st or 2nd line treatment, who are no candidates for autologous transplant. The primary objective of the phase II part of the study is to assess the efficacy or RCMC544 alternating with R-GEMOX as measured by the overall response rate (ORR) by IWG criteria (Cheson 1999) at the end of treatment (after complete treatment or at withdrawal).
    Protection of trial subjects
    Patients have been followed for safety (adverse event) during all study duration. If a patient does not respond to study treatment, relapses or has progressive disease, each site was free to initiate further treatment according to local guidelines
    Background therapy
    R-GEMOX is one of standard therapies for patients with relapsed/refractory diffuse large B-cell lymphoma.
    Evidence for comparator
    NA
    Actual start date of recruitment
    03 Dec 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    France: 11
    Worldwide total number of subjects
    11
    EEA total number of subjects
    11
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    3
    From 65 to 84 years
    8
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    1st patient included in France in December, 2012. Elevent patients included in France, no patient included in Belgium. Last patient included in phase I in February, 2014. Phase II cancelled due to poor overall response rate and long duration of phase I which led to investigators demotivation.

    Pre-assignment
    Screening details
    No patient screen failed in eCRF. - Histologically documented CD20 and CD22 positive diffuse large B-cell lymphoma, according to WHO classification. - In 1st or 2nd relapse or refractory to 1st and/or 2nd line treatment. - Measurable disease by bidimensional transverse CT scan assessment - Not eligible for autologous transplantation

    Period 1
    Period 1 title
    Induction
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    experimental
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    inotuzumab-ozogamicin
    Investigational medicinal product code
    CMC544
    Other name
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    CMC544 was given by IV route over 1 hour ± 10 minutes at the fixed dose rate of 50 mL/hour. Dose administered was 1.8mg/m²

    Number of subjects in period 1
    experimental
    Started
    11
    Completed
    5
    Not completed
    6
         Physician decision
    1
         disease progression
    4
         toxicity of study treatment
    1
    Period 2
    Period 2 title
    Consolidation
    Is this the baseline period?
    No
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Experimental
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    inotuzumab-ozogamicin
    Investigational medicinal product code
    CMC544
    Other name
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    CMC544 was given by IV route over 1 hour ± 10 minutes at the fixed dose rate of 50 mL/hour. Dose administered was 1.8mg/m²

    Number of subjects in period 2
    Experimental
    Started
    5
    Completed
    1
    Not completed
    4
         disease progression
    1
         toxicity of study treatment
    3

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Induction
    Reporting group description
    -

    Reporting group values
    Induction Total
    Number of subjects
    11 11
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        arithmetic mean (inter-quartile range (Q1-Q3))
    71.2 (64 to 78) -
    Gender categorical
    Units: Subjects
        Female
    6 6
        Male
    5 5

    End points

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    End points reporting groups
    Reporting group title
    experimental
    Reporting group description
    -
    Reporting group title
    Experimental
    Reporting group description
    -

    Subject analysis set title
    Evaluable set
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The evaluable population includes all enrolled patients who received at least one dose of any investigational drugs. Primary endpoint of the phase II will be analyzed on this population. Secondary efficacy and safety endpoints (for both phase Ib and II) will be performed on this population.

    Subject analysis set title
    DLT evaluable set
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    The DLT evaluable population includes all patients from “Evaluable population” with a DLT assessment. It is considered that a patient have a DLT assessment if he/she performed completely the first two cycles unless a DLT occurred before the end of the cycle 2, in which case he/she remains evaluable for DLT. Primary endpoint of the phase Ib will be analyzed on this population

    Primary: Number of patients with DLT

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    End point title
    Number of patients with DLT [1]
    End point description
    Recommended dose will be identified according to the incidence of DLTs during the first 2 cycles of treatment (induction). DLT is defined as follows (NCI CTCAE vs. 4): - Grade 4 neutropenia ≥ 7 days - Grade 4 thrombocytopenia ≥ 7 days - Grade 3 or 4 thrombocytopenia associated with bleeding requiring a transfusion - Grade 3 non-hematologic toxicity (except alopecia) ≥ 7 days or determined to be investigational product-related - Grade 4 non-hematologic toxicity (except alopecia) - Grade 4 AST/ALT increase irrespective of duration - Grade 2 hyperbilirubinemia (> 1.5 x ULN) > 7 days - Grade 3 or greater QTc prolongation (average of three ECGs) - Delayed recovery from an investigational product-related toxicity that prevents redosing by more than 21 days
    End point type
    Primary
    End point timeframe
    Two first induction cycles
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No statistical analysis is performed for the primary endpoint of the phase Ib part of the study as the Recommended Dose is determined by the number of patients with at least one DLT in each cohort level.
    End point values
    DLT evaluable set
    Number of subjects analysed
    6
    Units: patients
        1.8 mg/m²
    3
    No statistical analyses for this end point

    Secondary: ORR according to Cheson 99 at the end of treatment

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    End point title
    ORR according to Cheson 99 at the end of treatment
    End point description
    ORR as defined by Cheson 99 criteria: ORR = CR/CRu/PR
    End point type
    Secondary
    End point timeframe
    At the end of treatment defined as after complete treatment or at permanent treatment discontinuation
    End point values
    Evaluable set
    Number of subjects analysed
    11
    Units: percent
    number (confidence interval 95%)
        1.8 mg/m²
    18.2 (2.3 to 51.8)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse Events (AE) occurring from the signing of the Informed Consent and until 30 days after the end of the last cycle of treatment have been recorded on the AE pages of the CRF.
    Adverse event reporting additional description
    Only grade 3 and 4 toxicities (NCIC Common Toxicity Criteria grading system – version 4.03) or grade 2 for infections, and toxicities (grade 1 to 4) related to a Serious Adverse Event as described below, have been be reported as “Adverse Event” in the appropriate CRF pages. All “Alopecia” toxicity have not been recorded as “Adverse Event”.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    4.03
    Reporting groups
    Reporting group title
    All patients
    Reporting group description
    -

    Serious adverse events
    All patients
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 11 (36.36%)
         number of deaths (all causes)
    5
         number of deaths resulting from adverse events
    0
    General disorders and administration site conditions
    DISEASE PROGRESSION
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    Gastrointestinal disorders
    LARGE INTESTINE PERFORATION
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    DRUG-INDUCED LIVER INJURY
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    RENAL FAILURE ACUTE
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    PERITONITIS
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    LACTIC ACIDOSIS
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    All patients
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    11 / 11 (100.00%)
    Investigations
    LYMPHOCYTE COUNT DECREASED
         subjects affected / exposed
    3 / 11 (27.27%)
         occurrences all number
    5
    GAMMA-GLUTAMYLTRANSFERASE INCREASED
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    BLOOD ALKALINE PHOSPHATASE INCREASED
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    NEUTROPHIL COUNT DECREASED
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    PLATELET COUNT DECREASED
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    2
    WHITE BLOOD CELL COUNT DECREASED
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    THROMBOCYTOPENIA
         subjects affected / exposed
    6 / 11 (54.55%)
         occurrences all number
    16
    LYMPHOPENIA
         subjects affected / exposed
    4 / 11 (36.36%)
         occurrences all number
    6
    NEUTROPENIA
         subjects affected / exposed
    3 / 11 (27.27%)
         occurrences all number
    4
    ANAEMIA
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    LEUKOPENIA
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    General disorders and administration site conditions
    DISEASE PROGRESSION
         subjects affected / exposed
    2 / 11 (18.18%)
         occurrences all number
    2
    Gastrointestinal disorders
    LARGE INTESTINE PERFORATION
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Hepatobiliary disorders
    DRUG-INDUCED LIVER INJURY
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Renal and urinary disorders
    RENAL FAILURE ACUTE
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Infections and infestations
    PERITONITIS
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    LACTIC ACIDOSIS
         subjects affected / exposed
    1 / 11 (9.09%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    22 Jun 2012
    • A change in the name only of the Sponsor name from Groupe d’Etude des Lymphomes de l’Adulte Recherche Clinique (GELARC) to LYSARC on 1 June 2012. • The definition of DLTs was modified slightly to specify that all grade 4 non-hematologic toxicities will be considered as DLT whatever duration or relationship to study treatment. •The sentence explaining that a copy signed consent forms would be recovered by the sponsor in a sealed envelope was deleted
    25 Jul 2014
    • Prolongation of study duration from 4 years to 5.5 years. • Addition of details on the main study objective phase-by-phase • Precision of secondary and exploratory objectives • Correction of the inconsistencies identified between the body of the text on the dose de-escalation rules and the summary table: summary table was corrected to properly describe the de-escalation process, as described in the text. • Clarification of statistical endpoints of phase I and phase II

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    24 Mar 2015
    As written in the protocol and following the de-escalation rules, the recommended phase 2 study dose was found and confirmed by an IDMC. However, the long duration of the phase I slowed down the investigators motivation. In addition, the overall response rate was poor. Given these data, the sponsor decided not to proceed the phase 2 part of CMC-R-GEMOX study.
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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