Clinical Trial Results:
A Phase Ib/II study of OBINUTUZUMAB combined with LENALIDOMIDE for the treatment of relapsed/refractory follicular and Aggressive (DLBCL and MCL) B-cell Lymphoma.
Summary
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EudraCT number |
2011-005150-62 |
Trial protocol |
FR BE |
Global end of trial date |
20 May 2022
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Results information
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Results version number |
v1(current) |
This version publication date |
28 Oct 2023
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First version publication date |
28 Oct 2023
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
GALEN
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT01582776 | ||
WHO universal trial number (UTN) |
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Sponsors
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Sponsor organisation name |
LYSARC
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Sponsor organisation address |
Centre Hospitalier Lyon-Sud Bâtiment 2D, PIERRE-BÉNITE Cedex, France, 69495
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Public contact |
Project management, LYSARC, galen@lysarc.org
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Scientific contact |
Pr. Franck MORSCHHAUSER, LYSARC, Franck.MORSCHHAUSER@chu-lille.fr
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
13 Jan 2023
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
20 May 2022
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
Phase IB: to determine the recommended dose (RD) of lenalinomide (Revlimid) when administered in association with obinutuzumab by escalation approach (3+3 dosing).
Phase II: to assess the efficacy of the association of the recommended dose of lenalidomide in combination with obinutuzumab, as measured by the overall response rate (ORR) at the end of 6 cycles (end of induction) in 3 different populations of patients with lymphoma disease: relapsed/refractory follicular lymphoma , relapsed/refractory aggressive lymphoma [aNHL] (Diffuse large B-cell and
Mantle cell lymphoma) and untreated follicular lymphoma
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Protection of trial subjects |
No rescue treatment in this study
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Background therapy |
- | ||
Evidence for comparator |
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Actual start date of recruitment |
04 Jun 2012
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Belgium: 47
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Country: Number of subjects enrolled |
France: 265
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Worldwide total number of subjects |
312
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EEA total number of subjects |
312
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
151
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From 65 to 84 years |
159
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85 years and over |
2
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Recruitment
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Recruitment details |
Subjects were recruited between october 2012 and January 2018 | ||||||||||||||||||||||||
Pre-assignment
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Screening details |
Phase Ib : 21 patients were screened and 20 were included Phase II : 310 patients were screened and 297 were included | ||||||||||||||||||||||||
Period 1
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Period 1 title |
Treatment (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||||||||
Allocation method |
Not applicable
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Blinding used |
Not blinded | ||||||||||||||||||||||||
Arms
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Arm title
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Experimental | ||||||||||||||||||||||||
Arm description |
Patients who received combination of lenalidomide plus obinutuzumab. | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
Lenalidomide
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Capsule
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Routes of administration |
Oral use
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Dosage and administration details |
Lenalidomide treatment in Phase I part:
Cycle 1 D1 to D21 depending on dose level: 10 mg, 15mg, 20mg or 25mg
For cycles 2 to 6, lenalidomide will be given on day 2 to day 22
Treatment in Phase II part:
Induction: Oral lenalidomide will be given once daily at 20 mg on days 1-21 of a 28-day cycle for the first cycle and on days 2-22 of a 28-day cycle for cycles 2 to 6. Maintenance: If after cycle 6, the patient has achieved at least a PR, he will be eligible for maintenance treatment. First year of maintenance (12 cycles of 28 days), 10mg on days 2-22 of a 28-day cycle during a maximum of 12 cycles as tolerated, or until
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Investigational medicinal product name |
Obinutuzumab
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for injection
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Routes of administration |
Injection
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Dosage and administration details |
Treatment in Phase I part:
D8, D15, D22 (cycle 1) and D1 (cycles 2 to 6) : 1000mg
Treatment in Phase II part:
1000mg on D8, D15, and D22 of the first cycle and at D1 of cycles 2 to 6 days (total of 8 infusions)
During the first year of maintenance (12 cycles of 28 days), patient will received obinutuzumab (6
infusions of 1000mg every 2 cycles: C7, C9, C11, C13, C15 and C17) as tolerated, or until disease progression.
During the second year of maintenance (6 cycles of 56 days), patient will received obinutuzumab (6
infusions of 1000mg every 56 days).
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Baseline characteristics reporting groups
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Reporting group title |
Experimental
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Reporting group description |
Patients who received combination of lenalidomide plus obinutuzumab. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Subject analysis sets
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Subject analysis set title |
Cohort 1 : Relapsed/refractory aggressive patients
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Subject analysis set type |
Sub-group analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
Cohort 1 : Relapsed/refractory aggressive patients
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Subject analysis set title |
Cohort 2 : Relapsed/refractory follicular patients
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Subject analysis set type |
Sub-group analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
Cohort 2 : Relapsed/refractory follicular patients
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Subject analysis set title |
Cohort 3 : Untreated follicular lymphoma
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Subject analysis set type |
Sub-group analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
Cohort 3 : Untreated follicular lymphoma
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Subject analysis set title |
DLT set
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Subject analysis set type |
Sub-group analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
Phase Ib
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Subject analysis set title |
Cohorte 4
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Subject analysis set type |
Sub-group analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
Untreated follicular lymphoma
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End points reporting groups
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Reporting group title |
Experimental
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Reporting group description |
Patients who received combination of lenalidomide plus obinutuzumab. | ||
Subject analysis set title |
Cohort 1 : Relapsed/refractory aggressive patients
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Subject analysis set type |
Sub-group analysis | ||
Subject analysis set description |
Cohort 1 : Relapsed/refractory aggressive patients
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Subject analysis set title |
Cohort 2 : Relapsed/refractory follicular patients
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Subject analysis set type |
Sub-group analysis | ||
Subject analysis set description |
Cohort 2 : Relapsed/refractory follicular patients
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Subject analysis set title |
Cohort 3 : Untreated follicular lymphoma
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Subject analysis set type |
Sub-group analysis | ||
Subject analysis set description |
Cohort 3 : Untreated follicular lymphoma
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Subject analysis set title |
DLT set
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Subject analysis set type |
Sub-group analysis | ||
Subject analysis set description |
Phase Ib
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Subject analysis set title |
Cohorte 4
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Subject analysis set type |
Sub-group analysis | ||
Subject analysis set description |
Untreated follicular lymphoma
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End point title |
DLT - recommended dose [1] | ||||||||||||||
End point description |
Therefore, primary analysis will be based on safety parameters and particularly on incidence of DLTs as defined in section 8.3. Frequency of patients with DLT only during the first cycle of GALEN study
will be reported by dose level. Safety data (adverse events, laboratory data, vital signs and ECOG performance status) will be summarized overall and at each cycle.
Definition of DLTs :
- DLT 1 : 10 mg
- DLT 2 : 15 mg
- DLT 3 : 20 mg
- DLT 4 : 25 mg
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End point type |
Primary
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End point timeframe |
First six cycles of treatment
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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: GALEN is a phase-II study. There was no statistical tests because no comparison have been made with an another group. |
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Notes [2] - 10 patients with at least one DLT after cycle 1 |
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No statistical analyses for this end point |
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End point title |
Response rate [3] | ||||||||||||||||||||
End point description |
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End point type |
Primary
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End point timeframe |
At the end of induction (after 6 cycles)
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Notes [3] - 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: GALEN is a phase-II study. There was no statistical tests because no comparison have been made with an another group. |
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
from the date of informed consent signature to end of treatment evaluation (28 days after last drug administration)
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
25
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Reporting groups
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Reporting group title |
Adverse event
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Reporting group description |
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Frequency threshold for reporting non-serious adverse events: 0% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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30 Oct 2012 |
1. Addition of an exclusion criterion :
Patients with a history of PML cannot be included in the study.
The exclusion criterion "Prior history of Progressive Multifocal Leukoencephalopathy (PML)
is added.
- 2 Addition of a neurological examination during clinical examinations
A neurological examination must be performed at every clinical examination, during the
treatment and follow-up phases, in order to detect any neurological signs suggestive of
neurological signs suggestive of potential PML.
- 3 Indications on what to do if PML is suspected: symptoms,
diagnosis, treatment with anti-CD20 drugs
In the event of symptoms suggestive of PML, investigations should be carried out:
consultation with a neurologist, brain MRI, testing for JC virus in cerebrospinal fluid, etc.
cerebro-spinal fluid...
Treatment with Rituximab or Obinutuzumab should be suspended during these investigations,
and stopped permanently if the diagnosis of PML is confirmed. |
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19 Apr 2013 |
- For biological studies, the theoretical sampling time "C1J8 1h after end of infusion" has been changed to "C1J8 just after end of infusion".
- Exclusion criterion 8 has been modified to include patients with a history of non-melanoma skin tumours (basal cell carcinoma or squamous cell carcinoma of the skin) or surgically removed carcinoma of any grade 0 (in situ) in phase I, which does not include maintenance treatment with lenalidomide.
- Following recommendations made by the study's DSMC at the organizational meeting, an electrocardiogram was added to the list of tests to be performed during patient screening.
- Certain clarifications have been made concerning the rules for reporting adverse events |
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18 Mar 2014 |
- The recommended lenalidomide dose of 20 mg for phase II has been added.
- The doses of GA101 and lenalidomide for the two years of maintenance have been reformulated.
- Corrections have been made to the abstract to reflect the content of the protocol (inclusion criteria, DLT definitions and prophylaxis).
- AE and SAE deferrals have been added or clarified for each period. The NCI CTCAE version has been specified (version 4.03).
- Following Roche's recommendations in a February DIL, prophylaxis treatments have been adapted. The dose of paracetamol is now 1000mg, and that of antihistamines such as diphenhydramine hydrochloride 100mg. Recommendations have been added for patients with pre-existing heart and lung disease. BSA calculation and B symptom collection were added to the baseline. It was specified that biological analyses could be performed.
- During treatment, times for physical and neurological examinations and vital signs were clarified. Weight and BSA were collected only for assessments. CBC was maintained weekly for the 1st cycle, on the 1st day of each cycle for the induction period and at each visit for treatments during maintenance. All other CBCs were eliminated. Optional biological tests were added.
- For assessments, appointment "windows" have been specified: for cycle 3 between I C3J21 and C3J28; for cycle 6 between C6J22 and C6J28. Assessments every 6 months during the maintenance period and in the event of premature discharge.- For assessments, only weight (without BSA) will be requested. PET scans are mandatory at the end of cycles 3 and 6 and at the end of treatment, but optional during maintenance.
- During the maintenance period, it has been added that the PET scan is optional, bone marrow biopsy is compulsory every 6 months in the event of positive results at the previous assessment, response assessment must be carried out every 6 months as well as baseline assessments.- For biological studies, the theoretical sampling time "C1J8 |
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15 Oct 2014 |
o study duration shortened due to earlier inclusion than initially estimated
o contraception of women for 18 months after GA101 treatment
o withdrawal of the planned 20-patient efficacy/safety analysis, since a DSMC is planned every 6 months.
o updated GA101 data. |
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19 Jan 2015 |
The purpose of this amendment is to present GALEN's ancillary study: GALEN-IM.GALEN-IM is an exploratory, open-label, multicenter immunoPET ancillary study involving 30 GALEN patients with histologically confirmed CD20-positive follicular lymphoma.After signing specific information and consent documents, these patients will receive 0.6 MBq/kg (36-54 MBq) of 89Zr-obinutuzumab, in addition to the 1000 mg dose of obinutuzumab planned in the GALEN study, on Cycle 1 J8 and/or Cycle 2 J1.This administration will enable us to determine the tissue concentration of obinutuzumab in the tumor and in the main organs of interest, and to generate a PK model of obinutuzumab. Secondly, it will enable us to define patient radiation exposure, compare obinutuzumab concentration-time profiles in tumor and normal organs, correlate tissue and plasma PK with tumor burden, and evaluate the 89Zr-obinutuzumab uptake model. |
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08 Jun 2015 |
Addition of a cohort of 100 previously untreated follicular lymphoma patients.
Addition of biological studies adapted to this new cohort of 100 patients with previously untreated follicular lymphoma.
Addition of biological studies to search for correlations between transcriptomic profile (GCvs ABC) and response to treatment for patients with relapsed or refractory diffuse large relapsed or refractory diffuse large B-cell lymphoma (DLBCL) already included in the phase 2 aggressive lymphoma cohort.
Update of the Pregnancy Prevention Plan linked to lenalidomide treatment. |
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22 Nov 2016 |
We would therefore like to complete the enrolment of cohort 3 without offering the GALEN-IM study to patients, to enable analysis of the 100 patients as planned in the protocol, and to add a cohort of 15 patients with 1st-line Follicular Lymphoma solely for the GALEN-IM study (cohort 4). These 15 patients will receive exactly the same treatment as the GALEN patients, with one or two additional doses of 89Zr-obinutuzumab. The data collected will meet the objectives of the GALEN-IM study alone, and will not be included in the analysis of the GALEN study. |
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28 Aug 2017 |
The changes mainly concern the ancillary immunoPET exploratory study.
It was initially planned that each patient would receive 0.6 MBq/kg (36-54 MBq) of 89Zr-obinutuzumab, in addition to the GALEN dose.
the 1000 mg dose of obinutuzumab planned in the GALEN study, on Cycle 1 D8 and/or Cycle
Cycle 2 D1. The first 6 patients finally received a fixed dose of 37 MBq on Cycle 1 D8 and Cycle
Cycle 2 J1; subsequent patients will receive the same dose.
Analysis of the results obtained from the first six patients shows that immunoPET scans
scans performed on Cycle 1 Day 8 appear to be more informative than those performed on Cycle 2 Day 1. The experts therefore
decided, for the remaining 9 patients, to carry out a single injection of 89Zr-obinutuzumab at Cycle
Cycle 1 Day 8. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported | |||
Online references |
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http://www.ncbi.nlm.nih.gov/pubmed/30291335 http://www.ncbi.nlm.nih.gov/pubmed/30068505 http://www.ncbi.nlm.nih.gov/pubmed/31296423 http://www.ncbi.nlm.nih.gov/pubmed/34936697 |