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    Clinical Trial Results:
    A phase II trial of ibrutinib, lenalidomide and rituximab for patients with relapsed/refractory mantle cell lymphoma.

    Summary
    EudraCT number
    2013-005541-36
    Trial protocol
    SE   FI   DK  
    Global end of trial date
    31 Dec 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    29 Oct 2020
    First version publication date
    29 Oct 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    NLG-MCL6
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02460276
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Nordic Lymphoma Group represented by Skåne University Hospital
    Sponsor organisation address
    Gettingevägen, Lund, Sweden,
    Public contact
    Jan Sundberg, Lund University Hospital, +46 4617 70 34, jan.sundberg@skane.se
    Scientific contact
    Jan Sundberg, Lund University Hospital, +46 4617 70 34, jan.sundberg@skane.se
    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
    29 Jan 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    29 Jan 2018
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Dec 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Evaluation of overall response rate, based on PET and CT, with lenalidomide, ibrutinib and rituximab in relapsed/refractory mantle cell lymphoma patients.
    Protection of trial subjects
    The study was conducted according to the guidelines for Good Clinical Practice, issued by The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The protocol was approved by the local, regional or national Ethical Review Boards according to the existing national and local regulatory requirements. The study was conducted in agreement with the declaration of Helsinki, Tokyo, Venice and Hong Kong amendments and the laws and the regulations of the respective countries.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    30 Apr 2015
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Norway: 13
    Country: Number of subjects enrolled
    Sweden: 16
    Country: Number of subjects enrolled
    Denmark: 18
    Country: Number of subjects enrolled
    Finland: 3
    Worldwide total number of subjects
    50
    EEA total number of subjects
    50
    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)
    13
    From 65 to 84 years
    36
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    The trial was activated at a common start meeting held on 13th April 2015 for PIs and study nurses from the 10 participating sites. The first patient was included shortly after, on 30th April 2015. The last patient was included on 1st June 2016. Overall 50 patients were included in the trial over a period of 13 months.

    Pre-assignment
    Screening details
    Patients are screened for the complete list of inclusion and exclusion criteria according to the protocol.

    Period 1
    Period 1 title
    Experimental (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Experimental
    Arm description
    Induction therapy consisted of 12 cycles of 28 days: • Lenalidomide: 15 mg p o daily days 1-21, every 28 days, cycles 1-12 • Ibrutinib: 560 mg daily p o days 1-28, cycles 1-12 • Rituximab 375 mg/m2 iv Day 1 in cycle 1 • Rituximab 1400 mg s c (or 375 mg/m2 iv) days 8, 15 and 22 in cycle 1. Then given day 1 in cycles 3, 5, 7, 9 and 11 Maintenance therapy consisted of 12 cycles of 56 days: • Ibrutinib: 560 mg daily p o days 1-56, cycles 1-12 • Rituximab 1400 mg s c (or 375 mg/m2 iv) day 1, cycles 1-12
    Arm type
    Experimental

    Investigational medicinal product name
    Ibrutinib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    560 mg p o daily

    Investigational medicinal product name
    Lenalidomide
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    15 mg p o daily on days 1-21 of 28 days, 12 cycles

    Investigational medicinal product name
    Rituximab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Induction therapy: 375 mg/m2 iv days 1, 8, 15, 22 in cycle 1; thereafter 375 mg/m2 on day 1 of cycle 3,5,7,9,11 Alternatively, 1400 mg sc on days 8,15,22 in cycle 1 and day 1 of cycles 3,5,7,9,11 Maintenance therapy: 1400 mg sc (or 375 mg/m2 iv) day 1 of each cycle

    Number of subjects in period 1
    Experimental
    Started
    50
    Completed
    11
    Not completed
    39
         Adverse event, serious fatal
    2
         Consent withdrawn by subject
    3
         Physician's Decision
    1
         Adverse event, non-fatal
    8
         Patient's Decision
    1
         Allogeneic Stem Cell Transplantation
    4
         Lack of efficacy
    20

    Baseline characteristics

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

    Reporting group values
    Experimental Total
    Number of subjects
    50 50
    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
        median (full range (min-max))
    69 (45 to 85) -
    Gender categorical
    Units: Subjects
        Female
    14 14
        Male
    36 36
    ECOG Performance Status Score
    Units: Subjects
        0-1
    45 45
        >1
    5 5
    MIPI Score
    Units: Subjects
        Low risk (<5.7)
    8 8
        Intermediate risk (5.7 - 6.1)
    15 15
        High risk (>6.2)
    23 23
        Missing
    4 4
    Ann Arbor Stage
    Units: Subjects
        Stage IV disease
    42 42
        Stage I-III disease
    8 8
    Bone Marrow Involvement
    Units: Subjects
        Yes
    34 34
        No
    16 16
    Refractory Disease
    Units: Subjects
        Yes
    8 8
        No
    42 42
    Previous Therapy
    Units: Subjects
        Autologous Stem Cell Transplantation
    21 21
        Allogeneic Stem Cell Transplantation
    3 3
        Ibrutinib
    4 4
        Lenalidomide
    1 1
        Other
    21 21
    Number of Previous Therapies
    Units: Number
        median (full range (min-max))
    2 (1 to 7) -

    End points

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    End points reporting groups
    Reporting group title
    Experimental
    Reporting group description
    Induction therapy consisted of 12 cycles of 28 days: • Lenalidomide: 15 mg p o daily days 1-21, every 28 days, cycles 1-12 • Ibrutinib: 560 mg daily p o days 1-28, cycles 1-12 • Rituximab 375 mg/m2 iv Day 1 in cycle 1 • Rituximab 1400 mg s c (or 375 mg/m2 iv) days 8, 15 and 22 in cycle 1. Then given day 1 in cycles 3, 5, 7, 9 and 11 Maintenance therapy consisted of 12 cycles of 56 days: • Ibrutinib: 560 mg daily p o days 1-56, cycles 1-12 • Rituximab 1400 mg s c (or 375 mg/m2 iv) day 1, cycles 1-12

    Primary: Overall Response Rate

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    End point title
    Overall Response Rate [1]
    End point description
    End point type
    Primary
    End point timeframe
    Overall response rate at the end of induction therapy
    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: The analysis is described in the publication of the study in Lancet Haematology 2018; 5:e109-116
    End point values
    Experimental
    Number of subjects analysed
    44
    Units: subjects
        CR
    28
        PR
    10
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events was recorded from the time the subject signed the informed consent to 28 days after the last dose of study drug.
    Adverse event reporting additional description
    Non-serious adverse events were evaluated and reported per patient.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4.03
    Reporting groups
    Reporting group title
    All subjects
    Reporting group description
    -

    Serious adverse events
    All subjects
    Total subjects affected by serious adverse events
         subjects affected / exposed
    33 / 50 (66.00%)
         number of deaths (all causes)
    24
         number of deaths resulting from adverse events
    2
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    cutaneous basocellular carcinoma
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    vascular disorders
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    general disorders
         subjects affected / exposed
    6 / 50 (12.00%)
         occurrences causally related to treatment / all
    5 / 6
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    Immune system disorder
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Respiratory disorder
         subjects affected / exposed
    10 / 50 (20.00%)
         occurrences causally related to treatment / all
    15 / 15
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Cardiac disorders
         subjects affected / exposed
    6 / 50 (12.00%)
         occurrences causally related to treatment / all
    6 / 6
         deaths causally related to treatment / all
    1 / 1
    Nervous system disorders
    Nervous system disorder
         subjects affected / exposed
    5 / 50 (10.00%)
         occurrences causally related to treatment / all
    5 / 5
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Gastrointestinal disorder
         subjects affected / exposed
    3 / 50 (6.00%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Endocrine disorders
    Diabetes mellitus
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Musculoskeletal disorder
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Infection
         subjects affected / exposed
    8 / 50 (16.00%)
         occurrences causally related to treatment / all
    9 / 10
         deaths causally related to treatment / all
    1 / 1
    Metabolism and nutrition disorders
    Tumour lysis syndrome
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 1%
    Non-serious adverse events
    All subjects
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    50 / 50 (100.00%)
    Vascular disorders
    Vascular Adverse Events
    Additional description: grade 1-3
         subjects affected / exposed
    20 / 50 (40.00%)
         occurrences all number
    20
    General disorders and administration site conditions
    Fatigue
    Additional description: grade 1-3
         subjects affected / exposed
    28 / 50 (56.00%)
         occurrences all number
    28
    Respiratory, thoracic and mediastinal disorders
    Respiratory Adverse Events
    Additional description: grade 1-3
         subjects affected / exposed
    25 / 50 (50.00%)
         occurrences all number
    25
    Psychiatric disorders
    Psychiatric Adverse Events
    Additional description: grade 1-2
         subjects affected / exposed
    7 / 50 (14.00%)
         occurrences all number
    7
    Cardiac disorders
    Atrial fibrillation
    Additional description: grade 1-3
         subjects affected / exposed
    8 / 50 (16.00%)
         occurrences all number
    8
    Nervous system disorders
    Neurological Adverse Events
    Additional description: grade 1-2
         subjects affected / exposed
    17 / 50 (34.00%)
         occurrences all number
    17
    Blood and lymphatic system disorders
    Thrombocytopenia
    Additional description: grade 1-3
         subjects affected / exposed
    17 / 50 (34.00%)
         occurrences all number
    17
    Anaemia
    Additional description: grade 1-3
         subjects affected / exposed
    10 / 50 (20.00%)
         occurrences all number
    10
    Neutropenia
    Additional description: grade 1-3
         subjects affected / exposed
    33 / 50 (66.00%)
         occurrences all number
    33
    Eye disorders
    Ocular Adverse Events
    Additional description: grade 1-2
         subjects affected / exposed
    13 / 50 (26.00%)
         occurrences all number
    13
    Gastrointestinal disorders
    Gastrointestinal disorders
    Additional description: grade 1-3
         subjects affected / exposed
    48 / 50 (96.00%)
         occurrences all number
    48
    Skin and subcutaneous tissue disorders
    Cutaneous adverse events
    Additional description: grade 1-3
         subjects affected / exposed
    39 / 50 (78.00%)
         occurrences all number
    39
    Renal and urinary disorders
    Renal Adverse Events
    Additional description: grade 1-2
         subjects affected / exposed
    9 / 50 (18.00%)
         occurrences all number
    9
    Musculoskeletal and connective tissue disorders
    Muscle Cramps
    Additional description: grade 1-3
         subjects affected / exposed
    15 / 50 (30.00%)
         occurrences all number
    15
    Infections and infestations
    Infections
    Additional description: grade 1-3
         subjects affected / exposed
    38 / 50 (76.00%)
         occurrences all number
    38

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/29396091
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