E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients with rituximab-refractory indolent non-Hodgkin's lymphoma
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E.1.1.1 | Medical condition in easily understood language |
Patients with rituximab-refractory indolent non-Hodgkin's lymphoma |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To investigate whether copanlisib as monotherapy is superior to placebo in prolonging progression-free survival (PFS) in patients with rituximab-refractory iNHL who have received two or more prior lines of treatment, have been exposed to rituximab and alkylating agent(s), and have progressed within six months of the end of the last previous rituximab-containing regimen. |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives of this study are to evaluate:
- Efficacy including tumor response, time to progression and overall survival.
- The following characteristics of disease-related symptoms: time to deterioration and time to improvement.
- Safety.
The other objectives of this study are to evaluate:
- PFS2 in placebo-treated patients who switched to open-label copanlisib treatment.
- Pharmacokinetics.
- Biomarkers.
- Quality of life.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Ability to understand and willingness to sign written informed consent. Signed informed consent must be obtained before any study specific procedure.
2. Histologically confirmed diagnosis of indolent B-cell NHL, with histological subtype limited to the following:
o Follicular lymphoma (FL) grade 1-2-3a.
o Small lymphocytic lymphoma (SLL) with absolute lymphocyte count < 5 x 109/L at the time of diagnosis and at study entry.
o Lymphoplasmacytoid lymphoma/Waldenström macroglobulinemia (LPL/WM).
o Marginal zone lymphoma (MZL) (splenic, nodal, or extra-nodal).
3. Patients must have received two or more prior lines of treatment. A previous regimen is defined as one of the following: at least two months of single-agent therapy, at least two consecutive cycles of
polychemotherapy, autologous transplant, radioimmunotherapy.
4. Prior therapy must include rituximab and alkylating agent(s). Prior exposure to idelalisib or other PI3K inhibitors is acceptable provided that there is no resistance.
5. Patients must be refractory to the last rituximab-based treatment (no response or response lasting < 6 months).
6. Patients must have at least one bi-dimensionally measurable lesion (which has not been previously irradiated) according to the Recommendations for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The Lugano Classification.
7. Patients affected by WM, who do not have at least one bi-dimensionally measurable lesion in the baseline radiologic assessment, must have measurable disease, defined as presence of immunoglobulin M (IgM) paraprotein with a minimum IgM level ≥ 2 x
upper limit of normal (ULN).
8. Male or female patients ≥ 18 years of age.
9. ECOG performance status ≤ 1.
10. Life expectancy of at least 3 months.
11. Availability of fresh (preferred) and/or archival tumor tissue at Screening.
12. Women of childbearing potential and men must agree to use adequate contraception when sexually active. This applies since signing of the ICF until at least 3 months after the last study drug administration. The investigator or a designated associate is requested to advise the patient how to achieve an adequate birth control. Adequate contraception is defined in the study as any medically recommend method (or combination of methods) as per standard of care.
13. Adequate bone marrow, liver and renal function as assessed by the following laboratory requirements conducted within 7 days before start of study treatment:
o Total bilirubin ≤ 1.5 x ULN (≤ 3 x ULN for patients with Gilbert-Meulengracht syndrome or for patients with cholestasis due to compressive adenopathies of the hepatic hilum).
o Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
≤ 2.5 x ULN (≤ 5 x ULN for patients with liver involvement of their lymphoma).
o Amylase and lipase ≤ 1.5 x the ULN.
o Glomerular filtration rate (GFR) ≥ 30 ml/min/1.73 m2 according to the Modification of Diet in Renal Disease (MDRD) abbreviated formula.
o International normalized ratio (INR) and partial thromboplastin time (PTT) ≤ 1.5 x ULN.
Patients who are therapeutically treated with an agent such as warfarin or heparin will be allowed to participate provided that no prior evidence of underlying abnormality in coagulation parameters exists. Close monitoring is recommended according to the local standard of care.
o Platelet count ≥ 75,000/mm3.
o Hemoglobin (Hb) ≥ 10 g/dL.
o Absolute neutrophil count (ANC) ≥ 1500/mm3.
14. Left ventricular ejection fraction (LVEF) ≥ the lower limit of normal (LLN) for the Institution. |
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E.4 | Principal exclusion criteria |
1. Previous assignment to treatment during this study.
2. Close affiliation with investigational site.
3. Histologically confirmed diagnosis of FL grade 3b.
4. Chronic lymphocytic leukemia.
5. Transformed disease:
o histological confirmation of transformation, or
o clinical and laboratory signs: rapid disease progression, high standardized uptake value (>12) by positron emission tomography at baseline if PET scans are performed.
6. Previous/concurrent cancer that is distinct in primary site/histology from indolent B-cell NHL within 5 yrs before start of study treatment except for curatively treated cervical cancer in situ, non-melanoma skin cancer and superficial bladder tumors [Ta, Tis and T1].
8. Bulky disease
o Lymph nodes/tumor mass (except spleen) ≥7cm LDi (longest diameter).
11. Known lymphomatous involvement of the central nervous system.
12. Congestive heart failure > NYHA class 2.
13. Unstable angina (angina symptoms at rest), new-onset angina (begun within the last 3 mths). Myocardial infarction less than 6 mths before start of study treatment.
14. Uncontrolled arterial hypertension (systolic blood pressure >150mmHg or diastolic blood pressure >90mmHg despite optimal medical management).
15. Type I/II diabetes mellitus with HbA1c >8.5% or fasting plasma glucose >160mg/dL at Screening.
16. Arterial or venous thrombotic or embolic events such as cerebrovascular accident, deep vein thrombosis or pulmonary embolism within 6 mths before start of study treatment.
17. Non-healing wound, ulcer, or bone fracture.
18. Active clinically serious infections > CTCAE Grade 2.
19. Known history of HIV infection.
20. Hepatitis B or C. All patients must be screened for HBV and HCV up to 28 days before start of study treatment using the routine hepatitis virus laboratory panel. Patients positive for HBsAg or HBcAb will be eligible if negative for HBV-DNA. Patients positive for HCV IgG will be eligible if negative for HCV-RNA.
21. Patients with seizure disorder requiring medication.
22. Patients with evidence or history of bleeding diathesis. Any hemorrhage or bleeding event ≥ CTCAE Grade 3 within 4 wks before start of study treatment.
23. Renal failure requiring hemo- or peritoneal dialysis.
24. Proteinuria as measured by urine protein/creatinine ratio >3.5 on a random urine sample.
25. History/concurrent condition of interstitial lung disease of any severity and/or severely impaired lung function.
26. Concurrent diagnosis of phaeochromocytoma.
27. Pregnant/breast-feeding patients. Women of childbearing potential must have a serum pregnancy test performed a max. of 7 days before start of study treatment, and a negative result must be documented before start of study treatment.
28. Unresolved toxicity > CTCAE Grade 1 attributed to any prior therapy/procedure excluding alopecia and ≤ CTCAE Grade 2 peripheral neuropathy.
29. Known hypersensitivity to any of the study drugs, study drug classes, or excipients in the formulation.
30. Substance abuse, medical, psychological or social conditions that may interfere with the patient’s participation in the study or evaluation of the study results.
31. Any illness/medical conditions that are unstable or could jeopardize the safety of the patient and his/her compliance in the study.
33. Treatment with investigational drugs within 28 days before start of study treatment.
34. Ongoing immunosuppressive therapy.
35. Radiotherapy or immuno/chemotherapy within 4 wks before start of study treatment.
36. Radioimmunotherapy/autologous transplant within 3 mths before start of study treatment.
37. Myeloid growth factors within 14 days before start of study treatment.
38. Blood/platelet transfusion within 14 days before start of study treatment.
39. Ongoing systemic corticosteroid therapy at a daily dose higher than 15mg prednisone or equivalent. Previous corticosteroid therapy must be stopped or reduced to the allowed dose 7 days before performing the screening CT/MRI and again prior to the first study drug administration. If a patient is on chronic corticosteroid therapy, corticosteroids should be de-escalated to the maximum allowed dose before the Screening.
40. History of having received an allogeneic bone marrow/organ transplant.
41. Major surgical procedure/significant traumatic injury within 28 days before start of study treatment; open biopsy within 7 days before start of study treatment.
42. Anti-arrhythmic therapy.
43. Use of strong inhibitors of CYP3A4 is prohibited from Day -14 of Cycle 1 until SFU visit.
44. Use of strong inducers of CYP3A4 is prohibited from Day -14 of Cycle 1 until SFU visit.
45. Documented evidence of resistance to a prior treatment with idelalisib or other PI3K inhibitors defined as:
o No response (defined as PR or CR) at any time during therapy, or
o Progression (PD) after any response (PR/CR) or after stable disease (SD) within 6 mths from the end of the therapy with a PI3K inhibitor. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Progression free survival (PFS), defined as the time (in days) from randomization to disease progression or death from any cause (if no progression is documented). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The time (in days) from randomization to disease progression or death
from any cause (if no progression is documented). The actual date of tumor assessments will be used for this calculation. PFS for patients without PD or death at the time of analysis will be censored at the date of their last tumor evaluation. PFS for patients who have neither tumor assessments nor death after baseline will be
censored at Day 1. |
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E.5.2 | Secondary end point(s) |
- Objective tumor response rate (ORR) assessed in all patients up to the time of analysis of PFS.
- Duration of response (DOR)
-Complete response rate (CRR), assessed in all patients up to the time of
analysis of PFS.
- Time to progression (TTP)
- Overall survival (OS)
- Time to deterioration in disease-related symptoms – physical (DRS-P) of at least 3 points.
-Time to improvement in DRS-P of at least 3 points |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
- ORR: proportion of patients who have a best response rating over the duration of the study
- DOR: the time (in days) from first observed tumor response (CR, VGPR, PR or MR) until PD or death from any cause.
- CRR: assessed in all patients up to the time of analysis of PFS.
- TTP: the time (in days) from randomization to PD or death related to PD.
- OS: time (in days) from randomization until death from any cause.
-Time to deterioration in DRS-P of at least 3 points: measured by the FLymSI-18 questionnaire.
-Time to improvement in DRS-P of at least 3 point: measured by the FLymSI-18 questionnaire, will be evaluated for patients with a baseline DRS-P score of 30 points or less.
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Progression free survival, biomarkers and Quality of Life. |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 23 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Argentina |
Austria |
Belgium |
Brazil |
Bulgaria |
Chile |
Colombia |
France |
Hong Kong |
Italy |
Lithuania |
Mexico |
Poland |
Portugal |
Russian Federation |
South Africa |
Taiwan |
Turkey |
Ukraine |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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For each participating EU country, the end of the study according to the EU Clinical Trial Directive will be reached when the last visit of the last patient for all centers in the respective country has occurred.
However, as the primary endpoint of this study is event-based, the end of the study as a whole will only be reached when this endpoint has been achieved in patients in all participating centers (EU and non-EU).
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 9 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 9 |
E.8.9.2 | In all countries concerned by the trial days | 0 |