| 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 objective tumor response rate (ORR) assessed in all 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 complete response rate and overall survival.
- Safety.
The other objectives of this study are to evaluate:
- Pharmacokinetics.
- Biomarkers.
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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 (except to copanlisib)provided that there is no resistance.
5. Patients must be refractory to the last rituximab-based treatment defined as no response or response lasting < 6 months after completion of Treatment. Time interval to assess refractoriness will be calculated between the end date (last day) of the last rituximab-containing Regimen and the day of diagnosis confirmation of the subsequent relapse.
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) and positive immunofixation test.
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 (WOCBP) and men must agree to use effective contraception when sexually active. This applies for the time period between signing of the ICF and 3 months after the last administration of study treatment. A woman is considered of childbearing potential, i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilization methods include but are not limited to hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for continuous 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy.
o The investigator or a designated associate is requested to advise the patient how to achieve highly effective birth control (failure rate of less than 1%), e.g. intrauterine device (IUD), intrauterine hormone-releasing system (IUS), bilateral tubal occlusion, vasectomized partner and sexual abstinence.
o The use of condoms by male patients is required unless the female partner is permanently sterile.
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 (≤ 5 x ULN for patients with proven Gilbert-Meulengracht syndrome or ≤ 3 x ULN 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 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) ≤ 1.5 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. For patients with confirmed lymphomatous bone marrow infiltration, platelet count ≥ 50,000 /mm3. Platelet transfusion should not be given less than 7 days before the exam collection.
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.
2. Close affiliation with investigational site.
3. Histologically confirmed diagnosis of FL grade 3b.
4. Chronic lymphocytic leukemia.
5. Transformed disease: histological confirmation of transformation, or clinical and laboratory signs: rapid disease progression, high standardized uptake value (>12) by positron emission tomography at baseline if PET scans 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 & T1].
8. Bulky disease -Lymph nodes/tumor mass (except spleen) ≥7cm LDi.
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 despite optimal medical Management (per investigators assessment).
15. Type I/II diabetes mellitus with HbA1c >8.5% 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 treatment.
23. Renal failure requiring hemo- or peritoneal dialysis.
24. Proteinuria ≥CTCAE Grade 3 as assessed by either 24h total urine protein quantification or a urine protein to creatinine ratio (UPCR) >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 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 allowed dose at least 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 treatment; open biopsy within 7 days before start of 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: No response (defined as PR or CR) at any time during therapy, or Progression (PD) after any response (PR/CR) or after stable disease (SD) within 6 mths from start of therapy with a PI3K inhibitor.
46. Prior treatment with copanlisib
47. Positive cytomegalovirus (CMV) PCR test at baseline |
|
| E.5 End points |
| E.5.1 | Primary end point(s) |
| Objective tumor response rate (ORR), defined as the proportion of patients who have a best response rating over the whole duration of the study of complete response (CR) or partial response (PR) according to the Lugano Classification, and for patients with WM, a response rating of CR, very good partial response (VGPR), PR, or minor response (MR) according to the Owen criteria. |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
| A best response rating over the whole duration of the study of complete response (CR) or partial response (PR) according to the Lugano Classification, and for patients with WM, a response rating of CR, very good partial response (VGPR), PR, or minor response (MR) according to the Owen criteria. |
|
| E.5.2 | Secondary end point(s) |
- Duration of response (DOR)
-Complete response rate (CRR)
- Overall survival (OS) |
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
- DOR: the time (in days) from first observed tumor response (CR, VGPR, PR or MR) until PD or death from any cause, whichever is earlier.
- CRR: the proportion of patients who have a best response up to the dates of data cutoffs of complete response (CR), according to the Lugano Classification, and for patients with WM, a response rating of CR according to the Owen criteria.
- OS: time (in days) from assignment to study drug until death from any cause.
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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 |
| Objective tumor response rate and biomarkers |
|
| 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 | Yes |
| E.8.1.3 | Single blind | No |
| E.8.1.4 | Double blind | No |
| 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 | No |
| E.8.2.3 | Other | No |
| E.8.2.4 | Number of treatment arms in the trial | 1 |
| 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.8.5 | 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 |
| Austria |
| Belgium |
| Brazil |
| Bulgaria |
| Chile |
| Colombia |
| France |
| Hong Kong |
| Italy |
| Lithuania |
| Mexico |
| Poland |
| 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
|
| 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. |
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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 | |
| E.8.9.1 | In the Member State concerned months | |
| E.8.9.1 | In the Member State concerned days | |
| 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 |
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