E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
lymphoma (nodes of the neck, chest, armpit or groin) cancer |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | HLT |
E.1.2 | Classification code | 10026798 |
E.1.2 | Term | Mantle cell lymphomas |
E.1.2 | System Organ Class | 100000004851 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To determine the activity of ACP-196 in subjects with relapsed or refractory MCL as measured primarily by response rate. In addition, activity of ACP-169 will be assessed by duration of response, progression-free survival, and overall survival. |
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E.2.2 | Secondary objectives of the trial |
• To characterize the safety profile of ACP-196
• To characterize the pharmacokinetic (PK) profile of ACP-196
• To evaluate the PD effects of ACP-196 |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Men and women ≥ 18 years of age.
2. Pathologically confirmed MCL, with documentation of monoclonal B cells that have a chromosome translocation t(11;14)(q13;q32) and/or overexpress cyclin D1.
3. Disease has relapsed after or been refractory to ≥ 1 prior therapy for MCL and now requires further treatment.
4. Documented failure to achieve at least PR with, or documented disease progression after, the most recent treatment regimen.
5. Presence of radiographically measurable lymphadenopathy or extranodal lymphoid malignancy (defined as the presence of ≥ 1 lesion that measures ≥ 2.0 cm in the longest dimension and ≥ 1.0 cm in the longest perpendicular dimension as assessed by computed tomography [CT] scan).
6. At least 1, but no more than 5, prior treatment regimens for MCL (Note: Subjects having received ≥ 2 cycles of prior treatment with bortezomib, either as a single agent or as part of a combination therapy regimen, will be considered to be bortezomib-exposed.)
7. Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2.
8. Women who are sexually active and can bear children must agree to use highly effective forms of contraception during the study and for 90 days after the last dose of the study drug.
9. Men who are sexually active and can beget children must agree to use highly effective forms of contraception, and to refrain from sperm donation during the study and for 90 days after the last dose of the study drug.
10. Willing and able to participate in all required evaluations and procedures in this study protocol including swallowing capsules without difficulty.
11. Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information (in accordance with national and local subject privacy regulations). |
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E.4 | Principal exclusion criteria |
1. Prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer from which the subject has been disease free for ≥ 2 years or which will not limit survival to < 2 years. Note: these cases must be discussed with the Medical Monitor.
2. A life-threatening illness, medical condition or organ system dysfunction which, in the investigator’s opinion, could compromise the subject’s safety, interfere with the absorption or metabolism of ACP-196, or put the study outcomes at undue risk.
3. Significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of screening, or any Class 3 or 4 cardiac disease as defined by the New York Heart Association Functional Classification, or corrected QT interval (QTc) > 480 msec.
4. Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel, gastric bypass, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction.
5. Any immunotherapy within 4 weeks of first dose of study drug.
6. The time from the last dose of the most recent chemotherapy or experimental therapy to the first dose of study drug is < 5 times the half-life of the previously administered agent(s).
7. Prior exposure to a BCR inhibitor (eg, Btk, phosphoinositide-3 kinase (PI3K), or Syk inhibitors) or BCL-2 inhibitor (eg, ABT-199).
8. Ongoing immunosuppressive therapy, including systemic or enteric corticosteroids for treatment of MCL or other conditions. Note: Subjects may use topical or inhaled corticosteroids or low-dose steroids (≤ 10 mg of prednisone or equivalent per day) as therapy for comorbid conditions. During study participation, subjects may also receive systemic or enteric corticosteroids as needed for treatment-emergent comorbid conditions.
9. Grade ≥ 2 toxicity (other than alopecia) continuing from prior anticancer therapy including radiation.
10. Known history of human immunodeficiency virus (HIV) or active infection with hepatitis C virus (HCV) or hepatitis B virus (HBV) or any uncontrolled active systemic infection.
11. Major surgery within 4 weeks before first dose of study drug.
12. Uncontrolled autoimmune hemolytic anemia or idiopathic thrombocytopenia purpura.
13. Known history of a bleeding diathesis (eg, hemophilia, von Willebrand disease)
14. History of stroke or intracranial hemorrhage within 6 months before the first dose of study drug.
15. Requires or receiving anticoagulation with warfarin or equivalent vitamin K antagonist (eg, phenprocoumon) within 7 days of first dose of study drug.
16. Requires treatment with proton pump inhibitors (eg, omeprazole, esomeprazole, lansoprazole, exlansoprazole, rabeprazole, or pantoprazole).
17. ANC < 0.75 x 109/L or platelet count < 50 x 109/L; for subjects with disease involvement in the bone marrow, ANC < 0.50 x 109/L or platelet count < 30 x 109/L.
18. Creatinine > 2.5 x institutional upper limit of normal (ULN); total bilirubin > 2.5 x ULN ; and aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 3.0 x ULN.
19. Breastfeeding or pregnant.
20. Concurrent participation in another therapeutic clinical trial.
21. Known central nervous system (CNS) lymphoma or leptomeningeal disease.
22. Requires treatment with a strong CYP3A4 inhibitor/inducer.
23. Presence of a gastrointestinal ulcer diagnosed by endoscopy within 3 months prior to screening. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint of the study is the overall response rate (ORR) defined as a subject achieving either a partial response (PR) or complete response (CR) according to the Lugano Classification for non-Hodgkin lymphoma as assessed by investigators. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
@ 30 days after stopping study treatment |
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E.5.2 | Secondary end point(s) |
Efficacy:
• duration of response (DOR)
• progression-free survival (PFS)
• overall survival (OS)
Safety:
• frequency, severity, and relatedness of adverse events
• frequency of adverse events requiring discontinuation of study drug or dose reductions
• effect of ACP-196 on peripheral T/B/NK cell counts
• effect of ACP-196 on serum immunoglobulin levels
Pharmacokinetics:
• plasma pharmacokinetics of ACP-196
Patient Reported Outcomes (PRO):
• health-related quality of life
Pharmacokinetics:
• plasma pharmacokinetics of ACP-196
Patient Reported Outcomes (PRO):
• health-related quality of life |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
@ 30 days after stopping study treatment |
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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 | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
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 | 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 | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 20 |
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 |
Australia |
Belgium |
Czech Republic |
France |
Israel |
Italy |
Netherlands |
Poland |
Spain |
United Kingdom |
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
|
LVLS (at the end of the follow up visit after last dose) |
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |