E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Stage II - IV follicular lymphoma grade 1 - 3a and a high tumor burden not previously treated |
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E.1.1.1 | Medical condition in easily understood language |
Follicular Lymphoma in need of treatment |
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E.1.1.2 | Therapeutic area | Diseases [C] - Blood and lymphatic diseases [C15] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10016908 |
E.1.2 | Term | Follicle centre lymphoma, follicular grade I, II, III stage II |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10016910 |
E.1.2 | Term | Follicle centre lymphoma, follicular grade I, II, III stage IV |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10016909 |
E.1.2 | Term | Follicle centre lymphoma, follicular grade I, II, III stage III |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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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 |
The primary objective of this study is to evaluate the efficacy of the chemotherapy-free combination of ibrutinib and obinutuzumab (GA 101) in patients with previously untreated follicular lymphoma (FL) and a high tumor burden. Primary endpoint is the rate of progression free survival one year after registration. Progression-free survival (PFS) is chosen as primary endpoint since it represents besides overall survival the most relevant parameter for patients. PFS is defined as the time from registration to lymphoma progression or death from any cause. |
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E.2.2 | Secondary objectives of the trial |
Overall survival, complete response rate, overall response rate ORR and SD rates at end of induction, one year after start of therapy and after end of maintenance therapy, PFS (continuous observation), duration of response, 3-year-PFS, percentage of progression during induction and during maintenance therapy, percentage of progression during induction and during maintenance therapy, safety, percentage of MRD negative patients during induction therapy (midterm), after induction therapy and after maintenance therapy, duration of molecular remission for MRD negative patients after the end of induction and after end of maintenance, rate of secondary transformation to aggressive lymphoma, time to next anti-lymphoma therapy and time to next chemotherapy based treatment, percentage of secondary malignancies, time to first secondary malignancy, percentage of patients with compliance to therapy after 1, 2 and 3 years and patient-reported lymphoma symptoms and concerns as measured by FACT-Lym.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Histologically confirmed follicular lymphoma grade 1, 2 or 3a with a biopsy performed within 12 months before study entry and with material available for central review and complimentary scientific analyses
2. Ann Arbor Stage III/IV, or stage II not suitable for radiotherapy, or stage II bulky disease (nodal or extra nodal mass >7 cm)
3. Age ≥ 18 years
4. No prior lymphoma therapy
5. Need for start of therapy as defined by:
- bulky disease at study entry according to the GELF criteria (nodal or extra nodal mass >7 cm in its greater diameter)
- and/or B symptoms (fever, drenching night sweats, or unintentional weight loss of >10% of normal body weight over a period of 6 months or less)
- and/or hematopoietic insufficiency (granulocytopenia < 1.500/µl, Hb < 10 g/dl, thrombocytopenia < 100.000/µl)
- and/or compressive syndrome
- and/or pleural/peritoneal effusion caused by lymphoma
- and/or symptomatic extra nodal manifestations.
6. At least one bi-dimensionally measurable lesion (> 2 cm in its largest dimension by CT scan or MRI)
7. Performance status ≤2 on the ECOG scale
8. Adequate hematologic function (unless abnormalities are related to NHL), defined as
follows:
- hemoglobin ≥ 9.0 g/dl
- absolute neutrophil count ≥ 1500 /µL
- platelet count ≥ 75000 /µl.
9. Women are not breast feeding, are using highly effective contraception, are not pregnant and agree not to become pregnant during participation in the trial and during the 18 months thereafter (pregnancy testing is mandatory for premenopausal women)
10. Men agree not to father a child during participation in the trial and during the 18 months thereafter
11. Written informed consent
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E.4 | Principal exclusion criteria |
1. Transformation to high-grade lymphoma (secondary to “low grade” FL)
2. Grade 3b follicular lymphoma
3. Presence or history of CNS disease (either CNS lymphoma or leptomeningeal lymphoma).
4. Known hypersensitivity to any of the study drugs
5. Known sensitivity to murine products
6. Regular use of corticosteroids during the last 4 weeks, unless administered at a dose equivalent to < 20 mg/day prednisone.
7. Concomitant use of strong CY3A4 inhibitors and / or oral anticoagulants (warfarin and/or phenprocoumon)
8. Prior or concomitant malignancies except:
- non-melanoma skin cancer or adequately treated in carcinoma in situ of the cervix
- other malignant diseases not specified above which have been curatively treated by surgery alone and from which subject is disease-free for ≥5 years without further treatment.
9. Serious disease interfering with a regular therapy according to the study protocol:
- Clinically significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of Screening, or any Class 3 (moderate) or Class 4 (severe) cardiac disease as defined by the New York Heart Association Functional Classification.
- pulmonary (e.g. chronic lung disease with hypoxemia)
- endocrine (e.g. severe, not sufficiently controlled diabetes mellitus)
- renal insufficiency (unless caused by the lymphoma): creatinine > 2x upper normal value and/or creatinine clearance < 50 ml/min)
- impairment of liver function (unless caused by the lymphoma): transaminases > 3x normal or bilirubin > 2.0 mg/dl (unless caused by known Morbus Meulengracht [Gilbert-Meulengracht-Syndrome]).
10. Positive test results for chronic HBV infection (defined as positive HBsAg serology) Patients with occult or prior HBV infection (defined as negative HBsAg and positive total HBcAb) may be included if HBV DNA is undetectable, provided that they are willing to undergo monthly DNA testing. Patients who have protective titers of hepatitis B surface antibody (HBsAb) after vaccination or prior but cured hepatitis B are eligible.
11. Positive test results for hepatitis C (hepatitis C virus [HCV] antibody serology testing). Patients positive for HCV antibody are eligible only if PCR is negative for HCV RNA.
12. Known history of HIV seropositive status
13. Patients with a history of confirmed PML
14. Vaccination with a live vaccine within 28 days prior to registration
15. Recent major surgery (within 4 weeks prior to the start of Cycle 1)
16. History of stroke or intracranial hemorrhage within 6 months prior to registration
17. Serious underlying medical conditions, which could impair the ability of the patient to undergo the treatment offered in the study (e.g. ongoing infection, gastric ulcers, active autoimmune disease)
18. Treatment within a clinical trial within 30 days prior to trial entry
19. Prior organ, bone marrow or peripheral blood stem cell transplantation
20. Known or persistent abuse of medication, drugs or alcohol
21. Any other co-existing medical or psychological condition that will preclude participation in the study or compromise ability to give informed consent. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Progression-free survival (PFS) is chosen as primary endpoint for most phase III trials in FL, since it represents beside overall survival the most clinical relevant parameter for patients. PFS is in this trial defined as the time from registration to lymphoma progression or death from any cause. Since an early readout for efficacy is needed in this phase II trial, the rate of patients achieving a progression free survival of more than one year after registration (one year PFS) will be the primary endpoint of this trial. The use of this non-standard endpoint is well justified by the observation of progression free survival in former trials, showing a nearly linear shape of the Kaplan-Meier-estimates for PFS and a proportional hazard for different treatments.
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
One year after registration |
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E.5.2 | Secondary end point(s) |
- Rate of patients achieving a progression free survival of more than three years
- Progression free survival after start of therapy (continuous observation)
- CR, PR and SD rates after induction therapy, one year after start of therapy and after end of maintenance therapy (at 30 months after start of therapy: CR30)
- Duration of Response
- Percentage of progression during induction and during maintenance therapy
- Time to treatment failure after start of therapy (failure defined by missing CR/PR or progression after CR or PR or death in remission)
- Time to next anti-lymphoma therapy and time to next chemotherapy based treatment
- Safety including treatment associated adverse events
- Percentage of MRD negative patients during induction therapy (midterm), after induction therapy and after maintenance therapy
- Duration of molecular remission for MRD negative patients after the end of induction and after end of maintenance
- Percentage of secondary transformation to aggressive lymphoma
- Percentage of secondary malignancies
- Time to first secondary malignancy
- Overall survival
- Percentage of patients with compliance to therapy after 1, 2 and 3 years
- patient-reported lymphoma symptoms and concerns (FACT-Lym). |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
The time to event parameters survival, progression free survival, time to treatment failure, time to first secondary malignancy and time to next anti-lymphoma therapy/chemotherapy will be evaluated starting at registration in this trial. If an event has not been observed at evaluation, the parameter will be censored at the last documented event-free observation. |
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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 | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
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.8.3 |
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 | 40 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 6 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |