E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Follicular Lymphoma and Small Lymphocytic Lymphoma |
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E.1.1.1 | Medical condition in easily understood language |
Follicular Lymphoma and Small Lymphocytic Lymphoma |
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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 | PT |
E.1.2 | Classification code | 10065856 |
E.1.2 | Term | Non-Hodgkin's lymphoma unspecified histology indolent |
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 |
To optimize the safety and efficacy of chronic administration of idelalisib in subjects with follicular lymphoma (FL) or small lymphocytic lymphoma (SLL) who are randomized to treatment with idelalisib at 150 mg twice daily (BID) or 100 mg BID
To evaluate the overall safety profile of idelalisib
To evaluate the overall response rate (ORR) by Week 24
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E.2.2 | Secondary objectives of the trial |
- To assess the frequency, severity, timing, and drug interruptions for adverse events (AEs) of interest (≥ Grade 3 diarrhea/colitis, pneumonitis, ≥ Grade 3 transaminase elevations, and rash)
- To evaluate progression-free survival (PFS), duration of response (DOR), and overall survival (OS)
- To determine the pharmacokinetics (PK) of idelalisib and its major metabolite (GS-563117)
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male or female ≥ 18 years of age
2. Histologically confirmed diagnosis of B-cell FL or SLL, with histological subtype limited to the following based on criteria established by the WHO 2008 classification of tumors of hematopoietic and lymphoid tissues:
a. FL Grade 1, 2, or 3a
b. SLL with absolute lymphocyte count < 5 x 10^9 /L at the time of diagnosis
3. Previous systemic treatment for FL or SLL
4. Ann-Arbor Stage 2 (non-contiguous), 3, or 4 disease per Lugano Classification
5. Radiographically measurable lymphadenopathy or extranodal lymphoid malignancy (defined as the presence of ≥ 1 lesion that measures ≥ 1.5 cm in the LD and ≥ 1.0 cm in the LPD as assessed by PET CT, CT or MRI)
6. Has adequate performance status (such as ECOG Performance Status of ≤ 2 or Karnofsky Performance Status of ≥ 60)
7. Required baseline central laboratory data (within 4 weeks prior to start of study therapy) as shown in the table in the protocol.
8. For female subjects of childbearing potential, willingness to use a protocol recommended method of contraception during heterosexual intercourse from the signing of informed consent throughout the study treatment period and up to 30 days from the last dose of idelalisib (see Protocol)
9. For male subjects of reproductive potential having intercourse with females of childbearing potential, willing to use a protocol recommended method of contraception during heterosexual intercourse and to refrain from sperm donation throughout the study treatment period and for 90 days following discontinuation of idelalisib (see Protocol)
10. Lactating females must agree to discontinue nursing before study drug administration and at least 30 days following exposure
11. In the judgment of the investigator, participation in the protocol offers an acceptable benefit to risk ratio when considering current disease status, medical condition, and the potential benefits and risks of alternative treatments for the subject’s disease
12. Indicate willingness to comply with scheduled visits, drug administration plan, imaging studies, laboratory tests, other study procedures, and study restrictions
13. Evidence of a signed informed consent indicating that the subject is aware of the neoplastic nature of their disease and has been informed of the procedures to be followed, the experimental nature of the therapy, alternatives, potential benefits, possible side effects, potential risks and discomforts, and other pertinent aspects of study participation |
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E.4 | Principal exclusion criteria |
1. Known history of lymphoid malignancy other than FL or SLL
2. Known history of, or clinically apparent, central nervous system (CNS) lymphoma or leptomeningeal lymphoma
3. Known presence of intermediate- or high-grade myelodysplastic syndrome
4. Known history of serious allergic reaction including anaphylaxis or toxic epidermal necrolysis
5. History of a non-lymphoid malignancy except for the following: adequately treated local basal cell or squamous cell carcinoma of the skin, cervical carcinoma in situ, superficial bladder cancer, asymptomatic prostate cancer without known metastatic disease and with no requirement for therapy or requiring only hormonal therapy and with normal prostate specific antigen for ≥ 1 year prior to enrollment, or any other cancer that has been in complete remission for ≥ 5 years
6. Evidence of ongoing systemic bacterial, fungal, or viral infection at the time of enrollment
7. Known history of drug-induced liver injury, chronic active hepatitis B (HBV), chronic active hepatitis C (HCV), alcoholic liver disease, non-alcoholic steatohepatitis, cirrhosis of the liver, portal hypertension, primary biliary cirrhosis, or ongoing extrahepatic obstruction caused by cholelithiasis
8. Ongoing drug-induced pneumonitis
9. Ongoing inflammatory bowel disease
10. Known human immunodeficiency virus (HIV) infection
11. Presence of any condition that could, in the opinion of the investigator, compromise the subject’s ability to participate in the study, such as history of substance abuse, alcoholism, or a psychiatric condition
12. History of prior allogeneic bone marrow progenitor cell or solid organ transplantation
13. Ongoing immunosuppressive therapy, including systemic corticosteroids (> 10 mg prednisone or equivalent/day) with the exception of the use of topical, enteric, or inhaled corticosteroids as therapy for comorbid conditions and systemic steroids for autoimmune anemia and/or thrombocytopenia
13. Concurrent participation in another therapeutic clinical trial
14. Prior or ongoing clinically significant illness, medical condition, surgical history, physical finding, electrocardiogram (ECG) finding, or laboratory abnormality that, in the investigator’s opinion, could adversely affect the safety of the subject or impair the assessment of study results
15. Prior treatment with idelalisib or other PI3K delta inhibitors, ibrutinib or other BTK inhibitors, mTOR inhibitors, or Syk inhibitors |
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E.5 End points |
E.5.1 | Primary end point(s) |
• Overall safety profile of idelalisib, including the incidence of AEs and clinically significant laboratory abnormalities, severity, timing, and relationship to idelalisib of any AEs; SAEs; or adverse events leading to interruption of idelalisib
• Overall response rate (ORR) by Week 24 defined as the proportion of subjects who achieve a partial response (PR) or complete response (CR) by Week 24
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Laboratory/clinic visits will occur every 2 weeks through Week 16, every 4 weeks through Week 24, every 8 weeks through Week 48, and then every 12 weeks through end of study. Subjects will be assessed for safety at each visit.
Subjects will be assessed for FL or SLL disease status by continuous utilization of a single modality including PET-CT, CT, or MRI at baseline and at Weeks 8, 16, 24, and every 24 weeks thereafter until disease progression. |
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E.5.2 | Secondary end point(s) |
• Time to onset of AEs of interest (Grade ≥ 3 diarrhea/colitis, pneumonitis, ≥ Grade 3 transaminase elevations, and rash) defined as the interval from the start of idelalisib treatment to the first documentation of start of AE of interest
• Rate of AE of interest defined as the number of subjects with AE of interest
• Rate of drug interruptions for the number of subjects with AE of interest
• Progression free survival (PFS) defined as the interval from randomization to the earlier of the first documentation of disease progression by IRC or death from any cause
• Duration of response (DOR) defined as the interval from the first documentation of complete response (CR) or partial response (PR) to the earlier of the first documentation of disease progression by IRC or death from any cause
• Overall survival (OS) defined as the interval from randomization to death from any cause
• Idelalisib trough (pre-dose) and peak (1.5-hour samples) plasma concentrations assessed by validated bioanalytical method
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Laboratory/clinic visits will occur every 2 weeks through Week 16, every 4 weeks through Week 24, every 8 weeks through Week 48, and then every 12 weeks through end of study. Subjects will be assessed for safety at each visit.
Subjects will be assessed for FL or SLL disease status by continuous utilization of a single modality including PET-CT, CT, or MRI at baseline and at Weeks 8, 16, 24, and every 24 weeks thereafter until disease progression. |
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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 | No |
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 | Yes |
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) | 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 | Yes |
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) | Yes |
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 | 9 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 45 |
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 |
Canada |
Czech Republic |
France |
Israel |
Italy |
Poland |
Romania |
Serbia |
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
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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 | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |