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    Clinical Trial Results:
    A Prospective, Open-Label, Multicenter, Phase 2 Trial to Evaluate the Safety and Efficacy of the Combination of Tirabrutinib (GS-4059) and Idelalisib With and Without Obinutuzumab in Subjects with Chronic Lymphocytic Leukemia

    Summary
    EudraCT number
    2015-003909-42
    Trial protocol
    DE  
    Global end of trial date
    14 Jan 2021

    Results information
    Results version number
    v1(current)
    This version publication date
    11 Jan 2022
    First version publication date
    11 Jan 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    GS-US-401-1958
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02968563
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Gilead Sciences
    Sponsor organisation address
    333 Lakeside Drive, Foster City, CA, United States, 94404
    Public contact
    Gilead Clinical Study Information Center, Gilead Sciences, GileadClinicalTrials@gilead.com
    Scientific contact
    Gilead Clinical Study Information Center, Gilead Sciences, GileadClinicalTrials@gilead.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    14 Jan 2021
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    17 Jun 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    14 Jan 2021
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of this study was to determine the preliminary efficacy of the combination of tirabrutinib and idelalisib with obinutuzumab in adults with relapsed or refractory chronic lymphocytic leukemia (CLL). The study had a 6 participant per arm safety run-in to evaluate safety prior to the enrollment of subsequent participants. The treatment period was adaptive, with a duration of active treatment up to two years and a total follow-up on study for up to 30 days post end of treatment, or up to Week 25 should a participant discontinue treatment prior to Week 25 for reasons other than disease progression.
    Protection of trial subjects
    The protocol and consent/assent forms were submitted by each investigator to a duly constituted Independent Ethics Committee (IEC) or Institutional Review Board (IRB) for review and approval before study initiation. All revisions to the consent/assent forms (if applicable) after initial IEC/IRB approval were submitted by the investigator to the IEC/IRB for review and approval before implementation in accordance with regulatory requirements. This study was conducted in accordance with recognized international scientific and ethical standards, including but not limited to the International Conference on Harmonization guideline for Good Clinical Practice (ICH GCP) and the original principles embodied in the Declaration of Helsinki.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    13 Dec 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 35
    Worldwide total number of subjects
    35
    EEA total number of subjects
    35
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    15
    From 65 to 84 years
    20
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Participants were enrolled at study sites in Germany. The first participant was screened on 13 December 2016. The last study visit occurred on 14 January 2021.

    Pre-assignment
    Screening details
    35 participants were screened. Randomization was discontinued after implementation of Protocol Amendment 3; all additional participants were enrolled to Arm: Tirabrutinib + Idelalisib + Obinutuzumab.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Tirabrutinib + Idelalisib
    Arm description
    Tirabrutinib 80 mg (4 x 20 mg tablets/2 x 40 mg tablets/1 x 80 mg tablet) orally once daily + idelalisib 100 mg (1 x 100 mg tablet) orally once daily for up to 104 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    Idelalisib
    Investigational medicinal product code
    Other name
    Zydelig®, GS-1101, CAL-101
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    100 mg administered once daily

    Investigational medicinal product name
    Tirabrutinib
    Investigational medicinal product code
    Other name
    GS-4059
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    80 mg administered once daily

    Arm title
    Tirabrutinib + Idelalisib + Obinutuzumab
    Arm description
    Tirabrutinib 80 mg (4 x 20 mg tablets/ 2 x 40 mg tablets/ 1 x 80 mg tablet) orally once daily + idelalisib 100 mg (1 x 100 mg tablet) orally once daily for up to 104 weeks + obinutuzumab 100 mg on Day 1, 900 mg on Day 1 or 2, and 1000 mg subsequently for up to 8 doses on Day 1 of Weeks 2, 3, 5, and then every 4 weeks through Week 21.
    Arm type
    Experimental

    Investigational medicinal product name
    Tirabrutinib
    Investigational medicinal product code
    Other name
    GS-4059
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    80 mg administered once daily

    Investigational medicinal product name
    Obinutuzumab
    Investigational medicinal product code
    Other name
    Gazyvaro®
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    100 mg on day 1, 900 mg on day 1 or 2, and 1000 mg administered intravenously

    Investigational medicinal product name
    Idelalisib
    Investigational medicinal product code
    Other name
    Zydelig®, GS-1101, CAL-101
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    100 mg administered once daily

    Number of subjects in period 1
    Tirabrutinib + Idelalisib Tirabrutinib + Idelalisib + Obinutuzumab
    Started
    5
    30
    Completed
    4
    22
    Not completed
    1
    8
         Death
    1
    1
         Adverse event
    -
    6
         Lost to follow-up
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Tirabrutinib + Idelalisib
    Reporting group description
    Tirabrutinib 80 mg (4 x 20 mg tablets/2 x 40 mg tablets/1 x 80 mg tablet) orally once daily + idelalisib 100 mg (1 x 100 mg tablet) orally once daily for up to 104 weeks.

    Reporting group title
    Tirabrutinib + Idelalisib + Obinutuzumab
    Reporting group description
    Tirabrutinib 80 mg (4 x 20 mg tablets/ 2 x 40 mg tablets/ 1 x 80 mg tablet) orally once daily + idelalisib 100 mg (1 x 100 mg tablet) orally once daily for up to 104 weeks + obinutuzumab 100 mg on Day 1, 900 mg on Day 1 or 2, and 1000 mg subsequently for up to 8 doses on Day 1 of Weeks 2, 3, 5, and then every 4 weeks through Week 21.

    Reporting group values
    Tirabrutinib + Idelalisib Tirabrutinib + Idelalisib + Obinutuzumab Total
    Number of subjects
    5 30 35
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    62 ± 4.7 65 ± 9.4 -
    Gender categorical
    Units: Subjects
        Female
    3 10 13
        Male
    2 20 22
    Race
    Not Permitted = local regulators did not allow collection of race information.
    Units: Subjects
        White
    5 29 34
        Not Permitted
    0 1 1
    Ethnicity
    Not Permitted = local regulators did not allow collection of ethnicity information.
    Units: Subjects
        Not Hispanic or Latino
    5 29 34
        Not Permitted
    0 1 1

    End points

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    End points reporting groups
    Reporting group title
    Tirabrutinib + Idelalisib
    Reporting group description
    Tirabrutinib 80 mg (4 x 20 mg tablets/2 x 40 mg tablets/1 x 80 mg tablet) orally once daily + idelalisib 100 mg (1 x 100 mg tablet) orally once daily for up to 104 weeks.

    Reporting group title
    Tirabrutinib + Idelalisib + Obinutuzumab
    Reporting group description
    Tirabrutinib 80 mg (4 x 20 mg tablets/ 2 x 40 mg tablets/ 1 x 80 mg tablet) orally once daily + idelalisib 100 mg (1 x 100 mg tablet) orally once daily for up to 104 weeks + obinutuzumab 100 mg on Day 1, 900 mg on Day 1 or 2, and 1000 mg subsequently for up to 8 doses on Day 1 of Weeks 2, 3, 5, and then every 4 weeks through Week 21.

    Primary: Rate of Complete Response/Complete Remission (CR), as Assessed by Investigator Using Modified International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 2008 Criteria at Week 25

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    End point title
    Rate of Complete Response/Complete Remission (CR), as Assessed by Investigator Using Modified International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 2008 Criteria at Week 25 [1]
    End point description
    Rate of CR per modified IWCLL 2008 criteria at Week 25 was defined as the percentage of participants who achieved CR/complete remission with incomplete recovery of the bone marrow (CRi) at Week 25. CR: meeting following criteria and no disease related symptoms: no lymphadenopathy > 1.5 cm/hepatomegaly/splenomegaly; lymphocytes < 4000/μL; bone marrow sample must be normocellular with 30% lymphocytes and no B-lymphoid nodules; platelets > 100,000/µL; hemoglobin > 11 g/dL; and neutrophils > 1500/µL. CRi: CR criteria (no lymphadenopathy > 1.5 cm/hepatomegaly/splenomegaly; lymphocytes < 4000/μL; bone marrow [hypocellular] with 30% lymphocytes and no B-lymphoid nodules), persistent anemia/thrombocytopenia/neutropenia unrelated to CLL but related to drug toxicity. Analysis Population Description: The Full Analysis Set included all randomized or enrolled participants who received at least 1 dose of any study drug.
    End point type
    Primary
    End point timeframe
    Week 25
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No statistical comparison was planned or performed.
    End point values
    Tirabrutinib + Idelalisib Tirabrutinib + Idelalisib + Obinutuzumab
    Number of subjects analysed
    5
    30
    Units: percentage of participants
        number (confidence interval 90%)
    0 (0 to 45.1)
    6.7 (1.2 to 19.5)
    No statistical analyses for this end point

    Secondary: Rate of CR With Bone Marrow Minimal Residual Disease (CR/BM MRD) Negativity, as Assessed by the Investigator Using the Modified IWCLL 2008 Criteria at Week 25

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    End point title
    Rate of CR With Bone Marrow Minimal Residual Disease (CR/BM MRD) Negativity, as Assessed by the Investigator Using the Modified IWCLL 2008 Criteria at Week 25
    End point description
    Rate of CR/BM MRD at Week 25: percentage of participants who achieved CR/CRi per modified IWCLL 2008 criteria and achieved BM MRD negativity at Week 25. CR:meeting following criteria and no disease related symptoms:no lymphadenopathy >1.5 cm/hepatomegaly/splenomegaly;lymphocytes <4000/μL;bone marrow sample must be normocellular with 30% lymphocytes and no B-lymphoid nodules;platelets >100,000/µL;hemoglobin >11 g/dL;and neutrophils >1500/µL. CRi:CR criteria (no lymphadenopathy >1.5 cm/hepatomegaly/splenomegaly;lymphocytes <4000/μL;bone marrow [hypocellular] with 30% lymphocytes and no B-lymphoid nodules),persistent anemia/thrombocytopenia/neutropenia unrelated to CLL but related to drug toxicity. MRD response was assessed with four-color-flow cytometry (FACS) and MRD negativity was defined as one CLL cell per 10,000 leukocytes [0.01%], ie,<10^-4 and participants were defined as MRD negative if their disease burden was below threshold.Participants in the Full Analysis Set were analyzed.
    End point type
    Secondary
    End point timeframe
    Week 25
    End point values
    Tirabrutinib + Idelalisib Tirabrutinib + Idelalisib + Obinutuzumab
    Number of subjects analysed
    5
    30
    Units: percentage of participants
        number (confidence interval 90%)
    0 (0 to 45.1)
    0 (0 to 9.5)
    No statistical analyses for this end point

    Secondary: Rate of CR With Peripheral Minimal Residual Disease (CR/PB MRD) Negativity, as Assessed by the Investigator Using the Modified IWCLL 2008 Criteria at Week 25

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    End point title
    Rate of CR With Peripheral Minimal Residual Disease (CR/PB MRD) Negativity, as Assessed by the Investigator Using the Modified IWCLL 2008 Criteria at Week 25
    End point description
    Rate of CR/PB MRD at Week 25:percentage of participants who achieved CR/CRi per modified IWCLL 2008 criteria and also achieved PB MRD negativity at Week 25. CR: meeting following criteria and no disease related symptoms: no lymphadenopathy > 1.5 cm/hepatomegaly/splenomegaly; lymphocytes < 4000/μL; bone marrow sample must be normocellular with 30% lymphocytes and no B-lymphoid nodules; platelets > 100,000/µL; hemoglobin > 11 g/dL; and neutrophils > 1500/µL. CRi: CR criteria (no lymphadenopathy > 1.5 cm/hepatomegaly/splenomegaly; lymphocytes < 4000/μL; bone marrow [hypocellular] with 30% lymphocytes and no B-lymphoid nodules), persistent anemia/thrombocytopenia/neutropenia unrelated to CLL but related to drug toxicity. MRD response was assessed with FACS and MRD negativity was defined as one CLL cell per 10,000 leukocytes [0.01%], ie,<10^-4 and participants were defined as MRD negative if their disease burden was below this threshold.Participants in the Full Analysis Set were analyzed.
    End point type
    Secondary
    End point timeframe
    Week 25
    End point values
    Tirabrutinib + Idelalisib Tirabrutinib + Idelalisib + Obinutuzumab
    Number of subjects analysed
    5
    30
    Units: percentage of participants
        number (confidence interval 90%)
    0 (0 to 45.1)
    0 (0 to 9.5)
    No statistical analyses for this end point

    Secondary: Overall Response Rate (ORR), as Assessed by the Investigator Using the Modified IWCLL 2008 Criteria at Week 25

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    End point title
    Overall Response Rate (ORR), as Assessed by the Investigator Using the Modified IWCLL 2008 Criteria at Week 25
    End point description
    ORR was assessed based on modified IWCLL 2008 criteria and was defined as percentage of participants achieving a CR, CRi, partial remission (PR; including nodular partial response [nPR]), and PR with lymphocytosis (PR-L). CR and CRi: meeting all the criteria that have been defined in Outcome measures 1, 2 and 3. PR: ≥ 2 of these: ≥ 50% decrease in lymphocytes, lymphadenopathy, size of liver, size of spleen, and 50% decrease in bone marrow infiltrates; and ≥ 1 of these: neutrophils > 1500/μL or ≥ 50% increase from Baseline, platelets ≥ 100,000/µL or ≥ 50% increase from Baseline, hemoglobin >11 g/dL or ≥ 50% increase from Baseline. PR-L: meeting PR criteria; however, a lymphocytosis related to treatment may be present. nPR: All criteria for a CR/CRi were fulfilled, but the bone marrow showed lymphoid nodules. Participants in the Full Analysis Set were analyzed.
    End point type
    Secondary
    End point timeframe
    Week 25
    End point values
    Tirabrutinib + Idelalisib Tirabrutinib + Idelalisib + Obinutuzumab
    Number of subjects analysed
    5
    30
    Units: percentage of participants
        number (confidence interval 90%)
    60.0 (18.9 to 92.4)
    93.3 (80.5 to 98.8)
    No statistical analyses for this end point

    Secondary: Percentage of Participants Experiencing Any Treatment-Emergent Adverse Events (AEs) and Treatment-Emergent Serious Adverse Events (SAEs)

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    End point title
    Percentage of Participants Experiencing Any Treatment-Emergent Adverse Events (AEs) and Treatment-Emergent Serious Adverse Events (SAEs)
    End point description
    Treatment-emergent AEs are defined as 1 or both of the following: • Any AEs with an onset date on or after the study drug start date and no later than 30 days after permanent discontinuation of study drug • Any AEs leading to discontinuation of study drug A SAE is defined as an event that, at any dose, resulted in any of the following: death, life-threatening, in-patient hospitalization or prolongation of existing hospitalization, persistent or significant disability/incapacity, a congenital anomaly/birth defect, or a medically important event or reaction. The Safety Analysis Set included all randomized or enrolled participants who received at least 1 dose of any study drug.
    End point type
    Secondary
    End point timeframe
    First dose date up to the last dose date (maximum: 105 weeks) plus 30 days
    End point values
    Tirabrutinib + Idelalisib Tirabrutinib + Idelalisib + Obinutuzumab
    Number of subjects analysed
    5
    30
    Units: percentage of participants
    number (not applicable)
        Any Treatment-Emergent AEs
    100
    100
        Treatment-Emergent SAEs
    60.0
    46.7
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse Events: First dose date up to last dose date (maximum: 105 weeks) plus 30 days; All-Cause Mortality: Enrollment up to 31 months
    Adverse event reporting additional description
    Adverse Events: The Safety Analysis Set included all randomized or enrolled participants who received at least 1 dose of any study drug. All-Cause Mortality: The All Enrolled Analysis Set included all participants who received a study participant identification number in the study after screening.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.1
    Reporting groups
    Reporting group title
    Tirabrutinib + Idelalisib
    Reporting group description
    Tirabrutinib 80 mg (4 x 20 mg tablets/2 x 40 mg tablets/1 x 80 mg tablet) orally once daily + idelalisib 100 mg (1 x 100 mg tablet) orally once daily for up to 104 weeks.

    Reporting group title
    Tirabrutinib + Idelalisib + Obinutuzumab
    Reporting group description
    Tirabrutinib 80 mg (4 x 20 mg tablets/ 2 x 40 mg tablets/ 1 x 80 mg tablet) orally once daily + idelalisib 100 mg (1 x 100 mg tablet) orally once daily for up to 104 weeks + obinutuzumab 100 mg on Day 1, 900 mg on Day 1 or 2, and 1000 mg subsequently for up to 8 doses administered intravenously over 21 weeks.

    Serious adverse events
    Tirabrutinib + Idelalisib Tirabrutinib + Idelalisib + Obinutuzumab
    Total subjects affected by serious adverse events
         subjects affected / exposed
    3 / 5 (60.00%)
    14 / 30 (46.67%)
         number of deaths (all causes)
    1
    1
         number of deaths resulting from adverse events
    Investigations
    Hepatic enzyme increased
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigation
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutrophil count decreased
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acute myeloid leukaemia
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Squamous cell carcinoma
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac failure acute
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Coronary artery stenosis
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebral infarction
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Gastrointestinal disorders
    Colitis
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Stomatitis
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pleural effusion
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Dermatitis allergic
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Nephrolithiasis
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ureterolithiasis
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Atypical pneumonia
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cystitis
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Influenza
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Large intestine infection
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Tumour lysis syndrome
         subjects affected / exposed
    0 / 5 (0.00%)
    1 / 30 (3.33%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Tirabrutinib + Idelalisib Tirabrutinib + Idelalisib + Obinutuzumab
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    5 / 5 (100.00%)
    29 / 30 (96.67%)
    Vascular disorders
    Haematoma
         subjects affected / exposed
    1 / 5 (20.00%)
    6 / 30 (20.00%)
         occurrences all number
    1
    16
    Hypertension
         subjects affected / exposed
    0 / 5 (0.00%)
    5 / 30 (16.67%)
         occurrences all number
    0
    5
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    1 / 5 (20.00%)
    10 / 30 (33.33%)
         occurrences all number
    1
    11
    Pyrexia
         subjects affected / exposed
    1 / 5 (20.00%)
    7 / 30 (23.33%)
         occurrences all number
    3
    7
    Chills
         subjects affected / exposed
    1 / 5 (20.00%)
    6 / 30 (20.00%)
         occurrences all number
    1
    7
    Feeling cold
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Influenza like illness
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    3
    Oedema peripheral
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Medical device pain
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    0 / 5 (0.00%)
    8 / 30 (26.67%)
         occurrences all number
    0
    12
    Epistaxis
         subjects affected / exposed
    0 / 5 (0.00%)
    4 / 30 (13.33%)
         occurrences all number
    0
    6
    Dysphonia
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Haemoptysis
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Nasal mucosal disorder
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Psychiatric disorders
    Depression
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Insomnia
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 30 (3.33%)
         occurrences all number
    1
    1
    Sleep disorder
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Investigations
    Neutrophil count decreased
         subjects affected / exposed
    0 / 5 (0.00%)
    4 / 30 (13.33%)
         occurrences all number
    0
    9
    Alanine aminotransferase increased
         subjects affected / exposed
    1 / 5 (20.00%)
    2 / 30 (6.67%)
         occurrences all number
    2
    4
    Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 5 (20.00%)
    2 / 30 (6.67%)
         occurrences all number
    2
    3
    C-reactive protein increased
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    5
    Hepatic enzyme increased
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    4
    Platelet count decreased
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    3
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Weight decreased
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Injury, poisoning and procedural complications
    Infusion related reaction
         subjects affected / exposed
    0 / 5 (0.00%)
    5 / 30 (16.67%)
         occurrences all number
    0
    6
    Foot fracture
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 30 (3.33%)
         occurrences all number
    1
    1
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 30 (3.33%)
         occurrences all number
    1
    1
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    2 / 5 (40.00%)
    3 / 30 (10.00%)
         occurrences all number
    3
    4
    Memory impairment
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Headache
         subjects affected / exposed
    1 / 5 (20.00%)
    4 / 30 (13.33%)
         occurrences all number
    2
    6
    Restless legs syndrome
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Syncope
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Blood and lymphatic system disorders
    Thrombocytopenia
         subjects affected / exposed
    0 / 5 (0.00%)
    8 / 30 (26.67%)
         occurrences all number
    0
    8
    Neutropenia
         subjects affected / exposed
    0 / 5 (0.00%)
    11 / 30 (36.67%)
         occurrences all number
    0
    18
    Anaemia
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Leukopenia
         subjects affected / exposed
    0 / 5 (0.00%)
    4 / 30 (13.33%)
         occurrences all number
    0
    5
    Lymphopenia
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    3
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    0 / 5 (0.00%)
    6 / 30 (20.00%)
         occurrences all number
    0
    6
    Eye disorders
    Vision blurred
         subjects affected / exposed
    1 / 5 (20.00%)
    2 / 30 (6.67%)
         occurrences all number
    1
    2
    Visual impairment
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Lacrimation increased
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    2 / 5 (40.00%)
    10 / 30 (33.33%)
         occurrences all number
    7
    17
    Nausea
         subjects affected / exposed
    2 / 5 (40.00%)
    7 / 30 (23.33%)
         occurrences all number
    7
    10
    Vomiting
         subjects affected / exposed
    1 / 5 (20.00%)
    4 / 30 (13.33%)
         occurrences all number
    3
    4
    Constipation
         subjects affected / exposed
    1 / 5 (20.00%)
    2 / 30 (6.67%)
         occurrences all number
    1
    3
    Flatulence
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    4
    Abdominal distension
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Abdominal pain
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Abdominal pain upper
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    3
    Colitis
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Gastritis
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Diverticulum intestinal
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    0 / 5 (0.00%)
    8 / 30 (26.67%)
         occurrences all number
    0
    12
    Rash maculo-papular
         subjects affected / exposed
    2 / 5 (40.00%)
    3 / 30 (10.00%)
         occurrences all number
    2
    4
    Pruritus
         subjects affected / exposed
    0 / 5 (0.00%)
    4 / 30 (13.33%)
         occurrences all number
    0
    5
    Dry skin
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    3
    Ecchymosis
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    3
    Night sweats
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    3
    Skin lesion
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    3
    Petechiae
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Skin exfoliation
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    4
    Dermatitis allergic
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences all number
    2
    0
    Renal and urinary disorders
    Dysuria
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 30 (3.33%)
         occurrences all number
    1
    1
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    1 / 5 (20.00%)
    7 / 30 (23.33%)
         occurrences all number
    1
    9
    Arthralgia
         subjects affected / exposed
    0 / 5 (0.00%)
    4 / 30 (13.33%)
         occurrences all number
    0
    6
    Muscle spasms
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    4
    Flank pain
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 30 (3.33%)
         occurrences all number
    1
    1
    Myalgia
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 30 (3.33%)
         occurrences all number
    1
    1
    Osteoarthritis
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Pain in extremity
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Spinal pain
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Groin pain
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    0 / 5 (0.00%)
    10 / 30 (33.33%)
         occurrences all number
    0
    19
    Upper respiratory tract infection
         subjects affected / exposed
    2 / 5 (40.00%)
    7 / 30 (23.33%)
         occurrences all number
    11
    9
    Bronchitis
         subjects affected / exposed
    0 / 5 (0.00%)
    6 / 30 (20.00%)
         occurrences all number
    0
    8
    Sinusitis
         subjects affected / exposed
    0 / 5 (0.00%)
    4 / 30 (13.33%)
         occurrences all number
    0
    5
    Influenza
         subjects affected / exposed
    1 / 5 (20.00%)
    2 / 30 (6.67%)
         occurrences all number
    1
    2
    Pneumonia
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    4
    Urinary tract infection
         subjects affected / exposed
    0 / 5 (0.00%)
    3 / 30 (10.00%)
         occurrences all number
    0
    4
    Conjunctivitis
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Cystitis
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Cytomegalovirus infection
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Cytomegalovirus infection reactivation
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Febrile infection
         subjects affected / exposed
    1 / 5 (20.00%)
    1 / 30 (3.33%)
         occurrences all number
    1
    1
    Fungal infection
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    2
    Herpes virus infection
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    7
    Herpes zoster
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Oral pustule
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    3
    Hyperkalaemia
         subjects affected / exposed
    0 / 5 (0.00%)
    2 / 30 (6.67%)
         occurrences all number
    0
    4
    Hyperuricaemia
         subjects affected / exposed
    1 / 5 (20.00%)
    0 / 30 (0.00%)
         occurrences all number
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    16 Aug 2016
    • Update to benefit-risk assessment to include data on adverse events (AEs) that occurred in the idelalisib + obinutuzumab treatment arm of Study GS-US-312-0118 • Update to dose rationale for the combination treatment • Addition of weekly clinic visits and lab monitoring for the first 28 days of treatment • Inclusion of statement specifying that results from the safety cohort was provided to BfArM • Specification of safety monitoring throughout the duration of the study • Clarification that restaging radiologic evaluation was limited to affected areas identified at the time of the screening evaluation • Inclusion of statement that imaging assessments are in accordance with European Society for Medical Oncology (ESMO) guidelines • Update to instructions for safety reporting to clarify that serious adverse events (SAEs), regardless of cause or relationship, was reported from the time of informed consent throughout the duration of the trial, which is inclusive of the post-treatment period
    16 Sep 2016
    • Replaced idelalisib 50 mg twice daily (BID) with 100 mg once daily dosing regimen and updated the dose rationale language accordingly • Added requirement for evaluation for gastrointestinal events/colitis in alignment with updated idelalisib safety information • Revised dose adjustment guidelines and requirements in alignment with updated idelalisib safety information
    24 Aug 2017
    • Further enrollment into Arm A was discontinued. All additional participants were enrolled to Arm B. A total of approximately 6 participants were enrolled in Arm A and 30 participants in Arm B, thus the total sample size for the study was reduced from 60 participants to approximately 36 participants • The requirement for a bone marrow biopsy at Week 25 was limited to participants who otherwise would meet criteria for a CR or complete remission with incomplete bone marrow recovery (CRi). For participants without radiographic evidence of disease at screening, a bone marrow biopsy including aspirate was required at screening. In the presence of systemic disease, the bone marrow result was only critical for assessing a complete remission or progressive disease per International Workshop on Chronic Lymphocytic Leukemia (IWCLL) 2008 guidelines. As bone marrow evaluation in the case of progressive disease was performed only when clinical progression was suspected, the scheduled bone marrow assessment was only necessary to evaluate patients who did not have a radiographically evident change in disease assessment. This change did not preclude investigator assessment of disease response per IWCLL 2008 criteria and should decrease the burden of bone marrow biopsies to the overall cohort of participants enrolled.
    15 Jan 2019
    • The post treatment follow up period was removed. All subjects completed the study at the End of Treatment visit, or at the Week 25 visit, should treatment have discontinued prior to Week 25 • Based on ongoing study data that indicate minimal residual disease (MRD) negativity may be achieved post Week 25, additional exploratory endpoints were added to allow for analysis at later time points
    19 Nov 2019
    • The risk of progressive multifocal leukoencephalopathy was added as discontinuation and dose interruption criteria
    28 May 2020
    • The risk of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) was added as per Company Core Data Sheet (CCDS), the Idealisib IB edition 21 dated 02-Apr-2020 was updated to reflect this new information

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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