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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 Entospletinib With and Without Obinutuzumab in Subjects With Chronic Lymphocytic Leukemia

    Summary
    EudraCT number
    2016-002768-15
    Trial protocol
    DE  
    Global end of trial date
    01 Oct 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    16 Oct 2021
    First version publication date
    16 Oct 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    GS-US-401-2076
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02983617
    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
    01 Oct 2020
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    20 Feb 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    01 Oct 2020
    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 (formerly GS-4059) and entospletinib with obinutuzumab in adults with relapsed or refractory chronic lymphocytic leukemia (CLL).
    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
    06 Apr 2017
    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: 36
    Worldwide total number of subjects
    36
    EEA total number of subjects
    36
    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
    21
    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 06 April 2017. The last study visit occurred on 01 October 2020.

    Pre-assignment
    Screening details
    38 participants were screened. Randomization was discontinued after implementation of Protocol Amendment 3; all additional participants were enrolled to Arm: Tirabrutinib + Entospletinib + 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 + Entospletinib
    Arm description
    Tirabrutinib 80 mg (4 x 20 mg tablets/2 x 40 mg tablets/1 x 80 mg tablet) orally once daily + entospletinib 400 mg (2 x 200 mg tablets) orally once daily for up to 104 weeks.
    Arm type
    Experimental

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

    Investigational medicinal product name
    Entospletinib
    Investigational medicinal product code
    Other name
    GS-9973
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    400 mg administered once daily

    Arm title
    Tirabrutinib + Entospletinib + Obinutuzumab
    Arm description
    Tirabrutinib 80 mg (4 x 20 mg tablets/ 2 x 40 mg tablets/ 1 x 80 mg tablet) orally once daily + entospletinib 400 mg (2 x 200 mg tablets) 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 on Day 1 of Weeks 2, 3, 5, 9, 13, 17 and 21.
    Arm type
    Experimental

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

    Investigational medicinal product name
    Entospletinib
    Investigational medicinal product code
    Other name
    GS-9973
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    400 mg administered once daily

    Investigational medicinal product name
    Obinutuzumab
    Investigational medicinal product code
    Other name
    Gazyvaro®, Gazyva®, GA101
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    100 mg, 900 mg, and 1000 mg administered over 21 weeks

    Number of subjects in period 1
    Tirabrutinib + Entospletinib Tirabrutinib + Entospletinib + Obinutuzumab
    Started
    6
    30
    Completed
    6
    21
    Not completed
    0
    9
         Adverse Event
    -
    7
         Death
    -
    1
         Investigator`s Discretion
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Tirabrutinib + Entospletinib
    Reporting group description
    Tirabrutinib 80 mg (4 x 20 mg tablets/2 x 40 mg tablets/1 x 80 mg tablet) orally once daily + entospletinib 400 mg (2 x 200 mg tablets) orally once daily for up to 104 weeks.

    Reporting group title
    Tirabrutinib + Entospletinib + 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 + entospletinib 400 mg (2 x 200 mg tablets) 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 on Day 1 of Weeks 2, 3, 5, 9, 13, 17 and 21.

    Reporting group values
    Tirabrutinib + Entospletinib Tirabrutinib + Entospletinib + Obinutuzumab Total
    Number of subjects
    6 30 36
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    61 ± 8.3 67 ± 9.9 -
    Gender categorical
    Units: Subjects
        Female
    2 7 9
        Male
    4 23 27
    Ethnicity
    Not Permitted = local regulators did not allow collection of ethnicity information.
    Units: Subjects
        Hispanic or Latino
    0 0 0
        Not Hispanic or Latino
    4 29 33
        Not Permitted
    2 1 3
    Race
    Not Permitted = local regulators did not allow collection of race information.
    Units: Subjects
        American Indian or Alaska Native
    0 0 0
        Asian
    0 0 0
        Black
    0 0 0
        Native Hawaiian or Pacific Islander
    0 0 0
        White
    4 29 33
        Other
    0 0 0
        Not Permitted
    2 1 3

    End points

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    End points reporting groups
    Reporting group title
    Tirabrutinib + Entospletinib
    Reporting group description
    Tirabrutinib 80 mg (4 x 20 mg tablets/2 x 40 mg tablets/1 x 80 mg tablet) orally once daily + entospletinib 400 mg (2 x 200 mg tablets) orally once daily for up to 104 weeks.

    Reporting group title
    Tirabrutinib + Entospletinib + 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 + entospletinib 400 mg (2 x 200 mg tablets) 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 on Day 1 of Weeks 2, 3, 5, 9, 13, 17 and 21.

    Primary: Rate of Complete Remission/Complete Remission with Incomplete Recovery of the Bone Marrow (CR/CRi), 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 Remission/Complete Remission with Incomplete Recovery of the Bone Marrow (CR/CRi), 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 lymphoidnodules), persistent anemia/thrombocytopenia/neutropenia unrelated to CLL but related to drug toxicity. 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 + Entospletinib Tirabrutinib + Entospletinib + Obinutuzumab
    Number of subjects analysed
    6
    30
    Units: percentage of participants
        number (confidence interval 90%)
    0 (0 to 39.3)
    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 was defined as percentage of participants who achieved CR/CRi per modified IWCLL 2008 criteria and also achieved BM MRD negativity at Week 25. CR, CRi: meeting all the criteria that have been defined in end point 1. 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 this threshold. Participants in the Full Analysis Set were analyzed.
    End point type
    Secondary
    End point timeframe
    Week 25
    End point values
    Tirabrutinib + Entospletinib Tirabrutinib + Entospletinib + Obinutuzumab
    Number of subjects analysed
    6
    30
    Units: percentage of participants
        number (confidence interval 90%)
    0 (0 to 39.3)
    3.3 (0.2 to 14.9)
    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 was defined as the percentage of participants who achieved CR/CRi per modified IWCLL 2008 criteria and also achieved PB MRD negativity at Week 25. CR, CRi: meeting all the criteria that have been defined in end point 1. 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 + Entospletinib Tirabrutinib + Entospletinib + Obinutuzumab
    Number of subjects analysed
    6
    30
    Units: percentage of participants
        number (confidence interval 90%)
    0 (0 to 39.3)
    3.3 (0.2 to 14.9)
    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 end point 1. 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 + Entospletinib Tirabrutinib + Entospletinib + Obinutuzumab
    Number of subjects analysed
    6
    30
    Units: percentage of participants
        number (confidence interval 90%)
    100.0 (60.7 to 100.0)
    90.0 (76.1 to 97.2)
    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
    A treatment emergent AE is defined as an AE that occurs or worsens in severity on or after the date of the first dose of study drug but no later than 30 days after the permanent discontinuation of study drug or an AE 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. 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: 105.9 weeks) plus 30 days
    End point values
    Tirabrutinib + Entospletinib Tirabrutinib + Entospletinib + Obinutuzumab
    Number of subjects analysed
    6
    30
    Units: percentage of participants
    number (not applicable)
        Any Treatment-Emergent AEs
    100.0
    100.0
        Treatment-Emergent SAEs
    16.7
    50.0
    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: 105.9 weeks) plus 30 days; All-Cause Mortality: Enrollment up to 42 months
    Adverse event reporting additional description
    Adverse Events: Safety Analysis Set included all randomized or enrolled participants who received at least 1 dose of any study drug; All-cause mortality: 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 + Entospletinib + 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 + entospletinib 400 mg (2 x 200 mg tablets) 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 on Day 1 of Weeks 2, 3, 5, 9, 13, 17 and 21.

    Reporting group title
    Tirabrutinib + Entospletinib
    Reporting group description
    Tirabrutinib 80 mg (4 x 20 mg tablets/2 x 40 mg tablets/1 x 80 mg tablet) orally once daily + entospletinib 400 mg (2 x 200 mg tablets) orally once daily for up to 104 weeks.

    Serious adverse events
    Tirabrutinib + Entospletinib + Obinutuzumab Tirabrutinib + Entospletinib
    Total subjects affected by serious adverse events
         subjects affected / exposed
    15 / 30 (50.00%)
    1 / 6 (16.67%)
         number of deaths (all causes)
    4
    0
         number of deaths resulting from adverse events
    Injury, poisoning and procedural complications
    Infusion related reaction
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Procedural haemorrhage
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subdural haematoma
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Congenital, familial and genetic disorders
    Hydrocele
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Haematoma
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peripheral arterial occlusive disease
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Syncope
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Disease progression
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Benign prostatic hyperplasia
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pleural effusion
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonitis
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Pemphigoid
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (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
    Renal impairment
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urethral caruncle
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (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
    Pneumonia
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    3 / 5
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronchopulmonary aspergillosis
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Covid-19 pneumonia
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nasopharyngitis
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peritonsillitis
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Soft tissue infection
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tracheobronchitis
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 6 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Tirabrutinib + Entospletinib + Obinutuzumab Tirabrutinib + Entospletinib
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    29 / 30 (96.67%)
    6 / 6 (100.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Richter's syndrome
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Vascular disorders
    Haematoma
         subjects affected / exposed
    6 / 30 (20.00%)
    2 / 6 (33.33%)
         occurrences all number
    9
    2
    Hypotension
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    10 / 30 (33.33%)
    2 / 6 (33.33%)
         occurrences all number
    11
    4
    Pyrexia
         subjects affected / exposed
    10 / 30 (33.33%)
    1 / 6 (16.67%)
         occurrences all number
    22
    7
    Chills
         subjects affected / exposed
    7 / 30 (23.33%)
    0 / 6 (0.00%)
         occurrences all number
    9
    0
    Oedema peripheral
         subjects affected / exposed
    6 / 30 (20.00%)
    1 / 6 (16.67%)
         occurrences all number
    6
    1
    Asthenia
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Chest pain
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Mucosal inflammation
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 6 (16.67%)
         occurrences all number
    2
    2
    Impaired healing
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Reproductive system and breast disorders
    Benign prostatic hyperplasia
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Erectile dysfunction
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    9 / 30 (30.00%)
    1 / 6 (16.67%)
         occurrences all number
    11
    1
    Oropharyngeal pain
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 6 (16.67%)
         occurrences all number
    1
    2
    Pleural effusion
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Investigations
    Blood bilirubin increased
         subjects affected / exposed
    4 / 30 (13.33%)
    0 / 6 (0.00%)
         occurrences all number
    6
    0
    Lipase increased
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Immunoglobulins decreased
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Platelet count decreased
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Weight increased
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Blood glucose increased
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Haemoglobin urine present
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Red blood cells urine positive
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    2
    Injury, poisoning and procedural complications
    Infusion related reaction
         subjects affected / exposed
    4 / 30 (13.33%)
    0 / 6 (0.00%)
         occurrences all number
    4
    0
    Arthropod bite
         subjects affected / exposed
    3 / 30 (10.00%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Contusion
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 6 (16.67%)
         occurrences all number
    1
    1
    Cardiac disorders
    Palpitations
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Tachycardia
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 6 (16.67%)
         occurrences all number
    1
    1
    Aortic valve incompetence
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    3 / 30 (10.00%)
    1 / 6 (16.67%)
         occurrences all number
    3
    4
    Headache
         subjects affected / exposed
    6 / 30 (20.00%)
    1 / 6 (16.67%)
         occurrences all number
    7
    2
    Polyneuropathy
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Paraesthesia
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    4
    0
    Blood and lymphatic system disorders
    Neutropenia
         subjects affected / exposed
    14 / 30 (46.67%)
    0 / 6 (0.00%)
         occurrences all number
    28
    0
    Anaemia
         subjects affected / exposed
    3 / 30 (10.00%)
    1 / 6 (16.67%)
         occurrences all number
    3
    2
    Leukopenia
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Thrombocytopenia
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Ear and labyrinth disorders
    Ear pain
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Tinnitus
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Eye disorders
    Conjunctival haemorrhage
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    9 / 30 (30.00%)
    2 / 6 (33.33%)
         occurrences all number
    16
    4
    Diarrhoea
         subjects affected / exposed
    7 / 30 (23.33%)
    1 / 6 (16.67%)
         occurrences all number
    15
    8
    Constipation
         subjects affected / exposed
    8 / 30 (26.67%)
    0 / 6 (0.00%)
         occurrences all number
    9
    0
    Flatulence
         subjects affected / exposed
    3 / 30 (10.00%)
    1 / 6 (16.67%)
         occurrences all number
    3
    1
    Vomiting
         subjects affected / exposed
    5 / 30 (16.67%)
    0 / 6 (0.00%)
         occurrences all number
    5
    0
    Abdominal pain
         subjects affected / exposed
    3 / 30 (10.00%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Gastritis
         subjects affected / exposed
    3 / 30 (10.00%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Abdominal pain upper
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Dry mouth
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    5
    0
    Dyspepsia
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Gastrointestinal disorder
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Stomatitis
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    2
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    5 / 30 (16.67%)
    2 / 6 (33.33%)
         occurrences all number
    6
    2
    Pruritus
         subjects affected / exposed
    5 / 30 (16.67%)
    1 / 6 (16.67%)
         occurrences all number
    5
    1
    Night sweats
         subjects affected / exposed
    3 / 30 (10.00%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Petechiae
         subjects affected / exposed
    3 / 30 (10.00%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Urticaria
         subjects affected / exposed
    3 / 30 (10.00%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Eczema
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Rash papular
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Purpura
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Renal and urinary disorders
    Haematuria
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    4 / 30 (13.33%)
    2 / 6 (33.33%)
         occurrences all number
    5
    5
    Arthralgia
         subjects affected / exposed
    4 / 30 (13.33%)
    0 / 6 (0.00%)
         occurrences all number
    6
    0
    Muscle spasms
         subjects affected / exposed
    3 / 30 (10.00%)
    1 / 6 (16.67%)
         occurrences all number
    3
    1
    Pain in extremity
         subjects affected / exposed
    4 / 30 (13.33%)
    0 / 6 (0.00%)
         occurrences all number
    4
    0
    Neck pain
         subjects affected / exposed
    3 / 30 (10.00%)
    0 / 6 (0.00%)
         occurrences all number
    4
    0
    Musculoskeletal pain
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Osteoarthritis
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Osteoporotic fracture
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    10 / 30 (33.33%)
    4 / 6 (66.67%)
         occurrences all number
    20
    8
    Oral herpes
         subjects affected / exposed
    5 / 30 (16.67%)
    2 / 6 (33.33%)
         occurrences all number
    6
    5
    Urinary tract infection
         subjects affected / exposed
    6 / 30 (20.00%)
    1 / 6 (16.67%)
         occurrences all number
    11
    1
    Bronchitis
         subjects affected / exposed
    6 / 30 (20.00%)
    0 / 6 (0.00%)
         occurrences all number
    8
    0
    Upper respiratory tract infection
         subjects affected / exposed
    3 / 30 (10.00%)
    1 / 6 (16.67%)
         occurrences all number
    3
    1
    Sinusitis
         subjects affected / exposed
    3 / 30 (10.00%)
    1 / 6 (16.67%)
         occurrences all number
    3
    1
    Herpes virus infection
         subjects affected / exposed
    2 / 30 (6.67%)
    1 / 6 (16.67%)
         occurrences all number
    3
    1
    Gastroenteritis
         subjects affected / exposed
    1 / 30 (3.33%)
    2 / 6 (33.33%)
         occurrences all number
    1
    3
    Herpes zoster
         subjects affected / exposed
    3 / 30 (10.00%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Pneumonia
         subjects affected / exposed
    3 / 30 (10.00%)
    0 / 6 (0.00%)
         occurrences all number
    4
    0
    Conjunctivitis
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 6 (16.67%)
         occurrences all number
    1
    2
    Cystitis
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 6 (16.67%)
         occurrences all number
    1
    1
    Periodontitis
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Rhinitis
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    2
    0
    Folliculitis
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Respiratory tract infection
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Root canal infection
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    2 / 30 (6.67%)
    0 / 6 (0.00%)
         occurrences all number
    3
    0
    Folate deficiency
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1
    Hypertriglyceridaemia
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 6 (16.67%)
         occurrences all number
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    16 Nov 2016
    • Added study flow chart to reflect stratification by mutation, treatment of an early safety cohort, and review of 28-day safety data from the safety cohort by the Safety Review Team (SRT) • Included additional details on sample size determination • Incorporated recommendations from the Summary of Product Characteristics (SmPC) for Gazyvaro® (obinutuzumab) in the event of suspicion of progressive multifocal leukoencephalopathy (PML)
    02 Feb 2017
    • Updated entospletinib formulation information • Revised the recommendations for concomitant medications with entospletinib • Updated the study procedures for CLL immunophenotyping at disease progression
    24 Aug 2017
    • Further enrollment into Arm A was discontinued. All additional subjects were enrolled to Arm B. A total of approximately 6 subjects were enrolled in Arm A and 30 subjects in Arm B, thus the total sample size for the study was reduced from 60 subjects to approximately 36 subjects. • As of 07 June 2017, 10 subjects with CLL were treated on Phase 1b Study GS-US-401-1757 with the combination of tirabrutinib and entospletinib with a median exposure of 43 weeks (range: 18-55). All 10 subjects continued on study and treatment however no CLL subjects have achieved a complete remission (CR). Given the lack of CRs seen in the ongoing treatment experience with the combination of tirabrutinib and entospletinib and the primary endpoint of CR in this protocol (GS-US-401-2076), with Amendment 3, enrollment into the doublet combination of tirabrutinib and entospletinib without obinutuzumab was discontinued. Arm B continued enrollment as the safety and preliminary efficacy of the combination with the addition of obinutuzumab retained the potential to be safe and achieve a high rate and depth of response. • The requirement for a bone marrow biopsy at Week 25 was limited to subjects who otherwise would meet criteria for a CR or complete remission with incomplete bone marrow recovery (CRi). For subjects 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 a critical study for assessing a complete remission or progressive disease per IWCLL 2008 guidelines. As evaluation of the bone marrow in the case of progressive disease was performed only when clinical progression was suspected, the scheduled bone marrow assessment was only necessary to evaluate subjects who do not have radiographically evident disease. This change did not impact disease response assessment and should decrease the burden of bone marrow biopsies at the cohort level.
    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. • The primary endpoint of complete remission (CR) and secondary endpoints of rate of CR with bone marrow minimal residual disease (MRD) negativity (CR/BM MRD-) and the rate of CR with MRD negativity (<10-4) in peripheral blood (CR/PB MRD-) at Week 25 were not met, based on data from the ongoing study with the combination of tirabrutinib, entospletinib and obinutuzumab. Therefore, post-treatment disease assessments were no longer conducted. • Based on ongoing study data that indicate MRD negativity may be achieved post Week 25, additional exploratory endpoints were added to allow for analysis at later time points. • The lots of tirabrutinib 20 mg tablets expired in Feb 2020 and it was unknown if the shelf-life was extended, therefore the 20 mg tablets were replaced with 40 mg tablets. Data supporting the tablet formulation was contained within the protocol and supporting documents.

    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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