E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Untreated mantle cell lymphoma |
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E.1.1.1 | Medical condition in easily understood language |
Untreated mantle cell 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 | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10061275 |
E.1.2 | Term | Mantle cell lymphoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective is to estimate the minimum residual disease (MRD) rate using droplet digital PCR (ddPCR) in bone marrow and/or peripheral blood at the end of induction (after 6 cycles of Ibrutinib/CD20 Ab and Ibrutinib/CD20 Ab/Venetoclax) in previously untreated MCL patients. |
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E.2.2 | Secondary objectives of the trial |
- MRD response in PB and BM at the following timepoints: o C6 (qPCR +/-NGS+/- any other technique recommended by state of art) o C12(ddPCR +/-NGS+/-any other technique recommended by state of art) o C24(ddPCR +/-NGS+/-any other technique recommended by state of art) o Permanent treatment discontinuation (due to progression/relapse) - MRD response in PB (ddPCR/NGS or any other technique recommended by state of art at the time of the analysis) at the following timepoints: C3–C18–C30–C36–C42 - Overall response rate (Lugano response criteria 2014) - Complete response rate (Lugano response criteria 2014) - Overall Survival - Progression Free Survival - Response duration - Duration of MRD negativity and delay from MRD positivity to clinical relapse - Disease free survival - Tolerability and safety of Ibrutinib/CD20 Ab and Ibrutinib/CD20 Ab/Venetoclax - Investigate peripheral blood stem cell collection after at least 12 cycles and a wash-out period of 4 weeks for venetoclax |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Histologically confirmed (according to the WHO classification) mantle cell lymphoma. The diagnosis has to be confirmed by phenotypic expression of CD5, CD20 and cyclin D1 or the t(11;14) translocation (by cytogenetics and/or FISH and/or BCL1-IgH PCR)
OR
Untreated MCL
OR
Stage II-IV disease, measurable with at least lymph node > 1.5 cm and requiring treatment in the opinion of the treating clinician |
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E.4 | Principal exclusion criteria |
1. Clinically significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of screening, or any Class 3 (moderate) or Class 4 (severe) cardiac disease as defined by the New York Heart Association Functional Classification. 2. Impaired organ function (other than liver and renal) which will interfere with the treatment 3. Hemoglobin level < 10g/dL; Neutrophil count <1 G/L; Platelets < 75 G/L (except if related to lymphoma then platelet must be >50), 4. Major surgery within 28 days before enrollment 5. Known central nervous system lymphoma 6. History of stroke or intracranial hemorrhage within 6 months prior to enrollment. 7. Requires anticoagulation with warfarin or equivalent vitamin K antagonists (e.g., phenprocoumone) 8. Requires treatment with strong CYP3A inhibitors 9. Vaccinated with live, attenuated vaccines within 6 months of enrollment (except COVID vaccine) 10. Known history of human immunodeficiency virus (HIV) 11. Evidence of other clinically significant uncontrolled condition(s) including but not limited to: - Uncontrolled and/or active systemic infection (viral, bacterial or fungal) - Chronic hepatitis B virus (HBV) or hepatitis C (HCV) requiring treatment. Note: subjects with serologic evidence of prior vaccination to HBV (i.e. HBs antigen negative, anti-HBs antibody + and antiHBc antibody -) and subjects with anti-HB-core antibody that are HBV DNA negative may participate 12. Psychiatric illness or condition which could interfere with their ability to understand the requirements of the study 13. Any life-threatening illness, medical condition, or organ system dysfunction which, in the investigator’ opinion, could compromise the patient safety, interfere with the absorption or metabolism of treatment (Ibrutinib, CD20 Ab, venetoclax) or put the study outcomes at undue risk 14. Pregnant, planning to become pregnant, or lactating woman 15. Known hypersensitivity to study treatment (CD20 Ab, Ibrutinib, Venetoclax) or to any of the excipients 16. Known allergy to xanthine oxidase inhibitors or rasburicase 17. Known G6DP deficiency 18. Known bleeding disorders 19. Severe prior reactions to monoclonal antibodies or with prior significant toxicity (other than thrombocytopenia) from Bcl-2 inhibitor 20. History of prior other malignancy with the exception of: - curatively treated basal cell carcinoma - curatively treated squamous cell carcinoma of the skin or carcinoma in situ of the cervix at any time prior to study - other curatively treated cancer and patient disease-free for over 5 years 21. Anti-cancer therapies including chemotherapy, radiotherapy or other investigational therapy, including targeted small molecule agents 22. Biological agents (e.g. monoclonal antibodies) for anti-neoplastic intent: excluded 30 days prior to first dose of venetoclax 23. Person deprived of his/her liberty by a judicial or administrative decision 24. Adult person under legal protection |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is the Molecular residual disease (MRD) negativity at the end of induction in MRD informative set. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
end of induction phase : after 6 cycles of Ibrutinib/CD20 Ab and Ibrutinib/CD20 Ab/Venetoclax |
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E.5.2 | Secondary end point(s) |
Overall Response Rate (ORR) according to Lugano response Criteria Complete Response Rate (CRR) according to Lugano response Criteria Overall Response Rate (ORR) according to Lugano criteria (CT-based) Complete Response Rate (CRR) according to Lugano criteria (CT-based) MRD response in PB and BM at C6, C12, C24 and at permanent treatment discontinuation due to relapse/progression MRD response in PB at C3, C18, C30, C36 and C42 PFS OS Stem cell collection Duration of MRD negativity Delay from MRD positivity to clinical relapse Duration of response Disease free survival |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
ORR and CRR according to Lugano response Criteria => after C6, after C12 or at permanent treatment discontinuation (before C12). ORR and CRR according to Lugano criteria (CT-based) => after C3, after C6, after C12, after C18, after C24, after C30, after C36 and at end of treatment or permanent treatment discontinuation. MRD response in PB and BM at C6, C12, C24 and at permanent treatment discontinuation due to relapse/progression MRD response in PB at C3, C18, C30, C36 and C42 PFS and OS : from rando to progression/death Stem cell collection => after C12. Duration of MRD negativity and Delay from MRD positivity to clinical relapse and Duration of response and Disease free survival => during all study |
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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 | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | 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 | 35 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 40 |
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 |
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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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LVLS : patients will be followed until the last patient included will have been followed up for two years after his last intake of study medication |
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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 | 9 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 9 |
E.8.9.2 | In all countries concerned by the trial months | 6 |