Safety and Tolerability Study of PCI-32765 Combined With Fludarabine/Cyclophosphamide/Rituximab (FCR) and Bendamustine/Rituximab (BR) in Chronic Lymphocytic Leukemia (CLL)

Sponsor
Pharmacyclics LLC. (Industry)
Overall Status
Completed
CT.gov ID
NCT01292135
Collaborator
(none)
33
6
2
26.9
5.5
0.2

Study Details

Study Description

Brief Summary

The purpose of this study is to establish the safety of orally administered PCI-32765 in combination with fludarabine/cyclophosphamide/rituximab (FCR) and bendamustine/rituximab (BR) in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma(SLL).

Condition or Disease Intervention/Treatment Phase
Phase 1

Detailed Description

This is a Phase 1b, open-label, parallel-group, nonrandomized, multicenter study of PCI 32765 420 mg once daily oral (PO) administration in combination with 2 different chemotherapy regimens in subjects with relapsed/refractory chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL).

Study Design

Study Type:
Interventional
Actual Enrollment :
33 participants
Allocation:
Non-Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
A Phase 1b, Multicenter, Open-label, Parallel-group Safety Study of a Bruton's Tyrosine Kinase (Btk) Inhibitor, PCI 32765, in Combination With Chemotherapy in Subjects With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
Study Start Date :
Feb 1, 2011
Actual Primary Completion Date :
Nov 1, 2012
Actual Study Completion Date :
May 1, 2013

Arms and Interventions

Arm Intervention/Treatment
Experimental: PCI-32765 plus fludarabine/cyclophosphamide/rituximab (FCR)

Drug: PCI-32765
420 mg daily

Experimental: PCI-32765 plus bendamustine/rituximab (BR)

Drug: PCI-32765
420 mg daily

Outcome Measures

Primary Outcome Measures

  1. Incidence of Prolonged Hematologic Toxicity Started in Cycle 1 [From First day of dose to 30 days after last dose of any study medication. Participants were followed with a median follow-up time of 15.8 months.]

Secondary Outcome Measures

  1. Incidence of Adverse Events Requiring Dose Delay or Discontinuation of Ibrutinib [From First day of dose to 30 days after last dose of any study medication. Participants were followed with a median follow-up time of 15.8 months.]

  2. Overall Incidence of Grade ≥3 Adverse Events (AEs) Per NCI CTCAE V4.0 [From First day of dose to 30 days after last dose of any study medication. Participants were followed with a median follow-up time of 15.8 months.]

  3. Overall Incidence of Serious Adverse Events (SAEs) [From First day of dose to 30 days after last dose of any study medication. Participants were followed with a median follow-up time of 15.8 months.]

  4. Overall Response Rate (Complete Response [CR] + Complete Response With Incomplete Marrow Recovery [CRi] + Nodular Partial Response [nPR] + Partial Response [PR]) [From first response assessment to last response assessment. Participants were followed with a median follow-up time of 15.8 months.]

    Response criteria are as outlined in the IWCLL 2008 criteria (Hallek 2008) and as assessed by investigator, e.g. response requires 50% reduction in lymph node size. Assessment of response to treatment will be done every 2 cycles for the first 6 months and then every 3 months thereafter until disease progression or prior to the administration of a new anticancer therapy and at follow-up visits.

  5. Sustained Hematologic Improvement in Subjects With Neutropenia, Anemia, or Thrombocytopenia at Baseline [From first response assessment to last response assessment. Participants were followed with a median follow-up time of 15.8 months.]

  6. Progression Free Survival Rate at 12 Months [From first dose of any study medication to 12 months after first dose to progressive disease or death or the last clinical assessment before receiving new anticancer therapy or loss to follow-up, whichever occured the earliest.]

    Criteria for progression are as outlined in the IWCLL 2008 criteria (Hallek 2008) and as assessed by investigator, e.g. progression defined as a 50% increase in lymph node size.

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  1. Histologically confirmed CLL or SLL and satisfying at least 1 of the following criteria for requiring treatment:
  • Progressive splenomegaly and/or lymphadenopathy identified by physical examination or radiographic studies

  • Anemia (<11 g/dL) or thrombocytopenia (<100,000/μL) due to bone marrow involvement

  • Presence of unintentional weight loss > 10% over the preceding 6 months

  • NCI CTCAE Grade 2 or 3 fatigue

  • Fevers > 100.5° or night sweats for > 2 weeks without evidence of infection

  • Progressive lymphocytosis with an increase of > 50% over a 2 month period or an anticipated doubling time of < 6 months

  1. 1 to 3 prior treatment regimens for CLL/SLL

  2. ECOG performance status of ≤ 1

  3. ≥ 18 years of age

  4. Willing and able to participate in all required evaluations and procedures in this study protocol including swallowing capsules without difficulty

  5. Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information (in accordance with national and local subject privacy regulations)

Exclusion Criteria:
  1. Any chemotherapy, therapeutic antineoplastic antibodies (not including radio- or toxin immunoconjugates), radiation therapy, or experimental antineoplastic therapy within 4 weeks of first dose of study drug

  2. Radio- or toxin-conjugated antibody therapy within 10 weeks of first dose of study drug

  3. Concomitant use of medicines known to cause QT prolongation or torsades de pointes

  4. Transformed lymphoma or Richter's transformation Any life-threatening illness, medical condition or organ system dysfunction which, in the investigator's opinion, could compromise the subject's safety, interfere with the absorption or metabolism of PCI-32765 PO, or put the study outcomes at undue risk

  5. Any of the following laboratory abnormalities: oAbsolute neutrophil count (ANC) < 1000 cells/mm3 (1.0 x 109/L) oPlatelet count < 50,000/mm3 (50 x 109/L) oSerum aspartate transaminase (AST/SGOT) or alanine transaminase (ALT/SGPT) ≥ 3.0 x upper limit of normal (ULN) oCreatinine > 2.0 x ULN or creatinine clearance < 40 mL/min

Contacts and Locations

Locations

Site City State Country Postal Code
1 Dana Farber Cancer Center Boston Massachusetts United States 02115
2 CLL Research and Treatment Program New Hyde Park New York United States 11042
3 Weill Medical College of Cornell University New York New York United States 10065
4 University of Rochester Rochester New York United States 14642
5 Sarah Cannon Research Institute Nashville Tennessee United States 37203
6 MD Anderson Houston Texas United States 77030

Sponsors and Collaborators

  • Pharmacyclics LLC.

Investigators

  • Study Director: Thorsten Graef, MD, Pharmacyclics LLC.

Study Documents (Full-Text)

None provided.

More Information

Additional Information:

Publications

None provided.
Responsible Party:
Pharmacyclics LLC.
ClinicalTrials.gov Identifier:
NCT01292135
Other Study ID Numbers:
  • PCYC-1108-CA
  • PCI-32765
First Posted:
Feb 9, 2011
Last Update Posted:
Jul 24, 2014
Last Verified:
Jul 1, 2014

Study Results

Participant Flow

Recruitment Details
Pre-assignment Detail
Arm/Group Title PCI-32765 Plus Fludarabine/Cyclophosphamide/Rituximab (FCR) PCI-32765 Plus Bendamustine/Rituximab (BR)
Arm/Group Description PCI-32765: 420 mg daily FCR: Rituximab: 375 mg/m2 on Day 1 of Cycle 1 and a dose of 500 mg/m2 on Day 1(Cycle 2 to Cycle 6). Fludarabine: 25 mg/m2/day for 3 days (Days 1 to 3) of each cycle Cyclophosphamide: 250 mg/m2/day for 3 days (Days 1 to 3) of each cycle (Up to 6 Cycle) PCI-32765: 420 mg daily BR: Rituximab: 375 mg/m2 on Day 1 of Cycle 1 and a dose of 500 mg/m2 on Day 1 (Cycle 2 to Cycle 6). Bendamustine; 70 mg/m² on Day 1 and 2 of each cycle (Up to 6 Cycles)
Period Title: Overall Study
STARTED 3 30
COMPLETED 3 21
NOT COMPLETED 0 9

Baseline Characteristics

Arm/Group Title PCI-32765 Plus Fludarabine/Cyclophosphamide/Rituximab (FCR) PCI-32765 Plus Bendamustine/Rituximab (BR) Total
Arm/Group Description PCI-32765: 420 mg daily PCI-32765: 420 mg daily Total of all reporting groups
Overall Participants 3 30 33
Age (Years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [Years]
56.3
(1.53)
61.3
(9.58)
60.8
(9.24)
Age (Count of Participants)
<=18 years
0
0%
0
0%
0
0%
Between 18 and 65 years
3
100%
19
63.3%
22
66.7%
>=65 years
0
0%
11
36.7%
11
33.3%
Sex: Female, Male (Count of Participants)
Female
0
0%
5
16.7%
5
15.2%
Male
3
100%
25
83.3%
28
84.8%
Region of Enrollment (participants) [Number]
United States
3
100%
30
100%
33
100%

Outcome Measures

1. Primary Outcome
Title Incidence of Prolonged Hematologic Toxicity Started in Cycle 1
Description
Time Frame From First day of dose to 30 days after last dose of any study medication. Participants were followed with a median follow-up time of 15.8 months.

Outcome Measure Data

Analysis Population Description
The FCR arm was discontinued due to very limited use of this chemo regimen in this setting, statistical analysis were limited due to the small numbers of subjects in this treatment arm.
Arm/Group Title PCI-32765 Plus Bendamustine/Rituximab (BR) PCI-32765 Plus Fludarabine/ Cyclophosphamide/ Rituximab (FCR)
Arm/Group Description PCI-32765: 420 mg daily PCI-32765: 420 mg daily
Measure Participants 30 3
Number (95% Confidence Interval) [Percentage of Participants]
0
0%
0
0%
2. Secondary Outcome
Title Incidence of Adverse Events Requiring Dose Delay or Discontinuation of Ibrutinib
Description
Time Frame From First day of dose to 30 days after last dose of any study medication. Participants were followed with a median follow-up time of 15.8 months.

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title PCI-32765 Plus Bendamustine/Rituximab (BR) PCI-32765 Plus Fludarabine/ Cyclophosphamide/ Rituximab (FCR)
Arm/Group Description PCI-32765: 420 mg daily PCI- 32765: 420 mg daily
Measure Participants 30 3
Number [Percentage of Participants]
53.3
1776.7%
33.3
111%
3. Secondary Outcome
Title Overall Incidence of Grade ≥3 Adverse Events (AEs) Per NCI CTCAE V4.0
Description
Time Frame From First day of dose to 30 days after last dose of any study medication. Participants were followed with a median follow-up time of 15.8 months.

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title PCI-32765 Plus Bendamustine/Rituximab (BR) PCI-32765 Plus Fludarabine/ Cyclophosphamide/ Rituximab (FCR)
Arm/Group Description PCI-32765: 420 mg daily PCI- 32765: 420 mg daily
Measure Participants 30 3
Number [Percentage of Participants]
66.7
2223.3%
0
0%
4. Secondary Outcome
Title Overall Incidence of Serious Adverse Events (SAEs)
Description
Time Frame From First day of dose to 30 days after last dose of any study medication. Participants were followed with a median follow-up time of 15.8 months.

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title PCI-32765 Plus Bendamustine/Rituximab (BR) PCI-32765 Plus Fludarabine/ Cyclophosphamide/ Rituximab (FCR)
Arm/Group Description PCI-32765: 420 mg daily PCI-32765: 420 mg daily
Measure Participants 30 3
Number [Percentage of Participants]
20
666.7%
33.3
111%
5. Secondary Outcome
Title Overall Response Rate (Complete Response [CR] + Complete Response With Incomplete Marrow Recovery [CRi] + Nodular Partial Response [nPR] + Partial Response [PR])
Description Response criteria are as outlined in the IWCLL 2008 criteria (Hallek 2008) and as assessed by investigator, e.g. response requires 50% reduction in lymph node size. Assessment of response to treatment will be done every 2 cycles for the first 6 months and then every 3 months thereafter until disease progression or prior to the administration of a new anticancer therapy and at follow-up visits.
Time Frame From first response assessment to last response assessment. Participants were followed with a median follow-up time of 15.8 months.

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title PCI-32765 Plus Bendamustine/Rituximab (BR) PCI-32765 Plus Fludarabine/ Cyclophosphamide/ Rituximab (FCR)
Arm/Group Description PCI-32765: 420 mg daily PCI-32765: 420 mg daily
Measure Participants 30 3
Number (95% Confidence Interval) [Percentage of Participants]
93.3
3110%
100
333.3%
6. Secondary Outcome
Title Sustained Hematologic Improvement in Subjects With Neutropenia, Anemia, or Thrombocytopenia at Baseline
Description
Time Frame From first response assessment to last response assessment. Participants were followed with a median follow-up time of 15.8 months.

Outcome Measure Data

Analysis Population Description
No participants in the FCR group had neutropenia, anemia or thrombocytopenia at baseline.
Arm/Group Title PCI-32765 Plus Bendamustine/Rituximab (BR) PCI-32765 Plus Fludarabine/ Cyclophosphamide/ Rituximab (FCR)
Arm/Group Description PCI-32765: 420 mg daily PCI-32765: 420 mg daily
Measure Participants 30 0
Number (95% Confidence Interval) [Percentage of Participants]
76.2
2540%
7. Secondary Outcome
Title Progression Free Survival Rate at 12 Months
Description Criteria for progression are as outlined in the IWCLL 2008 criteria (Hallek 2008) and as assessed by investigator, e.g. progression defined as a 50% increase in lymph node size.
Time Frame From first dose of any study medication to 12 months after first dose to progressive disease or death or the last clinical assessment before receiving new anticancer therapy or loss to follow-up, whichever occured the earliest.

Outcome Measure Data

Analysis Population Description
[Not Specified]
Arm/Group Title PCI-32765 Plus Bendamustine/Rituximab (BR) PCI- 32765 Plus Fludarabine/ Cyclophosphamide/ Rituximab (FCR)
Arm/Group Description PCI-32765: 420 mg daily PCI-32765: 420 mg daily
Measure Participants 30 3
Number (95% Confidence Interval) [Percentage of Participants]
85.9
2863.3%
100
333.3%

Adverse Events

Time Frame
Adverse Event Reporting Description
Arm/Group Title PCI-32765 Plus Bendamustine/Rituximab (BR) PCI-32765 Plus Fludarabine/ Cyclophosphamide/Rituximab (FCR)
Arm/Group Description PCI-32765: 420 mg daily PCI-32765: 420 mg daily
All Cause Mortality
PCI-32765 Plus Bendamustine/Rituximab (BR) PCI-32765 Plus Fludarabine/ Cyclophosphamide/Rituximab (FCR)
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total / (NaN) / (NaN)
Serious Adverse Events
PCI-32765 Plus Bendamustine/Rituximab (BR) PCI-32765 Plus Fludarabine/ Cyclophosphamide/Rituximab (FCR)
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 6/30 (20%) 1/3 (33.3%)
Blood and lymphatic system disorders
Febrile neutropenia 2/30 (6.7%) 0/3 (0%)
Gastrointestinal disorders
Gastritis 0/30 (0%) 1/3 (33.3%)
Infections and infestations
Cellulitis 2/30 (6.7%) 0/3 (0%)
Viral Infection 0/30 (0%) 1/3 (33.3%)
Metabolism and nutrition disorders
Dehydration 1/30 (3.3%) 0/3 (0%)
Tumour lysis syndrome 1/30 (3.3%) 0/3 (0%)
Other (Not Including Serious) Adverse Events
PCI-32765 Plus Bendamustine/Rituximab (BR) PCI-32765 Plus Fludarabine/ Cyclophosphamide/Rituximab (FCR)
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 30/30 (100%) 3/3 (100%)
Blood and lymphatic system disorders
Neutropenia 12/30 (40%) 1/3 (33.3%)
Thrombocytopenia 5/30 (16.7%) 2/3 (66.7%)
Anaemia 2/30 (6.7%) 2/3 (66.7%)
Eye disorders
Conjuctivitis 2/30 (6.7%) 0/3 (0%)
Gastrointestinal disorders
Diarrhoea 21/30 (70%) 1/3 (33.3%)
Nausea 20/30 (66.7%) 2/3 (66.7%)
Constipation 9/30 (30%) 0/3 (0%)
Vomiting 9/30 (30%) 0/3 (0%)
Gastrooesophageal reflux disease 6/30 (20%) 0/3 (0%)
Abdominal discomfort 4/30 (13.3%) 0/3 (0%)
Dry mouth 4/30 (13.3%) 1/3 (33.3%)
Stomatitis 4/30 (13.3%) 1/3 (33.3%)
Abdominal distension 3/30 (10%) 0/3 (0%)
Dyspepsia 3/30 (10%) 1/3 (33.3%)
Flatulence 2/30 (6.7%) 0/3 (0%)
Mouth ulceration 2/30 (6.7%) 0/3 (0%)
Tongue ulcerlation 2/30 (6.7%) 0/3 (0%)
General disorders
Fatigue 14/30 (46.7%) 0/3 (0%)
Oedema peripheral 10/30 (33.3%) 0/3 (0%)
Pyrexia 7/30 (23.3%) 0/3 (0%)
Chills 5/30 (16.7%) 0/3 (0%)
Asthenia 3/30 (10%) 0/3 (0%)
Pain 3/30 (10%) 0/3 (0%)
Chest discomfort 2/30 (6.7%) 0/3 (0%)
Impaired healing 2/30 (6.7%) 1/3 (33.3%)
Immune system disorders
Drug hypersensitivity 2/30 (6.7%) 0/3 (0%)
Seasonal allergy 3/30 (10%) 0/3 (0%)
Infections and infestations
Upper respiratory tract infection 11/30 (36.7%) 1/3 (33.3%)
Sinusitis 8/30 (26.7%) 0/3 (0%)
Urinary tract infection 4/30 (13.3%) 0/3 (0%)
Cellulitis 2/30 (6.7%) 0/3 (0%)
Nasopharyngitis 2/30 (6.7%) 0/3 (0%)
Pneomonia 2/30 (6.7%) 1/3 (33.3%)
Oral herpes 0/30 (0%) 1/3 (33.3%)
Rhinitis 1/30 (3.3%) 1/3 (33.3%)
Skin Infection 0/30 (0%) 1/3 (33.3%)
Injury, poisoning and procedural complications
Contusion 6/30 (20%) 0/3 (0%)
Arthropod bite 3/30 (10%) 0/3 (0%)
Joint dislocation 0/30 (0%) 1/3 (33.3%)
Investigations
Weight decreased 3/30 (10%) 0/3 (0%)
Blood uric acid increased 2/30 (6.7%) 0/3 (0%)
Metabolism and nutrition disorders
Decreased appetite 5/30 (16.7%) 0/3 (0%)
Hyperuricaemia 4/30 (13.3%) 1/3 (33.3%)
Hypomagnesaemia 4/30 (13.3%) 2/3 (66.7%)
Hyperglycaemia 3/30 (10%) 1/3 (33.3%)
Hypocalcaemia 3/30 (10%) 3/3 (100%)
Fluid retention 2/30 (6.7%) 0/3 (0%)
Hypophosphataemia 2/30 (6.7%) 1/3 (33.3%)
Hyponatraemia 1/30 (3.3%) 1/3 (33.3%)
Musculoskeletal and connective tissue disorders
Arthralgia 8/30 (26.7%) 0/3 (0%)
Muscle spasms 7/30 (23.3%) 0/3 (0%)
Back Pain 5/30 (16.7%) 0/3 (0%)
Myalgia 5/30 (16.7%) 1/3 (33.3%)
Bone pain 3/30 (10%) 0/3 (0%)
Pain in extremity 3/30 (10%) 0/3 (0%)
Muscular weakness 2/30 (6.7%) 0/3 (0%)
Musculoskeletal pain 0/30 (0%) 1/3 (33.3%)
Neck Pain 0/30 (0%) 1/3 (33.3%)
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Squamous cell carcinoma 6/30 (20%) 0/3 (0%)
Basal cell carcinoma 2/30 (6.7%) 0/3 (0%)
Nervous system disorders
Headache 9/30 (30%) 0/3 (0%)
Dizziness 7/30 (23.3%) 0/3 (0%)
Paraesthesia 2/30 (6.7%) 0/3 (0%)
Syncope 2/30 (6.7%) 0/3 (0%)
Psychiatric disorders
Insomnia 7/30 (23.3%) 0/3 (0%)
Depression 2/30 (6.7%) 0/3 (0%)
Renal and urinary disorders
Haematuria 3/30 (10%) 0/3 (0%)
Pollakiuria 3/30 (10%) 0/3 (0%)
Respiratory, thoracic and mediastinal disorders
Cough 4/30 (13.3%) 0/3 (0%)
Oropharyngeal pain 4/30 (13.3%) 0/3 (0%)
Sinus congestion 3/30 (10%) 0/3 (0%)
Epistaxis 2/30 (6.7%) 0/3 (0%)
Nasal congestion 2/30 (6.7%) 0/3 (0%)
Skin and subcutaneous tissue disorders
Rash maculo papular 5/30 (16.7%) 0/3 (0%)
Increased tendency to bruise 4/30 (13.3%) 0/3 (0%)
Rash 3/30 (10%) 0/3 (0%)
Dermatitis 2/30 (6.7%) 0/3 (0%)
Ecchymosis 2/30 (6.7%) 0/3 (0%)
Onychoclasis 2/30 (6.7%) 0/3 (0%)
Pruritus 2/30 (6.7%) 0/3 (0%)
Sunburn 2/30 (6.7%) 0/3 (0%)
Vascular disorders
Flushing 2/30 (6.7%) 0/3 (0%)
Hypotension 2/30 (6.7%) 0/3 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

Results Point of Contact

Name/Title Thorsten Graef, MD
Organization Pharmacyclics
Phone 855.427.8846
Email medinfo@pcyc.com
Responsible Party:
Pharmacyclics LLC.
ClinicalTrials.gov Identifier:
NCT01292135
Other Study ID Numbers:
  • PCYC-1108-CA
  • PCI-32765
First Posted:
Feb 9, 2011
Last Update Posted:
Jul 24, 2014
Last Verified:
Jul 1, 2014