Efficacy of Axicabtagene Ciloleucel Compared to Standard of Care Therapy in Subjects With Relapsed/Refractory Diffuse Large B Cell Lymphoma

Overview

The purpose of this study is to evaluate whether axicabtagene ciloleucel therapy improves the clinical outcome compared with standard of care second-line therapy in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL).

Full Title of Study: “A Phase 3, Randomized, Open-Label Study Evaluating Efficacy of Axicabtagene Ciloleucel Versus Standard of Care Therapy in Subjects With Relapsed/Refractory Diffuse Large B Cell Lymphoma”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: January 15, 2022

Detailed Description

This is a phase 3 randomized, open-label, multicenter study evaluating the efficacy of axicabtagene ciloleucel versus standard of care therapy in subjects with relapsed/refractory DLBCL. Adult subjects with relapsed/refractory DLBCL after first-line rituximab and anthracycline-based chemotherapy will be randomized in a 1:1 ratio to receive axicabtagene ciloleucel or standard of care second-line therapy. Standard of care will consist of a protocol-defined, platinum-based salvage combination chemotherapy regimen followed by high-dose therapy and autologous stem cell transplant in those who respond to salvage chemotherapy.

Interventions

  • Biological: Axicabtagene Ciloleucel
    • A single infusion of chimeric antigen receptor (CAR)-transduced autologous T cells administered intravenously following a conditioning chemotherapy regimen of fludarabine and cyclophosphamide
  • Drug: Platinum-containing salvage chemotherapy (eg, R-ICE) followed by high dose therapy (eg, BEAM) and autologous stem cell transplant in responders.
    • Platinum-containing salvage chemotherapy (R-ICE, R-DHAP, R-ESHAP, or R-GDP as selected by treating investigator) followed by high dose therapy (eg, BEAM) and autologous stem cell transplant in responders.
  • Drug: Cyclophosphamide
    • Administered intravenously
  • Drug: Fludarabine
    • Administered intravenously

Arms, Groups and Cohorts

  • Experimental: Axicabtagene Ciloleucel Treatment
  • Active Comparator: Standard of Care Therapy

Clinical Trial Outcome Measures

Primary Measures

  • Event Free Survival (EFS)
    • Time Frame: Up to 5 years
    • Event free survival is defined as the time from randomization to the earliest date of disease progression per Lugano Classification (Cheson et al, 2014), commencement of new lymphoma therapy, or death from any cause as determined by blinded central review

Secondary Measures

  • Objective Response Rate (ORR)
    • Time Frame: Up to 5 years
    • Objective response rate is defined as the incidence of either a complete response or a partial response by the Lugano Classification (Cheson et al, 2014) as determined by blinded central review
  • Overall Survival (OS)
    • Time Frame: Up to 5 years
    • Overall survival is defined as the time from randomization to death from any cause
  • Modified Event Free Survival (mEFS)
    • Time Frame: Up to 5 years
    • Modified event free survival is defined the same way as EFS, except that failure to attain CR or PR by Day 150 assessment is not considered an event. mEFS will be analyzed per blinded central review and per investigator disease assessments.
  • Progression-Free Survival (PFS)
    • Time Frame: Up to 5 years
    • Progression Free Survival is defined as the time from randomization to disease progression per Lugano Classification (Cheson et al, 2014) or death from any cause
  • Duration of Response (DOR)
    • Time Frame: Up to 5 years
    • Duration of Response is derived only among subjects who experience an objective response per Lugano Classification (Cheson et al, 2014) as determined by blinded central review and is defined as the time from first response to disease progression per the Lugano Classification or death from any cause
  • Percentage of Adverse Events and Clinical Significant Changes in Safety Lab Values, including antibodies to axicabtagene ciloleucel.
    • Time Frame: Up to 5 years
  • Changes in European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Cancer-30 (EORTC QLQ-C30) domains
    • Time Frame: Up to 5 years
    • The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Cancer-30 (EORTC QLQ-C30) is a multi-item questionnaire measuring the following content five (5) multi-item functional scales, three (3) multi-item symptom scales, one (1) global health status scale, and one (1) global health-related quality of life (HRQoL) each scale is measured from 0 to 100 after a linear transformation. Higher scores for functioning scales and for the Global Health Status or Global HRQoL scales indicate a higher level of functioning and a better HRQoL respectively, whereas higher scores in symptom scales represent a higher level of symptoms.
  • Changes over time in the European Quality of Life Five Dimensions Five Levels scale(EQ-5D-5L)
    • Time Frame: Up to 5 years
    • The Euro-QOL, Five Dimensions, Five Levels (EQ-5D-5L) questionnaire is a generic measure of health status that provides a simple descriptive profile and a single index value. The EQ-5D-5L comprises 2 components: a questionnaire covering 5 dimensions and a tariff of values based upon direct valuations of health states using a visual analog scale (VAS).
  • Changes over time in the Visual analog scale (VAS) scores
    • Time Frame: Up to 5 years
    • The EQ-5D-5L VAS is a 20-cm VAS for recording self-rated current HRQoL state and is used to describe the subjects’ health status on the day of the assessment. The EQ-5D-5L VAS score is recorded by each subject for his or her current HRQoL state and scored 0 (“the worst health you can imagine”) to 100 (“the best health you can imagine”).

Participating in This Clinical Trial

Key Inclusion Criteria:

1. Histologically proven large B-cell lymphoma including the following types defined by WHO 2016 (Swerdlow et al, 2016)

  • DLBCL not otherwise specified (ABC/GCB) – HGBL with or without MYC and BCL2 and/or BCL6 rearrangement – DLBCL arising from FL – T-cell/histiocyte rich large B-cell lymphoma – DLBCL associated with chronic inflammation – Primary cutaneous DLBCL, leg type – Epstein-Barr virus (EBV) + DLBCL 2. Relapsed or refractory disease after first-line chemoimmunotherapy – Refractory disease defined as no complete remission to first-line therapy; individuals who are intolerant to first-line therapy are excluded. – Progressive disease (PD) as best response to first-line therapy – Stable disease (SD) as best response after at least 4 cycles of first-line therapy (eg, 4 cycles of R-CHOP) – Partial response (PR) as best response after at least 6 cycles and biopsy-proven residual disease or disease progression ≤ 12 months of therapy – Relapsed disease defined as complete remission to first-line therapy followed by biopsy-proven relapse ≤ 12 months of first-line therapy 3. Individuals must have received adequate first-line therapy including at a minimum: – Anti-CD20 monoclonal antibody unless investigator determines that tumor is CD20 negative, and – An anthracycline containing chemotherapy regimen 4. No known history or suspicion of central nervous system involvement by lymphoma 5. Eastern cooperative oncology group (ECOG) performance status of 0 or 1 6. Adequate bone marrow function as evidenced by: – Absolute neutrophil count (ANC) ≥ 1000/uL – Platelet ≥ 75,000/uL – Absolute lymphocyte count ≥ 100/uL 7. Adequate renal, hepatic, cardiac, and pulmonary function as evidenced by: – Creatinine clearance (Cockcroft Gault) ≥ 60 mL/min – Serum Alanine aminotransferase/Aspartate aminotransferase (ALT/AST) ≤ 2.5 Upper limit of normal (ULN) – Total bilirubin ≤ 1.5 mg/dl – Cardiac ejection fraction ≥ 50%, no evidence of pericardial effusion as determined by an Echocardiogram (ECHO), and no clinically significant Electrocardiogram (ECG) findings – No clinically significant pleural effusion – Baseline oxygen saturation > 92% on room air Key Exclusion Criteria:

1. History of malignancy other than nonmelanoma skin cancer or carcinoma in situ (eg cervix, bladder, breast) unless disease free for at least 3 years 2. Received more than one line of therapy for DLBCL 3. History of autologous or allogeneic stem cell transplant 4. Presence of fungal, bacterial, viral, or other infection that is uncontrolled or requiring intravenous antimicrobials for management. 5. Known history of infection with human immunodeficiency virus (HIV) or hepatitis B (HBsAg positive) or hepatitis C virus (anti-HCV positive). If there is a positive history of treated hepatitis B or hepatitis C, the viral load must be undetectable per quantitative polymerase chain reaction (PCR) and/or nucleic acid testing. 6. Individuals with detectable cerebrospinal fluid malignant cells or known brain metastases, or with a history of cerebrospinal fluid malignant cells or brain metastases. 7. History or presence of non-malignant central nervous system (CNS) disorder such as seizure disorder, cerebrovascular ischemia/hemorrhage, dementia, cerebellar disease, or any autoimmune disease with CNS involvement 8. Presence of any indwelling line or drain. Dedicated central venous access catheter such as a Port-a-Cath or Hickman catheter are permitted. 9. History of myocardial infarction, cardiac angioplasty or stenting, unstable angina, New York Heart Association Class II or greater congestive heart failure, or other clinically significant cardiac diseases within 12 months of enrollment 10. History of symptomatic deep vein thrombosis or pulmonary embolism within 6 months of enrollment 11. History of autoimmune disease, requiring systemic immunosuppression and/or systemic disease modifying agents within the last 2 years 12. History of anti-CD19 or CAR-T therapy or history of prior randomization in ZUMA-7 Note: Other protocol defined Inclusion/Exclusion criteria may apply

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Kite, A Gilead Company
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Kite Study Director, Study Director, Kite, A Gilead Company

References

Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, Lister TA; Alliance, Australasian Leukaemia and Lymphoma Group; Eastern Cooperative Oncology Group; European Mantle Cell Lymphoma Consortium; Italian Lymphoma Foundation; European Organisation for Research; Treatment of Cancer/Dutch Hemato-Oncology Group; Grupo Español de Médula Ósea; German High-Grade Lymphoma Study Group; German Hodgkin's Study Group; Japanese Lymphorra Study Group; Lymphoma Study Association; NCIC Clinical Trials Group; Nordic Lymphoma Study Group; Southwest Oncology Group; United Kingdom National Cancer Research Institute. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014 Sep 20;32(27):3059-68.

Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, Advani R, Ghielmini M, Salles GA, Zelenetz AD, Jaffe ES. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016 May 19;127(20):2375-90. doi: 10.1182/blood-2016-01-643569. Epub 2016 Mar 15. Review.

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