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Follicular LymphomaPhase 2PrE0403NCT03113422

Phase II Venetoclax, Obinutuzumab and Bendamustine in High Tumor Burden Follicular Lymphoma as Front Line Therapy

A Phase 2 study testing Induction Venetoclax and Maintenance Venetoclax in people with Follicular Lymphoma and Non-Hodgkin's Lymphoma Follicular, run by PrECOG, LLC. at 10 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Patients with high tumor burden, low grade follicular lymphoma that has never been treated, will receive venetoclax in combination with obinutuzumab and bendamustine. Venetoclax is an oral Bcl-2 family protein inhibitor. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Induction Venetoclax and Maintenance Venetoclax
Could I receive a placebo?
No, everyone receives an active treatment
How many people
56 participants
Where
10 sitesUnited States
Study dates
27 Dec 2017to 6 Jan 2023
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult
  • Patient must have a histologically confirmed (biopsy-proven) diagnosis of follicular B-cell non-Hodgkin lymphoma (WHO classification: follicular center grades 1, 2, and 3a [3b patients are not eligible]), with no evidence of transformation to large cell histology.
  • Patient must meet criteria for High Tumor Burden (higher risk) as defined by either the Groupe D'Etude des Lymphomes Follicularies (GELF) criteria [at least one criterion] OR the follicular lymphoma international prognostic index (FLIPI) [score of 3, 4, or 5].
  • Patient must have Stage II, III or IV disease.
  • Baseline measurements and evaluations (PET/ CT) must be obtained within 10 weeks of randomization to the study. Patient must have at least one objective measurable disease parameter.
  • Age ≥ 18 years.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.
  • Ability to understand and willingness to sign Institutional Review Board (IRB)-approved informed consent.
  • Willing to provide mandatory tissue samples (if sufficient tissue available) for research purposes.
  • Adequate organ function as measured by the following criteria:
  • Absolute Neutrophil Count (ANC) ≥ 1000/mm³
  • Hemoglobin ≥ 8 g/dL
  • Platelets ˃75,000/mm³
  • Creatinine clearance ≥ 50 mL/min, calculated with the use of 24-hour creatinine clearance or by Cockcroft-Gault formula
  • Total Bilirubin ≤ 1.5x Upper Limit of Normal (ULN) or ≤ 3x ULN for patients with documented Gilbert's syndrome
  • Aspartate aminotransferase (AST)/ alanine aminotransferase (ALT) ≤ 2.5x ULN
  • Alkaline Phosphatase <5x ULN
  • All females of childbearing potential (not surgically sterilized and between menarche and 1 year post menopause) must have a blood or urine test to rule out pregnancy within 2 weeks prior to registration.
  • Women must not be pregnant or breastfeeding.
  • Patient must have had no prior chemotherapy, radiotherapy or immunotherapy for lymphoma. For purposes of this trial, prednisone or other corticosteroids used for non-lymphomatous conditions will not be considered as prior chemotherapy. In addition, a prior/recent short course (<2 weeks) of steroids for symptom relief of lymphoma-related symptoms will not make a patient ineligible.
  • Patient must have no recent history of malignancy except for adequately treated basal cell or squamous cell skin cancer, Stage I melanoma of the skin, or in situ cervical cancer. Individuals in documented remission without treatment for ≥ 2 years prior to enrollment may be included at the discretion of the investigator.
  • Patient must have no active, uncontrolled infections.
  • Patients must be tested for hepatitis B virus (HBV), hepatitis B surface antigen (HBsAg+) and hepatitis C (HCV) antibody within 6 weeks of registration. Patients who are chronic carriers of HBV with positive HBsAg+ and positive HCV serology are excluded, as chemotherapy and B-cell depleting therapy have been associated with virus reactivation and fulminant hepatitis. NOTE: Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) may be included if HBV DNA is undetectable. If enrolled, patients must be willing to undergo monthly HBV DNA testing. Patients with positive HCV antibody must be negative for HCV by polymerase chain reaction (PCR) to be eligible for study participation.
  • HIV positive patients are not excluded, but to enroll, must meet all of the below criteria:
  • HIV is sensitive to antiretroviral therapy.
  • Must be willing to take effective antiretroviral therapy if indicated.
  • No history of CD4 prior to or at the time of lymphoma diagnosis <300 cells/mm³.
  • No history of AIDS-defining conditions.
  • If on antiretroviral therapy, must not be taking zidovudine or stavudine.
  • Must be willing to take prophylaxis for Pneumocystis jiroveci pneumonia during therapy and until at least 2 months following the completion of therapy or until the CD4 cells recover to over 250 cells/mm³, whichever occurs later.
  • Evidence of significant, uncontrolled concomitant diseases that could affect compliance with the protocol or interpretation of results or that could increase risk to the patient.
  • No major surgery within 2 weeks prior to cycle 1, other than for diagnosis.
  • A condition that precludes oral route of administration (venetoclax).
  • No known allergies to both xanthine oxidase inhibitors and rasburicase.
  • Patient must not require the use of warfarin (because of potential drug-drug interactions that may potentially increase the exposure of warfarin). Blood thinners of other classes are permitted.
  • Patient may not receive the following agents within 7 days prior to the first dose of venetoclax:
  • Strong and moderate CYP3A inhibitors
  • Strong and moderate CYP3A inducers
  • Consumed grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges), or star fruit within 3 days prior to the first dose of venetoclax.
  • Patient must not have serious medical or psychiatric illness likely to interfere with participation in this clinical study.

Trial locations and contacts

10 sites in 1 country.

10 sites in 1 country

United States10 sites

  • Winship Cancer Institute of Emory University

    Atlanta, Georgia, 30322

  • Sidney Kimmel Comprehensive Cancer Center at John Hopkins

    Baltimore, Maryland, 21205

  • University of Virginia

    Charlottesville, Virginia, 22908

  • Gunderson Health System Cancer Center

    La Crosse, Wisconsin, 54601

  • University of Wisconsin

    Madison, Wisconsin, 53792

  • Vanderbilt-Ingram Cancer Center

    Nashville, Tennessee, 37232

  • Rutgers Cancer Institute of NJ

    New Brunswick, New Jersey, 08903

  • Fox Chase

    Philadelphia, Pennsylvania, 19111

  • Mayo Clinic

    Rochester, Minnesota, 55905

  • Washington University School of Medicine

    St Louis, Missouri, 63110

Other trials in United States

About this study

Official title: Phase II Study of Venetoclax (ABT-199/GDC-0199) in Combination With Obinutuzumab and Bendamustine in Patients With High Tumor Burden Follicular Lymphoma as Front Line Therapy

Patients with high tumor burden, low grade follicular lymphoma that has never been treated, will receive venetoclax in combination with obinutuzumab and bendamustine.

Venetoclax is an oral Bcl-2 family protein inhibitor. It targets the B-cell lymphoma 2 (BCL-2) protein, which supports cancer cell growth and is overexpressed in many patients with follicular lymphoma. Venetoclax may help to slow down the growth of cancer or may cause cancer cells to die.

Read more

The purpose of this study is to see whether adding venetoclax to obinutuzumab and bendamustine improves the response (the tumor shrinks or disappears) in patients with follicular lymphoma.

As of 9/5/2018, a higher than expected incidence of tumor lysis syndrome (TLS) was experienced among patients receiving venetoclax, obinutuzumab and bendamustine on Cycle 1, Day 1 of treatment. TLS is caused by the fast breakdown of cancer cells. These patients developed an increase in some of their blood tests (uric acid, phosphorus, potassium and/or creatinine). They received a medication called rasburicase and continued with treatment. It is unclear if the TLS was due to the venetoclax or the standard treatment of obinutuzumab and bendamustine. For the remaining patients, venetoclax will start on Cycle 2, Day 1 (previously Cycle 1, Day 1).

As of 9/16/2021, additional maintenance therapy has been suspended for those patients who remain on study. These patients will not receive any further treatment and will move on to the two year survival follow-up.

Read the detailed description

Follicular lymphoma (FL) is the most common low grade lymphoma comprising 70% of low-grade non-Hodgkin's lymphoma (NHL) and 22% of all cases of NHL. The survival rates for patients with indolent NHL remained unchanged from the 1950s through the early 1990s, but recent evidence suggests that outcomes continue to improve. High-risk patients with FL, defined as having advanced stage and high tumor burden have significantly shorter progression free survival despite significant advances.

This is an open-label phase II study of venetoclax in combination with obinutuzumab and bendamustine. Patients will receive induction therapy with obinutuzumab and bendamustine for six cycles (1 cycle = 28 days). Venetoclax will start with 2nd cycle of induction therapy (previously started with cycle 1). There will be a formal, detailed toxicity evaluation after 21 patients complete 3 cycles of treatment.

Patients who achieve partial response or stable disease will receive therapy with obinutuzumab every 2 months for 12 cycles and venetoclax every month for 24 cycles. Patients who achieve a complete response will receive obinutuzumab every 2 months for 12 cycles. Patients with progressive disease will not continue onto the maintenance arm.

Tumor assessments will be performed approximately every 12 weeks during induction and every 6 months during maintenance therapy.

Mandatory pre-treatment tumor tissue sample (i.e., obtained during a previous procedure or biopsy) will be required for research (if sufficient tissue is available). Optional tumor biopsy samples obtained during treatment or post-treatment will also be requested for research.

Being tested
Induction Venetoclax, Maintenance Venetoclax
Keywords
High Tumor Burden Follicular Lymphoma, Venetoclax, Obinutuzumab, Bendamustine, Bcl-2 Family Protein Inhibitor, Monoclonal Antibody
Medical subject headings
Lymphoma, Follicular, Lymphoma, Non-Hodgkin

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Induction VenetoclaxDrug

    Also called GDC-0199, ABT-199, RO5537382

    1 cycle = 28 days.

    • Cycle 1-6: Obinutuzumab IV. Cycle 1, Day 1 obinutuzumab 100 mg and Cycle 1, Day 2 obinutuzumab 900 mg for total dose of 1000 mg. On Cycle 1, Day 8 and Day 15 obinutuzumab 1000 mg. Starting with Cycle 2, obinutuzumab 1000 mg on Day 1 only of each cycle.
    • Cycle 1-6: Bendamustine 90 mg/m² IV on Days 1 and 2 of each cycle over 15 minutes after obinutuzumab.
    • Cycle 2-6: Venetoclax 800 mg by mouth daily on Days 1-10 administered before obinutuzumab and/or bendamustine.

  • Maintenance VenetoclaxDrug

    Also called GDC-0199, ABT-199, RO5537382

    Patients whose disease is the same or improved will receive venetoclax 800 mg by mouth daily for 24 cycles (1 cycle=1 month) and obinutuzumab 1000 mg IV every 2 months for 12 cycles. Patients with no evidence of disease will receive obinutuzumab 1000 mg IV every 2 months for 12 cycles.

Study groups in NCT03113422
Study groupRoleWhat they receive
Induction VenetoclaxExperimentalCycle 1-6: Obinutuzumab intravenously (IV) and bendamustine IV. Cycle 2-6: Venetoclax (oral)
Receives: Drug: Induction Venetoclax
Maintenance VenetoclaxExperimentalPatients with stable or improved disease will receive venetoclax by mouth daily for 24 cycles (1 cycle=1 month) and obinutuzumab IV every 2 months for 12 cycles. Patients with no evidence of disease will receive obinutuzumab IV every 2 months for 12 cycles.
Receives: Drug: Maintenance Venetoclax

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Complete Response (CR) at End of Induction

    CR assessed in accordance with Lymphoma Response Criteria (Lugano Criteria)

    Measured: After 6 cycles (at 28 days/cycle) of induction therapy.

Secondary outcomes (6)

  1. Overall Response Rate (ORR)

    ORR assessed in accordance with Lymphoma Response Criteria (Lugano Criteria)

    Measured: After 6 cycles (at 28 days/cycle) of induction therapy

  2. Convert to CR During Maintenance Therapy (From PR in Induction)

    Conversion to CR during Maintenance Therapy assessed in accordance with Lymphoma Response Criteria (Lugano Criteria)

    Measured: Up to 24 cycles which corresponds to 22 months (at 28 days/cycle)

  3. Progression-Free Survival (PFS) in the Intent to Treat (ITT) Population.

    PFS assessed in accordance with Lymphoma Response Criteria (Lugano Criteria)

    Measured: Up to 24 months

  4. Overall Survival (OS) in the ITT Population.

    OS assessed in accordance with Lymphoma Response Criteria (Lugano Criteria)

    Measured: Up to 24 months

  5. Number of Participants With Treatment-related GRADE 3+ Adverse Events as Assessed by CTCAE V4.0

    Number of participants with abnormal laboratory values and/or adverse events related to treatment of GRADE 3 or higher

    Measured: Adverse events were captured through 6 cycles of therapy (at 28 days/cycle) and for 30 days after the last dose, for a total assessment period of approximately 7 months.

  6. Patient Compliance in Receiving Induction Therapy

    Off treatment Reasons

    Measured: Up to 6 cycles (at 28 days/cycle)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Apr 2017
  2. Study start27 Dec 2017
  3. Primary completion3 May 2021
  4. Study completion6 Jan 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
56 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03113422
Sponsor's protocol ID
PrE0403
Other IDs
ML39161
Acronym
PrE0403
Status last verified
May 2025
First submitted
10 Apr 2017
Last updated
23 May 2025
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No: Data is proprietary.

Publications

  • Portell CA, Jegede OA, Wagner-Johnston N, Nowakowski GS, Fletcher C, Cohen JB, Evens AM, Rosenstein LJ, Craig JW, Reddy N, Kahl BS. Phase II study of venetoclax added to bendamustine and obinutuzumab in patients with high-risk follicular lymphoma as front-line therapy: PrE0403. Blood Cancer J. 2025 May 12;15(1):93. doi: 10.1038/s41408-025-01300-1.

    PubMed 40355425

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Induction Venetoclax and Maintenance Venetoclax in people with Follicular Lymphoma and Non-Hodgkin's Lymphoma Follicular, run by PrECOG, LLC. at 10 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 23 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 18 Jul 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Complete Response (CR) at End of Induction (time frame: After 6 cycles (at 28 days/cycle) of induction therapy.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03113422, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 May 2025.

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