AzTrials
AzTrials

Chronic Lymphocytic Leukemia (CLL)Phase 2NCT03788291

Acalabrutinib and High Frequency Low Dose Subcutaneous Rituximab in Patients With Previously Untreated Chronic Lymphocytic Leukemia / Small Lymphocytic Lymphoma

A Phase 2 study testing Acalabrutinib and Rituximab in people with Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL), run by University of Rochester at 1 site 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

The main purpose of this research study is to find out if the combination of acalabrutinib and high frequency low dose subcutaneous rituximab is safe and effective in patients who have previously untreated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Acalabrutinib and Rituximab
Could I receive a placebo?
No, everyone receives an active treatment
How many people
39 participants
Where
1 siteUnited States
Study dates
25 Mar 2019to 19 May 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

Who may be able to join

  • Diagnosis of B-cell CLL or SLL, with diagnosis established according to IWCLL criteria and documented within medical records. Patients must not have received previous therapy for CLL/SLL
  • CLL/SLL that warrants treatment consistent with accepted IWCLL criteria for initiation of therapy. Any one of the following conditions constitutes CLL/SLL that warrants treatment:
  • Evidence of progressive marrow failure as manifested by the onset or worsening of anemia and/or thrombocytopenia, or
  • Massive (i.e., lower edge of spleen ≥6 cm below the left costal margin), progressive, or symptomatic splenomegaly, or
  • Massive (i.e., ≥10 cm in the longest diameter), progressive, or symptomatic lymphadenopathy, or
  • Progressive lymphocytosis in the absence of infection, with an increase in blood absolute lymphocyte count (ALC) ≥50% over a 2-month period or lymphocyte doubling time of <6 months (as long as initial ALC was ≥30,000/L), or
Show all 23Show fewer
  • Autoimmune anemia and/or thrombocytopenia that is poorly responsive to corticosteroids or other standard therapy, or
  • Constitutional symptoms, defined as any one or more of the following disease-related symptoms or signs occurring in the absence of evidence of infection:
  • Unintentional weight loss of ≥10% within the previous 6 months, or
  • Significant fatigue (≥Grade 2), or
  • Fevers >100.5°F or 38.0°C for ≥2 weeks, or
  • Drenching night sweats for >1 month.
  • Adequate organ system function, defined as follows:
  • Absolute neutrophil count (ANC) ≥ 0.5x109/L and platelet count ≥ 30x109/L
  • Total bilirubin ≤2.5 times the upper limit of normal (ULN) unless due to Gilbert's disease
  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 x ULN if no liver involvement or ≤5 x the ULN if known liver involvement
  • Calculated creatinine clearance >30 mL/min (as calculated by the Cockcroft-Gault formula)
  • Patients with PT/INR or aPTT ≤2xULN.
  • ECOG performance status ≤ 2 unless related to CLL.
  • Male or female ≥ 18 years of age.
  • Ability to swallow and retain oral medication.
  • Woman of childbearing potential (WOCBP) who are sexually active must use highly effective methods of contraception during treatment and for 2 days after the last dose of acalabrutinib and for 12 months following last dose of rituximab. (see Appendix 3 for examples)
  • Willingness and ability to comply with study and follow-up procedures, and give written informed consent.

Who cannot join

  • Patients receiving cancer therapy (i.e., chemotherapy, radiation therapy, immunotherapy, biologic therapy, hormonal therapy, surgery).
  • Systemic corticosteroid therapy started prior to study entry is allowed as clinically warranted. Topical or inhaled corticosteroids are permitted.
  • Serologic status reflecting active hepatitis B or C infection. Patients who are hepatitis B core antibody (anti-HBc) positive and who are surface antigen negative will need to have a negative polymerase chain reaction (PCR). Those who are hepatitis B surface antigen (HbsAg) positive or hepatitis B PCR positive will be excluded. Subjects who are hepatitis C antibody positive will need to have a negative PCR result. Those who are hepatitis C PCR positive will be excluded.
  • Known history of HIV.
  • Known histological transformation from CLL to an aggressive lymphoma.
  • Evidence of ongoing systemic bacterial, fungal or viral infection, except localized fungal infections of skin or nails. NOTE: Patients may be receiving prophylactic antiviral or antibacterial therapies at investigator discretion.
Show all 23Show fewer
  • Live virus vaccines within 4 weeks prior to C1D1 or during rituximab therapy.
  • History of anaphylaxis (excluding infusion related reactions) in association with previous anti-CD20 administration or acalabrutinib.
  • Any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study such as:
  • Symptomatic, or history of documented congestive heart failure (NY Heart Association functional classification III-IV)
  • Uncontrolled cardiac arrhythmia (Patients with controlled atrial fibrillation/flutter are eligible)
  • Myocardial infarction within 3 months of enrollment
  • Angina not well-controlled by medication
  • Poorly controlled or clinically significant atherosclerotic vascular disease including cerebrovascular accident (CVA), transient ischemic attack (TIA), angioplasty, cardiac/vascular stenting within 3 months of enrollment.
  • Active bleeding or history of bleeding diathesis (eg, hemophilia or von Willebrand disease).
  • Any history of intracranial bleed or stroke within 6 months of first dose of study drug
  • Patients with suspected or confirmed PML
  • Patients with malabsorption syndrome or gastrointestinal disease that limits absorption of oral medication
  • Malignancy within 2 years of study enrollment except for adequately treated basal, squamous cell carcinoma or non-melanomatous skin cancer, carcinoma in situ of the cervix, superficial bladder cancer not treated with intravesical chemotherapy or BCG within 6 months, localized prostate cancer and PSA <1.0 mg/dL on 2 consecutive measurements at least 3 months apart with the most recent one being within 4 weeks of study entry.
  • Patients with active uncontrolled autoimmune hemolytic anemia or ITP.
  • Inability to discontinue use of strong CYP3A inhibitors. Patients taking moderate CYP3A inhibitors or strong CYP3A inducers are eligible.
  • Requires or receiving anticoagulation with warfarin or equivalent vitamin K antagonists (eg, phenprocoumon) within 7 days of first dose of study drug.
  • Requires treatment with proton pump inhibitors (eg, omeprazole, esomeprazole, lansoprazole, dexlansoprazole, rabeprazole, or pantoprazole) at study entry. Subjects receiving proton pump inhibitors who switch to H2-receptor antagonists or antacids are eligible for enrollment to this study.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Rochester

    Rochester, New York, 14642

Other trials in United States

About this study

Official title: Phase II Study of Acalabrutinib and High Frequency Low Dose Subcutaneous Rituximab in Patients With Previously Untreated CLL/SLL

The main purpose of this research study is to find out if the combination of acalabrutinib and high frequency low dose subcutaneous rituximab is safe and effective in patients who have previously untreated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL).

Read the detailed description

Despite an array of available therapies, CLL remains an incurable disease. Furthermore, the presence of certain cytogenetic abnormalities and high-risk mutational features predicts for a reduced response to treatment, and as a result, a shorter period of progression-free survival. The development of a well-tolerated more effective, easily administered and limited duration therapy would be a major contribution to the management of CLL and other B cell malignancies.

Acalabrutinib is an imidazopyrazine analogue and a potent inhibitor of BTK in vitro and in vivo. Acalabrutinib shows improved selectivity for BTK compared with ibrutinib. Functional inhibition of non-target cells (eg, T cells, NK cells, platelets) was not observed for acalabrutinib at clinically relevant concentrations. Rituximab is a chimeric monoclonal antibody targeting CD20 FDA approved for the treatment of CLL/SLL using intravenous or subcutaneous formulations.

Antibody dependent cellular phagocytosis may be optimized using high frequency subcutaneous administration of anti-CD20 monoclonal antibodies. Unlike ibrutinib, acalabrutinib does not cause significant in vitro inhibition of rituximab induced antibody dependent cellular phagocytosis in vitro. The investigator thus proposes that acalabrutinib would be an ideal partner drug with high frequency low dose SQ rituximab in the treatment of CLL and that the combination will increase the efficacy of therapy for CLL patients by decreasing the time to achievement of complete response and allowing for shorter and less toxic therapy.

Being tested
Acalabrutinib, Rituximab
Keywords
Chronic Lymphocytic Leukemia (CLL), Small Lymphocytic Lymphoma (SLL), Phase II, Acalabrutinib, Rituximab
Medical subject headings
Leukemia, Lymphocytic, Chronic, B-Cell

What participants receive

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

  • AcalabrutinibDrug

    100 mg by mouth twice a day starting on day 8 of cycle 1

  • RituximabDrug

    Administered 2 times weekly for 6 cycles. Initial dose day 1: 50 mg IV, then 50 mg SQ thereafter.

Study groups in NCT03788291
Study groupRoleWhat they receive
Acalabrutinib and Rituximab treatmentExperimentalRituximab: administered 2 times weekly for 6 cycles. Initial dose day 1: 50 mg IV, Then 50 mg SQ thereafter. Acalabrutinib: 100 mg po BID starting on day 8 of cycle 1. * Patients who have attained a complete response who are also MRD negative at cycle 12 will undergo a BM biopsy to confirm CR and MRD negatively. If confirmed, the patient will stop therapy and be followed until disease progression. * Patients not in a MRD negative CR, will continue acalabrutinib. * Repeat response assessments (CTs, MRD testing in blood) will be performed at 24 cycles of therapy for those continuing on acalabrutinib. If both negative the patient will undergo a BM biopsy to confirm CR and MRD negativity. If confirmed, the patient will stop therapy and be followed until disease progression. In the absence of a CR or if MRD +, acalabrutinib may be continued until disease progression, unacceptable toxicity or physician/patient discretion.
Receives: Drug: Acalabrutinib; Drug: Rituximab

What is being measured

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

  1. Proportion of Subjects With a Complete Response Rate (CR) at 1 Year of Therapy

    To satisfy criteria for a CR, all of the following criteria must be met:

    • No evidence of new disease
    • ALC in peripheral blood of <4 x 109/L
    • Regression of all target nodal masses to normal size ≤1.5 cm in the LD
    • Normal spleen and liver size
    • Regression to normal of all nodal non-target disease and disappearance of all detectable non-nodal, non-target disease
    • Morphologically negative bone marrow defined as <30% of nucleated cells being lymphoid cells and no lymphoid nodules in a bone marrow sample (the presence of benign reactive nodules is still compatible with a CR)
    • Absence of constitutional symptoms
    • Peripheral blood counts meeting all of the following criteria:
    • ANC >1.5 x 109/L without need for exogenous growth factors (e.g., G-CSF)
    • Platelet count ≥100 x 109/L without need for exogenous growth factors
    • Hemoglobin ≥110 g/L (11.0 g/dL) without red blood cell transfusions or need for exogenous growth factors (e.g., erythropoietin)

    Measured: 1 year

Secondary outcomes (1)
  1. Proportion of Subjects With Minimal Residual Disease in Peripheral Blood and Bone

    6-color flow cytometry was performed on patients achieving a complete response to evaluate for minimal residual disease.

    Measured: 1 year

Timeline

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

  1. First posted27 Dec 2018
  2. Study start25 Mar 2019
  3. Primary completion19 May 2023
  4. Study completion19 May 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
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
39 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03788291
Sponsor's protocol ID
ULYM18086
Status last verified
Sep 2024
First submitted
24 Dec 2018
Last updated
26 Sep 2024
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Wallace DS, Zent CS, Baran AM, Reagan PM, Casulo C, Rice G, Friedberg JW, Barr PM. Acalabrutinib and high-frequency low-dose subcutaneous rituximab for initial therapy of chronic lymphocytic leukemia. Blood Adv. 2023 Jun 13;7(11):2496-2503. doi: 10.1182/bloodadvances.2022009382.

    PubMed 36689726

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Acalabrutinib and Rituximab in people with Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL), run by University of Rochester at 1 site 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?

The sponsor lists 23 inclusion and 23 exclusion criteria. 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 26 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site 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 26 Sep 2024). 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?

Proportion of Subjects With a Complete Response Rate (CR) at 1 Year of Therapy (time frame: 1 year). 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 NCT03788291, 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 26 Sep 2024.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in