Recurrent Chronic Lymphocytic LeukemiaPhase 2NCT04941716
Acalabrutinib in Combination With Venetoclax for the Treatment of Refractory or Recurrent Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma, The AVENUE-2 Trial
A Phase 2 study testing Acalabrutinib, Venetoclax and Biospecimen Collection in people with Recurrent Chronic Lymphocytic Leukemia and Recurrent Small Lymphocytic Lymphoma, run by Fred Hutchinson Cancer Center at 1 site in United States.
Trial summary
This phase II trial is to evaluate the effects of acalabrutinib in combination with venetoclax in treating patients with chronic lymphocytic leukemia or small lymphocytic lymphoma that does not respond to treatment (refractory) or that has come back (recurrent). Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Recurrent Chronic Lymphocytic Leukemia, Recurrent Small Lymphocytic Lymphoma, Refractory Chronic Lymphocytic Leukemia
- What is being tested?
- Acalabrutinib, Venetoclax and Biospecimen Collection
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 20 participants
- Where
- 1 siteUnited States
- Study dates
- 31 May 2023to 10 Aug 2031
- Phase
- Phase 2
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
- Men and women >= 18 years of age.
- Diagnosis of CLL or small lymphocytic lymphoma (SLL) that meets the published diagnostic criteria.
- Active disease per IWCLL 2018 criteria that require treatment. At least one of the following:
- Evidence of progressive marrow failure as manifested by the development of, or worsening of, anemia and/or thrombocytopenia
- Massive (> 6 cm below left costal margin), progressive, or symptomatic splenomegaly
- Massive nodes (> 10 cm in longest diameter), or progressive or symptomatic lymphadenopathy
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- Progressive lymphocytosis with an increase of > 50% over a 2-month period or lymphocyte-doubling time of < 6 months. Lymphocyte-doubling time may be obtained by linear regression extrapolation of absolute lymphocyte counts obtained at intervals of 2 weeks over an observation period of 2 to 3 months. In patients with initial blood lymphocyte counts of < 30 x 109/L lymphocyte-doubling time should not be used as a single parameter to define treatment indication. In addition, factors contributing to lymphocytosis or lymphadenopathy other than CLL/SLL (e.g., infection) should be excluded.
- Constitutional symptoms, defined as any 1 or more of the following disease-related symptoms or signs
- Unintentional weight loss of > 10% within the previous 6 months
- Significant fatigue
- Fevers > 100.5 degrees Fahrenheit (F) or 38 degrees Celsius (C) for 2 weeks without other evidence of infection
- Night sweats for > 1 month without evidence of infection
- Relapsed or refractory to at least 1 prior systemic therapy for CLL/SLL. A line of therapy is defined as completing at least 2 cycles of treatment of standard regimen according to current National Comprehensive Cancer Network (NCCN) guidelines, or of an investigational regimen on a clinical trial.
- Absolute neutrophil count (ANC) >= 750 cells/microliter (0.75 x 10^9/L); ANC >= 500 cells/microliter (0.50 x 10^9/L) in subjects with documented bone marrow involvement of CLL (independent of growth factor or transfusion support within 1 week of screening).
- Hemoglobin >= 10 g/dL (independent of growth factor or transfusion support within 1 week of screening).
- Platelet count >= 50,000 cells/microliter (50 x 10^9/L); platelet count >= 25,000 cells/microliter (25 x 10^9/L) in subjects with documented bone marrow involvement of CLL (independent of growth factor or transfusion support within 1 week of screening).
- Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN)
- Total bilirubin =< 2 x ULN, unless directly attributable to Gilbert's syndrome
- Estimated creatinine clearance of >= 50 mL/min
- Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
- Women of childbearing potential (WOCBP) who are sexually active must use highly effective methods of contraception during treatment and for 30 days after the last dose of acalabrutinib or venetoclax, whichever occurs later
- Willing and able to participate in all required evaluations and procedures in this study protocol, including swallowing tablets without difficulty
- Ability to understand the purpose and the risks of the study and provide signed and dated informed consent and authorization to use protected health information
Who cannot join
- Known prolymphocytic leukemia or history of, or currently suspected, Richter's transformation (biopsy based on clinical suspicion may be needed to rule out transformation)
- Prior disease progression while on a BTK inhibitor
- Prior disease progression while on venetoclax
- Prior intolerance to acalabrutinib or venetoclax
- Prior malignancy (or any other malignancy requiring active treatment), except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, low-grade prostate carcinoma (Gleason grade =< 6) or other cancer from which the subject has been disease free for >= 2 years or which will not limit survival to < 3 years
- 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 or 4 cardiac diseases as defined by the New York Heart Association Functional Classification, or corrected QT interval (QTc) > 480 msec at screening. Subjects with controlled, asymptomatic atrial fibrillation during screening can enroll on study.
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- Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel that is likely to affect absorption, symptomatic inflammatory bowel disease, partial or complete bowel obstruction, or gastric restrictions and bariatric surgery, such as gastric bypass. Patients with history of such operations are eligible if in treating physician's opinion they have no absorption issues.
- Known history of drug-specific hypersensitivity or anaphylaxis to acalabrutinib or venetoclax
- Active bleeding or history of bleeding diathesis (e.g. hemophilia or von Willebrand disease), or requires/is receiving anticoagulation with warfarin or equivalent vitamin K antagonists
- Prothrombin time (PT)/international normalized ratio (INR) or activated partial thromboplastic time (aPTT) (in the absence of lupus anticoagulant) > 2 x ULN
- Uncontrolled autoimmune hemolytic anemia (AIHA) or idiopathic thrombocytopenic purpura (ITP)
- Presence of a gastrointestinal ulcer diagnosed by endoscopy within 3 months before screening
- Requires treatment with a strong cytochrome P450 3A4 (CYP3A4) inhibitor or inducers. The use of strong or moderate CYP3A inhibitors or inducers within 7 days of the first dose of study drug is prohibited.
- History of significant cerebrovascular disease/event, including stroke or intracranial hemorrhage, within 6 months before the first dose of study drug
- Major surgical procedure within 7 days of first dose of study drug. Note: If a subject had major surgery, they must have recovered adequately from any toxicity and/or complications from the intervention before the first dose of study drug
- Hepatitis B or C serologic status: subjects 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.
- Breastfeeding or pregnant
- Concurrent participation in another therapeutic clinical trial
- Known history of infection with human immunodeficiency virus (HIV) or any active significant infection (e.g,. bacterial, viral, or fungal)
- History of or ongoing confirmed central nervous system (CNS) CLL
- History of confirmed progressive multifocal leukoencephalopathy (PML)
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
United States1 site, 1 recruiting
- Recruiting
Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, 98109
Mazyar Shadman, 206-667-5467, mshadman@fredhutch.org
Mazyar Shadman
About this study
Official title: AVENUE-2: Acalabrutinib in Combination With Venetoclax (AV) for Previously Treated Chronic Lymphocytic Leukemia (CLL) or Small Lymphocytic Lymphoma (SLL)
This phase II trial is to evaluate the effects of acalabrutinib in combination with venetoclax in treating patients with chronic lymphocytic leukemia or small lymphocytic lymphoma that does not respond to treatment (refractory) or that has come back (recurrent). Acalabrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Chemotherapy drugs, such as venetoclax, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Given acalabrutinib and venetoclax may kill more cancer cells.
Read the detailed description
OUTLINE:
Patients receive acalabrutinib orally (PO) twice a day (BID) and venetoclax PO once daily (QD) on days 1-28. Patients receive acalabrutinib alone for the first three 28 day cycles. Venetoclax is added beginning with Cycle 4. Treatment repeats every 28 days for up to 26 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo blood sample collection, bone marrow aspiration and biopsy, and computed tomography (CT) or magnetic resonance imaging (MRI) throughout the trial.
After completion of study treatment, patients are followed-up every 12 weeks and annually for 10 years.
- Conditions
- Recurrent Chronic Lymphocytic Leukemia, Recurrent Small Lymphocytic Lymphoma, Refractory Chronic Lymphocytic Leukemia, Refractory Small Lymphocytic Lymphoma
- Being tested
- Acalabrutinib, Venetoclax, Biospecimen Collection, Bone Marrow Aspiration, Bone Marrow Biopsy
- 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
Also called ACP-196, Bruton Tyrosine Kinase Inhibitor ACP-196, Calquence
Given PO
VenetoclaxDrug
Also called ABT-0199, ABT-199, ABT199, GDC-0199
Given PO
Biospecimen CollectionProcedure or surgery
Undergo blood sample collection
Bone Marrow AspirationProcedure or surgery
Undergo bone marrow aspiration and biopsy
Bone Marrow BiopsyProcedure or surgery
Undergo bone marrow aspiration and biopsy
Computed TomographyProcedure or surgery
Also called CT Scan, CAT Scan, Computed Axial Tomography
Undergo CT
Magnetic Resonance ImagingProcedure or surgery
Also called MRI
Undergo MRI
| Study group | Role | What they receive |
|---|---|---|
| Treatment (acalabrutinib, venetoclax) | Experimental | Patients receive acalabrutinib PO BID and venetoclax PO QD on days 1-28. Patients receive acalabrutinib alone for the first three 28 day cycles. Venetoclax is added beginning with Cycle 4. Treatment repeats every 28 days for up to 26 cycles in the absence of disease progression or unacceptable toxicity.
Patients also undergo blood sample collection, bone marrow aspiration and biopsy, and CT or MRI throughout the trial. Receives: Drug: Acalabrutinib; Drug: Venetoclax; Procedure: Biospecimen Collection; Procedure: Bone Marrow Aspiration; Procedure: Bone Marrow Biopsy; Procedure: Computed Tomography; Procedure: Magnetic Resonance Imaging |
What is being measured
The primary outcome is the main question the study is designed to answer.
Rate of undetectable measurable residual disease (uMRD)
MRD will be assessed using multicolor flow cytometry (sensitivity 10^-4) (uMRD4) from peripheral blood (PB).
Measured: At the end of treatment (26 cycles, 1 cycle = 28 days)
Secondary outcomes (6)
Overall response rate (ORR)
Evaluated as defined by International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2018.
Measured: Up to 10 years
Complete response (CR)
Evaluated as defined by International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2018.
Measured: Up to 10 years
Partial response (PR)
Evaluated as defined by International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2018.
Measured: Up to 10 years
Progression-free survival (PFS)
Kaplan-Meier curves and median time-to-event estimation with 95% confidence intervals will be presented.
Measured: Time from receiving the first treatment to the first observation of disease progression or death from any cause, whichever occurs first, assessed up to 10 years
Overall survival (OS)
Kaplan-Meier curves and median time-to-event estimation with 95% confidence intervals will be presented.
Measured: Time from receiving the first treatment to death from any cause, assessed up to 10 years
Toxicity of combination
Defined as grade 3-4 hematologic and non-hematologic malignancies.
Measured: Up to 10 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Jun 2021
- Study start31 May 2023
- Primary completion10 Aug 2027 (estimated)
- Study completion10 Aug 2031 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Recurrent Chronic Lymphocytic LeukemiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- 20 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Fred Hutchinson Cancer Center
- Sponsor type
- University, hospital or other
- Collaborators
- AstraZeneca
- Responsible party
- Sponsor
- Investigators
- Mazyar Shadman, Principal investigator, Fred Hutch/University of Washington Cancer Consortium
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04941716
- Sponsor's protocol ID
- RG1121341
- Other IDs
- NCI-2021-05947, 10602
- Status last verified
- Oct 2026
- First submitted
- 21 Jun 2021
- Last updated
- 23 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No