A Phase 2 Study of Loncastuximab Tesirine Plus Mosunetuzumab in Patients With Relapsed/Refractory Diffuse Large B-cell Lymphoma
This phase II trial studies the safety and how well of loncastuximab tesirine when given together with mosunetuzumab works in treating patients with diffuse large B-cell lymphoma that has come back (relapsed) or does not respond to treatment (refractory). Loncastuximab tesirine is a monoclonal antibody, loncastuximab, linked to a toxic agent called tesirine. Loncastuximab attaches to anti-CD19 cancer cells in a targeted way and delivers tesirine to kill them. Mosunetuzumab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Giving loncastuximab tesirine with mosunetuzumab may help treat patients with relapsed or refractory diffuse large B-cell lymphoma.
• Documented informed consent of the participant and/or legally authorized representative.
‣ Assent, when appropriate, will be obtained per institutional guidelines.
• Be willing to provide tissue from a fresh core or excisional biopsy (performed as standard of care) of a tumor lesion prior to starting study therapy or from diagnostic tumor biopsies.
‣ If unavailable, exceptions may be granted with study principal investigator (PI) approval.
• Age: \>= 18 years.
• Eastern Cooperative Oncology Group (ECOG) =\< 2.
• Histologically confirmed diagnosis of diffuse large B-cell lymphoma or Follicular Lymphoma Grade 3B according to the World Health Organization (WHO) classification, with hematopathology review at the participating institution. Subtypes of DLBCL including transformed indolent lymphomas (TIL) including Richter's Transformation, primary mediastinal large B-cell lymphoma (PMBCL), and high-grade B-cell lymphoma not otherwise specified (HGBCL-NOS) are eligible.
• Life expectancy \> 12 months.
• Histologically confirmed diagnosis of diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma Grade 3B according to the WHO classification, with hematopathology review at the participating institution. Subtypes of DLBCL including transformed indolent lymphomas (TIL) including Richter's Transformation, primary mediastinal large B-cell lymphoma (PMBCL), and high-grade B-cell lymphoma not otherwise specified (HGBCL-NOS) are eligible.
• Relapsed or refractory disease after \>= 1 prior line of therapy (prior CD19-directed therapy and prior autologous stem cell transplant are allowed).
‣ Relapse at the time of study enrollment must have been confirmed histologically (with hematopathology review at the participating institution). Exceptions may be granted with study PI approval.
• Measurable disease by computerized tomography (CT) or positron emission tomography (PET)/CT scan with one or more sites of disease \>= 1.5 cm in longest dimension.
• Tumor must be positive for both CD19 and CD20 by immunohistochemistry after the most recent therapy.
• Fully recovered from the acute toxic effects (except alopecia) to =\< Grade 1 to prior anti-cancer therapy
• Without bone marrow involvement: Absolute neutrophil count (ANC) \>= 1,000/mm\^3.
‣ (G-CSF is allowed to reach ANC requirement).
• With bone marrow involvement: no minimum ANC requirement.
‣ (G-CSF is allowed to reach ANC requirement).
• Platelets \>= 75,000/mm\^3.
• Total bilirubin =\< 1.5 X upper limit of normal (ULN).
‣ If hepatic involvement by lymphoma, or Gilbert's disease: =\< 3X ULN.
• Aspartate aminotransferase (AST) =\< 2.5 x ULN.
‣ If hepatic involvement by lymphoma: AST =\< 5 x ULN.
• Alanine aminotransferase (ALT) =\< 2.5 x ULN.
‣ If hepatic involvement by lymphoma: ALT =\< 5 x ULN .
• Creatinine clearance of \>= 40 mL/min per 24 hour urine test or the Cockcroft-Gault formula
• If not receiving anticoagulants: International Normalized Ratio (INR) OR Prothrombin (PT) =\< 1.5 x ULN.
• If on anticoagulant therapy: PT must be within therapeutic range of intended use of anticoagulants.
• If not receiving anticoagulants: Activated Partial Thromboplastin Time (aPTT) =\< 1.5 x ULN
• If on anticoagulant therapy: aPTT must be within therapeutic range of intended use of anticoagulants.
• Women of childbearing potential (WOCBP): negative urine or serum pregnancy test
‣ If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
• Agreement by females of childbearing potential to abstain from heterosexual intercourse or use two adequate method of birth control, including at least 1 method with a failure rate of \< 1% per year, for at least 28 days prior to Day 1 of Cycle 1, during the treatment period (including periods of treatment interruption), until 3 months after the final dose mosunetuzumab and 9 months after the last dose of loncastuximab tesirine. Women must refrain from donating eggs during this same period. Agreement by males to abstain from heterosexual intercourse or use a condom with female partners of childbearing potential or pregnant female partners during the treatment period and for 3 months after the final dose of mosunetuzumab and 6 months after the last dose of loncastuximab tesirine. Men must refrain from donating sperm during this same period.
‣ Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for \> 1 year (women only) with no identified cause other than menopause.
⁃ Examples of non-hormonal contraceptive methods with a failure rate of \< 1% per year include bilateral tubal ligation, male sterilization, established and proper use of progestogen only hormonal contraceptives that inhibit ovulation, hormone releasing intrauterine devices, and copper intrauterine devices. Barrier methods must always be supplemented with the use of a spermicide. Note: Combined oral contraceptives are not recommended.