A Phase II, Multicenter, Open-label Study Evaluating Glofitamab in Combination With Venetoclax Plus Zanubrutinib or Venetoclax Alone in Subjects With Untreated or Relapsed/Refractory High-risk Mantle-cell Lymphoma
This open-label, multicenter, three cohorts, phase II study is designed to assess a combination of Zanubrutinib/Venetoclax/Glofitamab or Venetoclax/Glofitamab in high-risk subjects with either first line or R/R Mantle Cell Lymphoma (MCL). Three independent cohorts will be run: * Cohort A will include subjects with a primary refractory or progressive disease within 24 months from initiation of first line treatment (POD 24). * Cohort B will be open for subjects with R/R MCL and refractory or progressive to a BTK inhibitor given previously (\>24 months if first line). * Cohort C will only enrol newly diagnosed and untreated MCL subjects with very high-risk features.
⁃ In cohort A, subject must meet the following inclusion criteria:
• Subject must be primary refractory or in progression within 24 months from initiation of first line treatment (POD24 defined as time between D1C1 of the first treatment line and ICF signature)) (including an anti-CD20 combined with chemotherapy). Subject previously exposed to BTK inhibitor at first line is eligible. Subject in failure of CAR-T cell first line is eligible.
• Primary refractory subjects (ie with a progressive disease) to the BTKi and Venetoclax combination will not be eligible.
• In cohort B, subject must meet the following inclusion criterion:
• Subject must be R/R MCL and refractory or progressive to a BTK inhibitor given in a previous line of treatment (the number of treatment lines is not limited). If first progression, time from diagnosis (defined as D1C1 of the first treatment line) to inclusion (defined as the date of ICF signature) must be superior to 24 months.
• Subject previously exposed to Bcl-2 therapy and/or relapsing post CAR-T cell therapy is eligible, except if they presented a progressive disease under BTKi and Venetoclax combination.
• In cohort C, subject must meet the following inclusion criteria:
• Subject not previously treated for mantle cell lymphoma.
• Subject at high risk of relapse presenting at least two of the following risk factors:
∙ TP53 mutation, del17p, or p53 expression (IHC) \> 50%,
‣ blastoïd variant,
‣ complex karyotype,
‣ c-myc rearrangement (FISH),
‣ Ki67≥30%,
‣ high MIPI score, (or MIPI simplified)
‣ high MIPI-combined score ((ie high MIPI score + Ki67≥30%): this criterion alone is sufficient.
• Subject must meet all of the following additional criteria to be enrolled in the study for cohort A, B and C:
• Subject is ≥ 18 years and \< 80 years of age at the time of signing the informed consent form (ICF).
• Subject understood and voluntarily signed and dated an informed consent prior to any study-specific assessments/procedures being conducted.
• Subject with histologically proven mantle cell lymphoma (latest WHO classification). The diagnosis has to be confirmed by phenotypic expression of CD5, CD20 and cyclin D1 or the t(11;14) translocation. Diagnostic tissue should be available for central pathology review and ancillary molecular studies.
⁃ Bi-dimensionally measurable disease defined by at least one single node or tumor lesion ≥ 1.5 cm assessed by CT scan, or one bi-dimensionally measurable (≥1 cm) extranodal lesion, as measured on CT scan, and/or clinical examination.
⁃ Stage II-IV disease,
⁃ ECOG performance status of 0, 1, 2.
⁃ Life expectancy of more than 3 months.
⁃ Adequate renal function as demonstrated by a creatinine clearance \> 30 mL/min; calculated by the Cockcroft Gault formula or MDRD formula.
⁃ Adequate hepatic function per local laboratory reference range as follow (unless if due to lymphoma involvement):
• Aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 2.5x upper limit of normal (ULN)
∙ Bilirubin \< 1.5 x ULN (unless bilirubin rise is due to Gilbert's syndrome or of non-hepatic origin. in which case total bilirubin should be \< 3 x ULN).
⁃ Women of childbearing potential (WOCBP) (refer to section 14.7 for more details) must have negative results for highly effective urine/serum pregnancy test 10-14 days prior to Day 1 of Cycle 1 and within 24 hours prior to day 1 Cycle 1 prior to initiating study treatment and agree to abstain from becoming pregnant or breastfeeding during study participation and until at least 18 months after C1 with Obinutuzumab, or 3 months after the final dose of tocilizumab (if applicable), or 2 months after the final dose of Glofitamab, or or 1 month after the final dose of Zanubrutinib (if applicable), or 30 days after the final dose of Venetoclax, whichever is longer. WOCBP agree to remain abstinent (from heterosexual intercourse) or use two methods of contraception, and to refrain from donating eggs, during the treatment period and for at least 18 months after the final dose of Obinutuzumab, 3 months after the final dose of tocilizumab (if applicable), 2 months after the final dose of Glofitamab, 1 month after the final dose of Zanubrutinib (if applicable), and 30 days after the final dose of Venetoclax (refer to section 14.6).
⁃ Men of reproductive potential (refer to section 14.6 for more details) agree to remain abstinent (from heterosexual intercourse) or use effective methods of birth control with a non-pregnant female partner of childbearing potential or a pregnant female partner and to refrain from donating sperm, during the treatment period and for at least 3 months after the final dose of Obinutuzumab, 2 months after the final dose of Glofitamab, 2 months after the final dose tocilizumab (if applicable), 30 days after the final dose of Venetoclax, 1 week after the final dose of Zanubrutinib (if applicable).
⁃ Adequate bone marrow function as defined by:
• Absolute neutrophil count (ANC) ≥ 1000/mm3, except for subjects with bone marrow involvement in which ANC must be ≥ 500/mm3.
∙ Platelet ≥ 75,000/mm3, except for subjects with bone marrow involvement in which the platelet count must be ≥ 50,000/mm3 .
⁃ Subject covered by any social security system (France).
⁃ Subject who understands and speaks one of the country official languages unless local regulation authorizes independent translators.
⁃ Subject with a SARS-COV2 vaccination status in line with local National guidelines/recommendations (COSV, ANRS MIE).
⁃ Subject must be willing and able to comply with protocol-mandated hospitalization upon administration of the first two doses of Glofitamab. Subject must also be willing to comply with all study-related procedures.
⁃ Adverse events from prior anti-cancer therapy must have resolved to Grade ≤ 1 (hematological toxicities excepted)
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