A Phase 2 Study of Loncastuximab Tesirine and Rituximab as Bridging Therapy Prior to Standard-of-care CD19 CAR T-cell Therapy in Patients With Large B-cell Lymphoma
The purpose of this clinical trial is to learn if the study treatment Loncastuximab tesirine and Rituximab is safe and efficient before standard of care chimeric antigen receptor T-cell (CAR-T) therapy in patients with relapsed or refractory large B-cell lymphoma.
• Subject aged ≥ 18 years.
• Intended to receive commercial CD19-directed CAR-T cell therapy (axi-cel and liso-cel).
• Need for bridging therapy as deemed clinically necessary by the treating physician.
• Relapsed or refractory DLBCL, tFL or PMBCL as defined by the 2016 World Health Organization classification (including patients with DLBCL transformed from indolent lymphoma), or high-grade B-cell lymphoma (HGBL), not otherwise specified, and HGBL with MYC and BCL2 and/or BCL6 rearrangements.
⁃ -Relapsed (disease that has recurred following a response) or refractory (disease that failed to respond to prior therapy) disease following at least one multi-agent systemic treatment regimen.
• Measurable disease as defined by the 2014 Lugano Classification as assessed by positron-emission tomography (PET)- computed tomography (CT) or by CT or magnetic resonance imaging (MRI) if the tumor is not fluorodeoxyglucose (FDG)-avid on screening PET-CT.
• ECOG Performance Status ≤ 2.
• Time between prior anticancer therapy and first dose of lonca-R as below
‣ Autologous hematopoietic cell transplantation - At least 30 days
⁃ Allogeneic hematopoietic cell transplantation - At least 60 days
⁃ Cytotoxic chemotherapy - At least 21 days
⁃ Non-cytotoxic chemotherapy (e.g., small molecule inhibitor) - At least 14 days
• Adequate organ function as defined as:
‣ Hematologic:
• Absolute neutrophil count (ANC) ≥ 1000/mm3
∙ Platelet count ≥ 75,000/mm3
∙ Hemoglobin ≥ 8 g/dL
⁃ Hepatic:
• Bilirubin ≤1.5 x upper limit of normal (ULN) or ≤3 x ULN with document liver involvement and/ or Gilbert's disease
∙ Transaminases (AST or ALT) ≤ 3 x ULN or ≤ 5 x ULN with documented liver involvement
⁃ Renal:
• Estimated creatinine clearance ≥ 60 mL/min by Cockcroft-Gault formula.
• For female subjects: Negative pregnancy test or evidence of post-menopausal status. The post-menopausal status will be defined as having been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply:
‣ Women \< 50 years of age:
• Amenorrheic for ≥ 12 months following cessation of exogenous hormonal treatments; and
∙ Luteinizing hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution; or
∙ Underwent surgical sterilization (bilateral oophorectomy or hysterectomy).
⁃ Women ≥ 50 years of age:
• Amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments; or
∙ Had radiation-induced menopause with last menses \>1 year ago; or
∙ Had chemotherapy-induced menopause with last menses \>1 year ago; or
∙ Underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy, or hysterectomy).
• Female subjects of childbearing potential and male subjects with a sexual partner of childbearing potential must agree to use a highly effective method of contraception and the lactation requirements as described in Sections 5.41.1 and 5.4.2.
• Subjects or their legal representatives must be able to read, understand, and provide informed consent to participate in the trial.
• Willing and capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in the protocol