Dose De-escalation Study of the PI3k Alpha/Delta Inhibitor, Copanlisib Given in Combination With the Immunotherapeutic Agents, Nivolumab and Rituximab in Patients With Relapsed/Refractory Indolent Lymphoma

  • End date
    Jun 28, 2026
  • participants needed
  • sponsor
    Big Ten Cancer Research Consortium
Updated on 28 July 2022


Patients with relapsed or refractory follicular or marginal zone lymphoma who have received at least one prior line of therapy will receive

  • Copanlisib IV: day 1, 8, 15 every 28 days
  • Nivolumab IV: Cycle 1 days 1 and 15; then day 1 only
  • Rituximab IV: Cycle 1 days 1, 8, 15, 22; then day 1 (C2-6); then Q2 cycles (8-12)


Patients with relapsed/refractory lymphoma generally have few if any curative options and demonstrate poor response rates to standard salvage therapies. Novel regimens utilizing molecular targets are needed to improve outcomes in this patient population. While studies evaluating single agent small-molecule inhibitors have demonstrated activity in this setting, combinations of these drugs are generally thought to be more efficacious due to targeting separate mechanisms of action and decreased chance of developing resistance. The PD-1/PD-L1 axis is a molecular target that has been demonstrated to be up-regulated in several tumors including malignant lymphoma. Several pre-clinical studies have demonstrated the importance of this axis on clinical outcomes of patients afflicted with low grade lymphoma including FL. Targeting this axis with specific inhibitors would appear to be a rationale way to improve outcomes in patients afflicted with these diseases. PI3K inhibitors in addition to inhibiting signaling, impart changes in the immune cells in the tumor microenvironment and would appear to be a logical candidate to explore in combination with immunotherapy. Based on these preliminary data, we believe that we have justification for proceeding with our proposed phase I study to combine the PD-1 inhibitor, nivolumab, with the PI3K inhibitor, copanlisib, and the CD20 antibody, rituximab, in patients with relapsed/refractory follicular and marginal zone lymphoma. This work has the potential to provide a novel strategy to improve upon the clinical response noted in this patient population.

Condition Indolent Lymphoma
Treatment Rituximab, Nivolumab, Copanlisib
Clinical Study IdentifierNCT04431635
SponsorBig Ten Cancer Research Consortium
Last Modified on28 July 2022


Yes No Not Sure

Inclusion Criteria

Age ≥18 years at the time of informed consent
Diagnosis of relapsed or refractory indolent follicular or marginal zone lymphoma established by histologic assessment by a hematopathologist that has relapsed after at least one line of chemo-immunotherapy
Immunohistochemistry of the biopsy or
Flow cytometry of the biopsy
ECOG Performance Status ≤ 2
Has an indication for treatment based on the presence of symptoms and/or GELF criteria as referenced in appendix A
Must have failed or not be a candidate for an autologous stem cell transplantation
Women of childbearing potential must be willing to use appropriate contraception (barrier and hormonal therapy) or abstain from heterosexual activity from the point of registration through at least 12 months after the last dose of study drugs
\-- NOTE: Women of childbearing potential are those who have not been
surgically sterilized, have not been free of menses for ≥ 1 year, or her sole
male partner has had a vasectomy at least 6 months prior to screening
Male subjects capable of fathering a child who have a female partner of childbearing potential must agree to use appropriate method(s) of contraception or abstain from heterosexual activity starting with the first dose of study drug through 1 month after the last dose of the study drugs
Adequate organ function defined as
Total Bilirubin ≤ 1.5 mg/dL
AST and ALT ≤ 2.5 x ULN
Renal: Creatinine < 2.0 mg/dl or CrCL > 30 mL/minute
Bone marrow function
ANC ≥ 1000/mm3 (500/mm3 if known bone marrow (BM) involvement)
Platelet ≥ 75,000/mm3 (or 50,000/mm3 if known BM involvement)
Hgb > 9 g/dL (transfusions allowed to meet this criterion)
Adequate glycemic control as demonstrated by a baseline fasting blood sugar (BS) ≤ 150
Adequate blood pressure (BP) control as demonstrated by a baseline BP of < 150/90. If uncontrolled then patient must be referred to PCP for medical management. Patient may be enrolled if adequate control is obtained prior to day 1 of therapy
mg/dL. If uncontrolled then patient must be referred to PCP or endocrinology
Prior treatment is allowed if
for medical management. Patient may be enrolled if adequate control is
obtained prior to day 1 of therapy
at least 3 months must have passed since radio-immunotherapy
at least 4 weeks must have elapsed since last chemotherapy and/or radiation and the patient has recovered to ≤ grade 1 toxicity from all treatment related events
at least 3 months have passed since date of stem cell infusion (autograft) and patient has recovered to ≤ grade 1 toxicities related to this procedure
Prior treatment with a PD-1/PD-L1 and/or PI3K inhibitor is allowed unless patient
prior treatment was discontinued for intolerance

Exclusion Criteria

Pregnant or breastfeeding women. NOTE: Women of childbearing potential must have a negative serum or urine pregnancy test within 7 days prior to study registration. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required. NOTE: Breast milk cannot be stored for future use while the mother is being treated on study
Diagnosis of follicular grade 3b, post-transplant lymphoproliferative disorder (PTLD), or presence of histologic transformation
Subjects with LFT abnormalities at baseline (above values per inclusion criteria), history of cirrhotic liver morphology or alcoholic cirrhosis, subjects who use acetaminophen at doses in excess of 2 g every day and have evidence of compromised hepatic reserve
Primary or metastatic CNS disease prior to study enrollment
Uncontrolled current illness, including, but not limited to ongoing or active infections, symptomatic congestive heart failure, unstable angina pectoris, unstable cardiac arrhythmia, evidence of interstitial lung disease or active, noninfectious pneumonitis including symptomatic and/or pneumonitis requiring treatment and/or psychiatric illness or social situations that would limit compliance with study requirements
History of inflammatory bowel disease i.e. Crohn's disease, ulcerative colitis
HIV infection. NOTE: HIV testing is required
Active infection with Hepatitis B or C virus (defined as a positive Hepatitis B surface antigen/ positive Hepatitis C antibody or detectable viral load by PCR). Patients with positive antibody but negative viral loads will be eligible for study participation but will require appropriate prophylaxis
NOTE: Hepatitis B and C testing are required
Screening rate-corrected (using Friderica's correction) QT interval (QTcF) must not be > 480 msec via a standard 12-lead ECG within 28 days prior to registration
Active or prior documented autoimmune or inflammatory disorders within the past 3 years prior to study registration. The following are exceptions to this criterion
Subjects with vitiligo or alopecia
Subjects with hypothyroidism (eg. following Hashimoto syndrome) stable on hormone replacement or psoriasis not requiring systemic treatment
Known allergy or reaction to any component of either study drug formulation
Concomitant therapy in the last 4 weeks of any of the following: cytotoxic chemotherapy, immunosuppressive agents, other investigational therapies, or chronic use of systemic corticosteroids (doses ≤ 10 mg/day prednisone or equivalent are permitted)
Prior allogeneic stem cell transplant
Receipt of live attenuated vaccine within 30 days before the first dose of study treatment
HbA1c > 8.5% at Screening
Patient that require treatment with agents that are CYP3A4 inhibitors or strong CYP3A4 inducers. Patients who are on agents that fall into this category must be off for at least two weeks prior to start of treatment
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