Orelabrutinib and Sintilimab in Relapsed or Refractory Central Nervous System Lymphoma

  • STATUS
    Recruiting
  • End date
    Dec 31, 2026
  • participants needed
    48
  • sponsor
    Second Affiliated Hospital, School of Medicine, Zhejiang University
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Updated on 23 July 2021
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Summary

This phase Ib/II trial is evaluating the efficacy and side effect of orelabrutinib and sintilimab as possible treatments for relapsed or refractory central nervous system lymphoma.

Description

Both orelabrutinib and sintilimab are promising classes of therapy for central nervous system lymphoma. Given the poor outcomes and limited options for relapsed or refractory central nervous system lymphoma. The investigators seek to evaluate the efficacy and toxicity of the combination of orelabrutinib with sintilimab in this patient population.

Phase 1b (maximum 12 total cycles) Orelabrutinib dose escalation will occur using a standard 3+3 dose-escalation approach to determined the maximum tolerated dose(MTD) of orelabrutinib dose in combined regimen, beginning at dose level I (150 mg daily) and potentially escalating to dose level 2 (200mg) and dose level 3 (250mg) with rules for escalation and de-escalation. If the dose-limiting toxicity is not found, the dose of 250mg qd will be used for phase II trial.

Orelabrutinib: orally daily Sintilimab: The dose of sintilimab is fixed dose. 200 mg intravenously every 3 weeks (maximum 12 total dose)

Phase 2 Participants will receive orelabrutinib and sintilimab at the pre-determined dosage level established in Phase 1b, until progression of the disease (PD), unacceptable toxicity, or patient/investigator discretion. The response will be evaluated every 2 cycles.

Orelabrutinib: orally maximum tolerated dose from phase 1b daily (150 mg or 200 mg or 250mg) Sintilimab: The dose of sintilimab is fixed dose. 200 mg intravenously every 3 weeks

Details
Condition Primary Central Nervous System Hodgkin Lymphoma
Treatment Sintilimab, orelabrutinib
Clinical Study IdentifierNCT04961515
SponsorSecond Affiliated Hospital, School of Medicine, Zhejiang University
Last Modified on23 July 2021

Eligibility

 Yes No Not Sure

Inclusion Criteria

Histologically documented primary central nervous system(CNS) lymphoma or secondary diffuse large B-cell lymphoma (DLBCL) isolated to CNS
Relapsed or refractory disease with at least 1 prior methotrexate-based therapy
Participant must be able to understand and willing to sign a written informed consent document
Participant must have signed and dated written informed consent form in accordance with regulatory and institutional guidelines. This must be obtained before the performance of any protocol-related procedures that are not part of normal subject care
Participant must be willing and able to comply with scheduled visits, treatment schedule, laboratory tests, and other requirements of the study
Participant must be at least 18 years old on day of signing informed consent
PCNSL subjects should have evidence of measurable or evaluable enhancing disease on MRI
Able to submit at least 10 but up to 20 unstained formalin-fixed, paraffin-embedded (FFPE) slides from the initial or most recent tissue diagnosis for correlative studies. Histologically confirmed tissue will be required from the time of relapse or at the time of initial surgery. If tissue is unavailable and/or diagnosis was made from cerebrospinal fluid or vitreal biopsy, approval from the overall principal investigator is needed
Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 3
Life expectancy of >3 months (in the opinion of the investigator)
Toxicities due to prior therapy must be stable and recovered to Grade 1
Must be able to tolerate lumbar puncture and MRI/CT
Demonstrate adequate organ function as defined below, all screening labs should be performed within 14 days of treatment initiation
Absolute neutrophil count (ANC) 1.0 x 109/L
Platelets 75 x 10^9/L and no platelet transfusion within the past 7 days prior to initiation of protocol treatment
Prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR) < 2 times the upper limit of normal
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 2.5 times the upper limit of normal
Serum bilirubin 1.5 times the upper limit of normal
Creatinine clearance > 30 mL/min calculated by the Cockcroft-Gault formula using actual body weight
Women of child-bearing potential, must agree to use a highly effective method of contraception consistently and correctly as described below during study treatment and for 120 days after study discontinuation
Male participants must agree to use at least one of the following methods of contraception starting with the first dose of study therapy through 120 days after the last dose of therapy
Ability to swallow oral medications

Exclusion Criteria

CNSL with systematic disease
The pathological diagnosis was T-cell lymphoma
Prior chemotherapy within 4 weeks or prior targeted small molecule therapy within 2 weeks , prior antibody-drug-conjugates within 10weeks, autologous stem cell transplant within 6 months, prior to the first day of study treatment, prior to the first day of study treatment
Prior allogenic stem cell transplant
Participation in another clinical study with an investigational product during the 4 weeks prior to the first day of study treatment
External beam radiation therapy to the CNS within 14 days of the first day of study treatment
Patient requires more than 8 mg of dexamethasone daily or the equivalent for control of CNS symptoms at the time of initiation of study therapy. Patients must taper off high dose corticosteroids for the control of CNS symptoms within 14 days after starting on study therapy
History of intracranial hemorrhage or clinically significant stroke within 6 months prior to first day of study treatment
History of significant gastrointestinal disease that would limit absorption of oral medications
Active concurrent malignancy requiring active therapy
Prior therapy with a checkpoint inhibitor or BTK inhibitor
Warfarin or any other Coumadin-derivative anticoagulant or vitamin K antagonists. Patients must be off warfarin-derivative anticoagulants for at least seven days prior to starting the study drug. Use of low molecular weight heparin and novel oral anticoagulants (eg. rivaroxaban, apixaban) is permitted if required
Concurrent use of a moderate or strong inhibitor or inducer of the P450 isoenzyme CYP3A. Participants must be off P450/CYP3A inhibitors and inducers prior to starting the study drug
Receipt of live attenuated vaccine within 30 days prior to the first day of study treatment. Note: Patients, if enrolled, should not receive live vaccine while receiving IP and up to 30 days after the last day of study treatment
Suspicion of or confirmed progressive multifocal leukoencephalopathy
Active autoimmune disease (including autoimmune hemolytic anemia and immune thrombocytopenia purpura) requiring systemic treatment within the past two years (i.e. with the use of disease modifying agents, corticosteroids, or immunosuppressive drugs). The following are exceptions to this criterion
Patients with vitiligo or alopecia
Patients with hypothyroidism (e.g., due to Hashimoto syndrome) stable on hormone replacement
Any chronic skin condition that does not require systemic therapy
Patients without active disease in the last 5 years may be included but only after consultation with the study physician
Patients with celiac disease controlled by diet alone
Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroids replacement therapy for adrenal or pituitary insufficiency, etc.)
Significant medical diseases or conditions, as assessed by the investigator, that would substantially increase the risk to benefit ratio of participating in the study. This includes, but is not limited to, acute myocardial infarction in the past 6 months, unstable angina, uncontrolled diabetes mellitus, significant active infections, severely immunocompromised state, and congestive heart failure, New York Heart Association Class III-IV
Known bleeding diathesis (e.g. von Willebrand's disease), hemophilia, or active bleeding
Known Human immunodeficiency virus (HIV) infection
Known active infection with hepatitis C virus (HCV) or hepatitis B virus (HBV) as determined by serologic tests and/or PCR
History of invasive fungal infection, including invasive aspergillosis, or known active tuberculosis
Major surgery 6 weeks prior to starting the trial treatment (or has not recovered from the side effects of such surgery) or plans to have surgery within 2 weeks of the first dose of the study drug
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