A Study of the Bruton's Tyrosine Kinase Inhibitor Ibrutinib Given in Combination With Bendamustine and Rituximab in Patients With Newly Diagnosed Mantle Cell Lymphoma

This is a randomized (individuals assigned to study treatment by chance), double blind
(neither physician nor participant knows the treatment that the participant receives),
placebo (an inactive substance that is compared with a drug to test whether the drug has a
real effect in a clinical trial)-controlled study to compare the efficacy and safety of
ibrutinib given in combination with bendamustine and rituximab (BR) with BR alone in
participants newly diagnosed with mantle cell lymphoma (MCL) who are 65 years of age or
older. Approximately 520 participants will be randomly assigned in a 1:1 ratio and stratified
by simplified Mantle Cell Lymphoma International Prognostic Index (MIPI) score (low risk
[0-3] versus intermediate risk [4-5] versus high risk [6-11]). The treatment phase will
extend from randomization until discontinuation of all study treatment or the clinical cutoff
for the end of study. A cycle is defined as 28 days. All participants will receive open-label
(identity of assigned study drug will be known) BR background therapy for a maximum of 6
cycles; participants with a complete response or partial response will continue to receive
open-label background therapy with rituximab maintenance every second cycle for a maximum of
12 additional doses. In addition to the background therapy, all participants will receive
blinded study drug (ibrutinib or placebo). Participants randomized to treatment Arm A will
receive placebo capsules and participants randomized to treatment Arm B will receive
ibrutinib capsules. Study drug will be administered daily and continuously until disease
progression, unacceptable toxicity, or study end. Participants with stable disease after
initial chemoimmunotherapy (BR+ibrutinib/placebo) should continue treatment with
ibrutinib/placebo until disease progression, unacceptable toxicity, or study end.
Participants with progressive disease must discontinue all study treatment. For participants
who discontinue background therapy and do not have progressive disease, treatment with study
drug will continue until disease progression or unacceptable toxicity or the clinical cutoff
for the final analysis of progression-free survival (PFS). Participants receiving BR,
rituximab, or ibrutinib at the clinical cutoff for the final analysis of PFS will continue
open-label treatment until disease progression or unacceptable toxicity. Placebo will be
stopped when the study is unblinded for the clinical cutoff for the final analysis of PFS.
The posttreatment follow-up phase will begin once a participant discontinues bendamustine and
rituximab and study drug. Participants who discontinue for reasons other than disease
progression must continue to have disease evaluations as outlined in the protocol.
Participants who discontinue due to disease progression will be followed for survival and
subsequent anti-MCL therapy. The posttreatment follow-up phase will continue until death,
lost to follow up, consent withdrawal, or study end, whichever occurs first. Four clinical
cutoffs are planned. The first 3 clinical cutoffs will occur when approximately 134, 180, and
265 PFS events have been observed, respectively. The interim analyses and the final analysis
of PFS will take place at these 3 clinical cutoffs, respectively; participant treatment
assignment will be unblinded and placebo treatment will be stopped at the clinical cutoff for
the final analysis of PFS. Treatment unblinding and stopping of placebo treatment could occur
before the planned final analysis of PFS if recommended by the independent Data Monitoring
Committee (DMC) after an interim analysis. The last cutoff will occur at the end of study,
when 60% of the randomized participants have died or the Sponsor terminates the study,
whichever comes first. Efficacy assessments will be conducted in accordance with the Revised
Response Criteria for Malignant Lymphoma. Safety will be monitored throughout the study and
summarized. Blood samples will be drawn for assessment of pharmacokinetic parameters. Blood
and bone marrow will be collected for assessment of minimal residual disease and biomarker
studies.

Inclusion Criteria:

- Diagnosis of mantle cell lymphoma (MCL) reviewed and approved by central laboratory:
diagnosis must include morphology and expression of either cyclin D1 in association
with other relevant markers (eg, CD19, CD20, PAX5 and CD5) or evidence of t(11;14) as
assessed by cytogenetics, fluorescent in situ hybridization (FISH), or polymerase
chain reaction (PCR)

- Clinical Stage II, III, or IV by Ann Arbor Classification

- At least 1 measurable site of disease according to Revised Response Criteria for
Malignant Lymphoma

- No prior therapies for MCL

- Eastern Cooperative Oncology Group (ECOG) performance status grade 0 or 1

- Hematology and biochemical laboratory values within protocol-defined limits

- Agrees to protocol-defined use of effective contraception

- Negative blood or urine pregnancy test at screening

Exclusion Criteria:

- Major surgery within 4 weeks of random assignment

- Known central nervous system lymphoma

- Diagnosed or treated for malignancy other than MCL, except: malignancy treated with
curative intent and with no known active disease present for >=3 years before random
assignment; adequately treated non-melanoma skin cancer or lentigo maligna without
evidence of disease; adequately treated cervical carcinoma in situ without evidence of
disease

- Patients for whom the goal of therapy is tumor debulking prior to stem cell transplant

- History of stroke or intracranial hemorrhage within 6 months prior to random
assignment

- Requires anticoagulation with warfarin or equivalent vitamin K antagonists

- Requires treatment with strong CYP3A inhibitors

- Clinically significant cardiovascular disease such as uncontrolled or symptomatic
arrhythmias, congestive heart failure, or myocardial infarction within 6 months of
Screening, or any Class 3 (moderate) or Class 4 (severe) cardiac disease as defined by
the New York Heart Association Functional Classification

- Vaccinated with live, attenuated vaccines within 4 weeks of random assignment

- Known history of human immunodeficiency virus (HIV) or active hepatitis C virus or
active hepatitis B virus infection or any uncontrolled active systemic infection
requiring intravenous antibiotics

- Any life-threatening illness, medical condition, or organ system dysfunction which, in
the investigator's opinion, could compromise the patient's safety, interfere with the
absorption or metabolism of ibrutinib capsules, or put the study outcomes at undue
risk