A Study to Evaluate Safety, Pharmacokinetics, Pharmacodynamics and Preliminary Efficacy of the Combination of Ibrutinib With Nivolumab in Participants With Hematologic Malignancies



Status:Active, not recruiting
Conditions:Blood Cancer
Therapuetic Areas:Oncology
Healthy:No
Age Range:18 - Any
Updated:3/6/2019
Start Date:March 11, 2015
End Date:July 28, 2020

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A Phase 1/2a Study to Evaluate the Safety, Pharmacokinetics, Pharmacodynamics, and Preliminary Efficacy of the Combination of Ibrutinib With Nivolumab in Subjects With Hematologic Malignancies

The purpose of this study is to determine the safety and to establish the recommended phase 2
dose (RP2D) for the combination of ibrutinib and nivolumab in participants with chronic
lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL), follicular cell lymphoma (FL)
and diffuse large B-cell lymphoma (DLBCL). Once the dose is optimized, the combination will
be assessed for Pharmacokinetics, Pharmacodynamics, and preliminary efficacy, further safety
in participants with CLL/SLL, FL or DLBCL and in participants with Richter syndrome.

This is an open-label study, which consists of Part A (Dose Optimization Cohorts) and Part B
(Expansion Cohorts). Part A consists of two dose optimization cohorts (cohort A1 and cohort
A2) will determine the RP2D for the combination based on safety, pharmacokinetic, and
pharmacodynamic assessments in participants with relapsed/refractory CLL/SLL or B-cell
non-Hodgkin lymphoma (B-NHL). Part B consists 3 participant populations to further evaluate
the safety and clinical activity of ibrutinib in combination with nivolumab: Cohort B1
(participants with CLL/SLL with del 17p or del 11q), Cohort B2 (participants with FL), Cohort
B3 (participants with DLBCL) and Cohort B4 (participants with Richter syndrome). Part A and B
will consist of Screening Period (28 days before enrollment), Treatment Period and Follow up
Period (every 3 months until death or the end of study). Participants will receive nivolumab
intravenously (Day 1 of every cycle) and ibrutinib orally once daily on a 14-day cycle.
Efficacy will primarily be evaluated by International Workshop on Chronic Lymphocytic
Leukemia (IWCLL) and International Working Group (IWG) for lymphoma guidelines. Participants'
safety will be monitored throughout the study. Further exploration of
pharmacokinetic/pharmacodynamic and biomarker information will be assessed throughout the
trial.

Inclusion Criteria:

- Eastern Cooperative Oncology Group (ECOG) performance status grade 0, 1, or 2

- Adequate bone marrow, liver, and renal function defined as: 1) Absolute neutrophil
count (ANC) greater than equal to (>=) 1.5* 10^9cells/litre (L); 2) Platelets >=75 x
109cells/L without transfusion support within 7 days prior to test; 3) Hemoglobin >= 8
gram/deciliter (g/dL) without transfusion support within 7 days prior to test 4)
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) less than equal to
(<=) 2.5 * upper limit of normal (ULN) 5) Total bilirubin less than (<) 2
milligram/deciliter (mg/dL) 6) Creatinine determined by serum creatinine levels <=1.5
* ULN or a calculated creatinine clearance of >= 50 mL/min/1.73 m^2

- Histologically confirmed B-cell non-Hodgkin lymphoma (B-NHL), Chronic Lymphocytic
Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL)

- Relapsed refractory disease after at least 1 but not more than 4 lines of previous
systemic therapy

- Measurable disease (NHL: At least 1 measurable site of disease [>1.5 centimeter [cm]
in the long axis regardless of short axis measurement or >1.0 cm in the short axis
regardless of long axis measurement, and clearly measurable in 2 perpendicular
dimensions])

- Cohort B-1: SLL/CLL: 1) Deletion of short arm of chromosome 17 or 11 q based on
institutional assessment 2) Relapsed/refractory after at least 1 prior systemic
therapy 3) Active disease based in IWCLL criteria

- Cohort B-2: 1) B- cell follicular lymphoma Grade 1, 2, or 3a (WHO criteria) 2)
Relapsed/refractory disease >= 2 lines separated by Progression, prior treatment (or
not eligible for receiving) CD20 antibody 3) Measurable disease (IWG -Lugano 2014)

- Cohort B-3: 1) Histologically-confirmed DLBCL 2) Prior standard rituximab +
anthracyclin containing regimen, received or not eligible or considered candidate of
HD-ASCT 3) Measurable disease (IWG -Lugano 2014)

- Cohort B-4: 1) Histologically-confirmed Richter syndrome defined as transformation of
CLL or SLL into an aggressive lymphoma 2) Previously treated with at least one line of
standard, systemic chemotherapy or not eligible for standard therapy 3) At least 1
measurable site of disease based on the Revised Response Criteria for Malignant
Lymphoma

Exclusion Criteria:

- Prior therapy or surgery (3 to 10 weeks depending type)

- Prior BTK inhibitor or anti PD1, anti PDL1, anti PD-L2 and anti-CD137, anti-cytotoxic
T-lymphocyte associated antigen (CTLA-4) antibody

- 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, or congenital long QT
syndrome, or QT interval corrected for heart rate, using Fridericia formula (QTcF) at
Screening greater than (>) 470 milliseconds (ms)

- History of stroke or intracranial hemorrhage within 6 months prior to the first dose
of ibrutinib

- Requires treatment with anticoagulation with warfarin or equivalent vitamin K
antagonists

- Requires treatment with strong cytochrome P450 3A (CYP3A) inhibitors

- Known history of Human Immunodeficiency Virus (HIV), Hepatitis B or Hepatitis C
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