A Study of Copanlisib and Ibrutinib in Mantle Cell Lymphoma

Inclusion Criteria:

- Patient is ≥ 18 years of age at the time of signing Informed Consent

- Patient is able and willing to adhere to the study visit schedule and other protocol
requirements

- Patient has histologically confirmed diagnosis of R/R mantle cell lymphoma who has
received at least 1 line of therapy

°Autologous stem cell transplant recipients must have adequate bone marrow recovery
and transfusion independent

- Patients may have been previously treated with BTK or PI3K inhibitors:

- If it was their last treatment, patients must have had stable disease

- If not the immediate last line of therapy, patients who progressed on these
agents are still eligible

- Patient has at least one measurable lesion (≥ 2 cm) according to RECIL criteria[37]

- Patient has an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2

- Patient has adequate bone marrow and organ function by:

- Absolute neutrophil count (ANC) ≥ 1 x 10^9/L , independent of growth factor
support for 14 days unless there is bone marrow involvement. For patients with
bone marrow involvement, ANC ≥ 500/uL independent of growth factor support for 14
days

- Platelets ≥100 x 10^9/L, or ≥50 x 10^9/L if bone marrow involvement and
independent of transfusion support for 14 days in either situation

- Hemoglobin (Hgb) ≥ 9.0 g/dL (no RBC transfusion within past 14 days)

- International Normalized Ratio (INR) ≤ 1.5

- Serum Creatinine ≤ 1.5 x upper limit of normal (ULN) or creatinine clearance ≥ 25
mL/min as determined by the Cockcroft-Gault equation or a 24 hour urine
collection

- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ ULN (or ≤ 3
x ULN if liver involved with disease

- Total serum bilirubin ≤ ULN (or ≤ 1.5 x ULN if documented hepatic involvement; or
total bilirubin ≤ 3 x ULN with direct bilirubin ≤ 1.5 x ULN in patients with
documented Gilbert's Syndrome.

- Lipase ≤ 1.5x ULN

- LVEF ≥ 50%

- Hemoglobin A1c ≤ 8.5%

Exclusion Criteria:

- Patient has a history of non-compliance to medical regimen or inability to grant
consent

- Patient is concurrently using other approved or investigational antineoplastic agent

- Patient has not recovered to Grade 1 or better (except alopecia) from related side
effects of any prior antineoplastic therapy

- Patient has had major surgery or a wound that has not fully healed within 4 weeks of
starting study drugs.

- Patients who have had chemotherapy or radiotherapy within 2 weeks (6 weeks for
nitrosoureas or mitomycin C) prior to entering the study or those who have not
recovered from adverse events due to agents administered more than 2 weeks earlier.

- Patients who have undergone an allogenic hematopoietic stem cell transplant

- Patient has active or history of central nervous system (CNS) disease or meningeal
involvement.

- Patient has history of clinically significant interstitial lung disease and/or lung
disease that severely impairs lung function (as judged by the investigator)

- Patient has history of stroke or intracranial hemorrhage ≤ 6 months from starting
study drugs.

- Patient has impairment of gastrointestinal (GI) function or GI disease that may
significantly alter the absorption of study drug (e.g., ulcerative diseases,
uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel
resection)

- Patient has 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, Left Ventricular
Ejection Fraction (LVEF) <50% as determined by Multiple Gated acquisition (MUGA) scan
or echocardiogram (ECHO), unstable angina pectoris, symptomatic pericarditis, QTcF >
480 msec on the screening ECG (using the QTcF formula)

- Patient has a concurrent active malignancy. Malignancies treated with a curative
intent with an expected life expectancy ≥ 5 years or a non-competing life expectancy
risk are eligible (i.e. adequately treated basal or squamous cell carcinoma,
non-melanomatous skin cancer, early stage breast cancer, treated prostate cancer or
any other cancer from which the patient has been disease free for ≥ 3 years).

- Patient with known history of human immunodeficiency virus (HIV), or any uncontrolled
active systemic infection.

- Patient has CMV viremia (peripheral blood CMV PCR positive), acute viral hepatitis
(typically defined by elevated AST/ALT), or a history of chronic or active HBV or HCV
infection. HBV infection is defined as having HBsAg and/or HBcAb positive test with
concurrent detectable HBV DNA levels. HCV infection is defined as detectable HCV RNA
levels.

- Patient requires treatment with a strong or moderate cytochrome P450 (CYP) 3A4
inhibitors, and inducers, and the treatment cannot be discontinued or switched to a
different medication prior to starting study drug. Moderate and strong CYP modulators
(inducers and inhibitors) should have a washout period of at least 5-6 half-lives
before initiating ibrutinib or copanlisib.

- Patients with known bleeding diathesis (e.g. von Willebrand 's disease) or hemophilia

- Patient is currently receiving warfarin or other Vitamin K antagonist. Therapy with
heparin, low molecular weight heparin (LMWH), or fondaparinux is allowed. Refer to
Section 9.5 for Concomitant medication

- Patients with Child Pugh Class B or C hepatic cirrhosis

- Patients with any life threatening illness, medical condition or organ system
dysfunction that in the opinion of the investigator could compromise the subject's
safety, interfere with absorption of metabolism of study drugs or put the study
outcomes at undue risk.