Study Adding Drugs to Usual Treatment for Large B-Cell Lymphoma That Returned or Did Not Respond to Treatment
Start Date
9/26/2023
Completion Date
1/1/2029
Summary
This phase 2 trial studies the side effects and best dose of tazemetostat and zanubrutinib in combination with tafasitamab and lenalidomide, and to see how well these combinations work in treating patients with large B-cell lymphoma that returned or did not respond to earlier treatment. Tazemetostat is in a class of medications called EZH2 inhibitors. It helps to stop the spread of cancer cells. Zanubrutinib is in a class of medications called kinase inhibitors. It works by blocking the action of the abnormal protein that signals cancer cells to multiply. This helps stop the spread of cancer cells. tafasitamab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Lenalidomide is in a class of medications called immunomodulatory agents. It works by helping the bone marrow to produce normal blood cells and by killing abnormal cells in the bone marrow. The addition of tazemetostat or zanubrutinib to tafasitamab and lenalidomide may be able to shrink the cancer or extend the time without cancer symptoms coming back.
Detailed Description
PRIMARY OBJECTIVES: I. To determine the recommended phase II dose of tafasitamab + lenalidomide + tazemetostat AND of tafasitamab + lenalidomide + zanubrutinib. (Safety Run-in) II. To compare progression-free survival (PFS) of patients with relapsed/refractory large B-cell lymphoma (R/R LBCL) treated with tafasitamab + lenalidomide + tazemetostat vs control (tafasitamab + lenalidomide) AND treated with tafasitamab + lenalidomide + zanubrutinib versus (vs) control. (Randomized Phase II Study) SECONDARY OBJECTIVES: I. To estimate the hazard ratio for PFS for control vs. tafasitamab + lenalidomide + tazemetostat in germinal center B-cell (GCB) and non-GCB (activated B-cell \[ABC\]/unclassified) subsets. II. To estimate the hazard ratio for PFS for control vs. tafasitamab + lenalidomide + zanubrutinib in GCB and non-GCB (ABC/unclassified) subsets. III. To estimate progression-free survival (PFS), overall response rate (ORR), complete response rate (CR), partial response rate (PR), duration of response (DOR), event-free survival (EFS), overall survival (OS), in GCB and non-GCB LBCL for each treatment. IV. To evaluate adverse events within each treatment arm. OTHER OBJECTIVES: I. To explore PFS within subgroups defined by molecular profile (e.g., MCD, BN2, N1 and EZB) and genetic subtypes. II. To explore PFS in the tafasitamab-lenalidomide control arm vs that in matched historical control from L-MIND and realMIND studies. III. To assess frailty (Cumulative Illness Rating Scale \[CIRS\] and Timed Get Up and Go \[TUG\]) and its correlation with outcome. PRIMARY PATIENT-REPORTED OUTCOMES OBJECTIVE: I. To compare patient-reported lymphoma-specific symptoms as measured by the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) Trial Outcome Index sub-scale at 3 months after randomization between the control arm and each experimental arm (Arm 1 versus Arm 2 and Arm 3 versus Arm 2). SECONDARY PATIENT-REPORTED OUTCOMES OBJECTIVE: I. To compare participant-reported toxicity (treatment side effect) symptoms using selected Patient Reported Outcomes-Common Terminology Criteria for Adverse Events (PRO-CTCAE) items between experimental vs control arms. EXPLORATORY PATIENT-REPORTED OUTCOMES OBJECTIVES: I. To compare patient-reported quality of life using the FACT-General (G) subscale score and the FACT-Lym total score at 3 months after randomization between the control arm and each experimental arm. II. To compare quality of life over time between treatment arms from baseline to 12 months after randomization as measured by the FACT-Lym trial outcome index (TOI), FACT-G, and FACT-Lym total score using longitudinal analysis. BANKING OBJECTIVE: I. To bank specimens for future correlative studies. OUTLINE: This is a dose-escalation study of tazemetostat and zanubrutinib. PART I (SAFETY RUN-IN): Patients are assigned to 1 of 2 arms per treating investigator's choice. ARM I: Patients receive tafasitamab intravenously (IV), lenalidomide orally (PO), and tazemetostat PO on study. Patients also undergo positron emission tomography/computed tomography (PET/CT) and CT or magnetic resonance imaging (MRI) scans throughout the trial. Patients also have the option to undergo collection of blood samples during screening and on study. ARM III: Patients receive tafasitamab IV, lenalidomide PO, and zanubrutinib PO on study. Patients also undergo PET/CT and CT or MRI scans throughout the trial. Patients also have the option to undergo collection of blood samples during screening and on study. PART II: Patients are randomized to 1 of 3 arms. ARM I: Patients receive tafasitamab IV, lenalidomide PO, and tazemetostat PO on study. Patients also undergo PET/CT and CT or MRI scans throughout the trial. Patients also have the option to undergo collection of blood samples during screening and on study. ARM II: Patients receive tafasitamab IV and lenalidomide PO on study. Patients also undergo PET/CT and CT or MRI scans throughout the trial. Patients also have the option to undergo collection of blood samples during screening and on study. ARM III: Patients receive tafasitamab IV, lenalidomide PO, and zanubrutinib PO on study. Patients also undergo PET/CT and CT or MRI scans throughout the trial. Patients also have the option to undergo collection of blood samples during screening and on study.
Eligibility Criteria
Age Range: 18 years to No maximum
Interventions
Biospecimen Collection
Computed Tomography
Lenalidomide
Magnetic Resonance Imaging
Positron Emission Tomography
Quality-of-Life Assessment
Questionnaire Administration
Tafasitamab
Tazemetostat
Zanubrutinib
Conditions
Locations
Banner University Medical Center - Tucson
Tucson, Arizona 85719
United States
University of Arizona Cancer Center-North Campus
Tucson, Arizona 85719
United States
Tower Cancer Research Foundation
Beverly Hills, California 90211
United States
City of Hope Comprehensive Cancer Center
Duarte, California 91010
United States
City of Hope Seacliff
Huntington Beach, California 92648
United States
City of Hope Antelope Valley
Lancaster, California 93534
United States
City of Hope at Long Beach Elm
Long Beach, California 90813
United States
Cedars Sinai Medical Center
Los Angeles, California 90048
United States
City of Hope Newport Beach
Newport Beach, California 92660
United States
City of Hope South Pasadena
South Pasadena, California 91030
United States
City of Hope South Bay
Torrance, California 90503
United States
City of Hope Upland
Upland, California 91786
United States
Holy Cross Hospital
Fort Lauderdale, Florida 33308
United States
Mount Sinai Medical Center
Miami Beach, Florida 33140
United States
University of Illinois
Chicago, Illinois 60612
United States
University of Chicago Comprehensive Cancer Center
Chicago, Illinois 60637
United States
Carle at The Riverfront
Danville, Illinois 61832
United States
Carle Physician Group-Effingham
Effingham, Illinois 62401
United States
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois 61938
United States
UC Comprehensive Cancer Center at Silver Cross
New Lenox, Illinois 60451
United States
University of Chicago Medicine-Orland Park
Orland Park, Illinois 60462
United States
Memorial Hospital East
Shiloh, Illinois 62269
United States
Carle Cancer Center
Urbana, Illinois 61801
United States
Northwest Cancer Center - Main Campus
Crown Point, Indiana 46307
United States
Northwest Oncology LLC
Dyer, Indiana 46311
United States
Northwest Cancer Center - Hobart
Hobart, Indiana 46342
United States
Saint Mary Medical Center
Hobart, Indiana 46342
United States
Saint Catherine Hospital
Indianapolis, Indiana 46312
United States
The Community Hospital
Munster, Indiana 46321
United States
Women's Diagnostic Center - Munster
Munster, Indiana 46321
United States
Northwest Cancer Center - Valparaiso
Valparaiso, Indiana 46383
United States
UI Health Care Mission Cancer and Blood - Ankeny Clinic
Ankeny, Iowa 50023
United States
Mercy Hospital
Cedar Rapids, Iowa 52403
United States
Oncology Associates at Mercy Medical Center
Cedar Rapids, Iowa 52403
United States
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
Clive, Iowa 50325
United States
Mercy Medical Center - Des Moines
Des Moines, Iowa 50314
United States
UI Health Care Mission Cancer and Blood - Laurel Clinic
Des Moines, Iowa 50314
United States
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
Ann Arbor, Michigan 48106
United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton
Brighton, Michigan 48114
United States
Trinity Health Medical Center - Brighton
Brighton, Michigan 48114
United States
Trinity Health IHA Medical Group Hematology Oncology - Canton
Canton, Michigan 48188
United States
Trinity Health Medical Center - Canton
Canton, Michigan 48188
United States
Chelsea Hospital
Chelsea, Michigan 48118
United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
Chelsea, Michigan 48118
United States
Cancer Hematology Centers - Flint
Flint, Michigan 48503
United States
Genesee Hematology Oncology PC
Flint, Michigan 48503
United States
Genesys Hurley Cancer Institute
Flint, Michigan 48503
United States
Hurley Medical Center
Flint, Michigan 48503
United States
University of Michigan Health - Sparrow Lansing
Lansing, Michigan 48912
United States
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan 48154
United States
Trinity Health Saint Joseph Mercy Oakland Hospital
Pontiac, Michigan 48341
United States
Huron Gastroenterology PC
Ypsilanti, Michigan 48106
United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
Ypsilanti, Michigan 48197
United States
Essentia Health - Deer River Clinic
Deer River, Minnesota 56636
United States
Essentia Health Cancer Center
Duluth, Minnesota 55805
United States
Essentia Health Hibbing Clinic
Hibbing, Minnesota 55746
United States
Essentia Health Sandstone
Sandstone, Minnesota 55072
United States
Essentia Health Virginia Clinic
Virginia, Minnesota 55792
United States
University of Mississippi Medical Center
Jackson, Mississippi 39216
United States
Siteman Cancer Center at Saint Peters Hospital
City of Saint Peters, Missouri 63376
United States
Siteman Cancer Center at West County Hospital
Creve Coeur, Missouri 63141
United States
Washington University School of Medicine
St Louis, Missouri 63110
United States
Siteman Cancer Center-South County
St Louis, Missouri 63129
United States
Siteman Cancer Center at Christian Hospital
St Louis, Missouri 63136
United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York 10032
United States
University of Rochester
Rochester, New York 14642
United States
Wilmot Cancer Institute at Webster
Webster, New York 14580
United States
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma 73104
United States
Providence Newberg Medical Center
Newberg, Oregon 97132
United States
Providence Willamette Falls Medical Center
Oregon City, Oregon 97045
United States
Providence Portland Medical Center
Portland, Oregon 97213
United States
Providence Saint Vincent Medical Center
Portland, Oregon 97225
United States
Medical University of South Carolina
Charleston, South Carolina 29425
United States
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Houston, Texas 77030
United States
Ben Taub General Hospital
Houston, Texas 77030
United States
University of Texas Health Science Center at San Antonio
San Antonio, Texas 78229
United States
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah 84112
United States
VCU Massey Cancer Center at Stony Point
Richmond, Virginia 23235
United States
VCU Massey Comprehensive Cancer Center
Richmond, Virginia 23298
United States
ThedaCare Regional Cancer Center
Appleton, Wisconsin 54911
United States
Duluth Clinic Ashland
Ashland, Wisconsin 54806
United States
Aurora Cancer Care-Southern Lakes VLCC
Burlington, Wisconsin 53105
United States
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin 54701
United States
Aurora Health Care Germantown Health Center
Germantown, Wisconsin 53022
United States
Aurora Cancer Care-Grafton
Grafton, Wisconsin 53024
United States
Aurora BayCare Medical Center
Green Bay, Wisconsin 54311
United States
Aurora Cancer Care-Kenosha South
Kenosha, Wisconsin 53142
United States
Gundersen Lutheran Medical Center
La Crosse, Wisconsin 54601
United States
Aurora Bay Area Medical Group-Marinette
Marinette, Wisconsin 54143
United States
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin 54449
United States
Aurora Cancer Care-Milwaukee
Milwaukee, Wisconsin 53209
United States
Aurora Saint Luke's Medical Center
Milwaukee, Wisconsin 53215
United States
Aurora Sinai Medical Center
Milwaukee, Wisconsin 53233
United States
Marshfield Medical Center - Minocqua
Minocqua, Wisconsin 54548
United States
Vince Lombardi Cancer Clinic - Oshkosh
Oshkosh, Wisconsin 54904
United States
Aurora Cancer Care-Racine
Racine, Wisconsin 53406
United States
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin 54868
United States
Vince Lombardi Cancer Clinic-Sheboygan
Sheboygan, Wisconsin 53081
United States
Marshfield Medical Center-River Region at Stevens Point
Stevens Point, Wisconsin 54482
United States
Aurora Medical Center in Summit
Summit, Wisconsin 53066
United States
Vince Lombardi Cancer Clinic-Two Rivers
Two Rivers, Wisconsin 54241
United States
Aurora Cancer Care-Milwaukee West
Wauwatosa, Wisconsin 53226
United States
Aurora West Allis Medical Center
West Allis, Wisconsin 53227
United States
Marshfield Medical Center - Weston
Weston, Wisconsin 54476
United States