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NCT05890352PHASE2Recruiting

Study Adding Drugs to Usual Treatment for Large B-Cell Lymphoma That Returned or Did Not Respond to Treatment

SWOG Cancer Research Network

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

Inclusion Criteria: * Participants must have: * Histologically confirmed relapsed/refractory LBCL as outlined by the World Health Organization (WHO) guidelines * Follicular lymphoma, grade 3B * Transformed lymphoma * High grade B-cell lymphoma with or without MYC, BCL2 and/or BCL6 rearrangements * Participants must have staging imaging performed within 28 days prior to registration, as follows. Positron emission tomography (PET)-computed tomography (CT) baseline scans are strongly preferred; diagnostic quality magnetic resonance imaging (MRI), contrast-enhanced CT, or contrast-enhanced MRI scans are also acceptable if PET-CT is not feasible at baseline. Note: PET-CT will be required at end of treatment (EOT) and progression for response assessment. All measurable lesions (longest diameter \>= 1.5 cm) must be assessed within 28 days prior to registration. Tests to assess non-measurable disease must be performed within 28 days prior to registration. All disease must be documented on the Baseline Tumor Assessment Form. * Participants must have cell of origin (COO) determination of germinal center (GC)(GCB or non-GC GCB) of LBCL based on Hans immunohistochemistry algorithm (CD10, BCL6, MUM1) as noted on pathology report. * Participants must have had 1-5 prior systemic treatment regimens including one systemic multiagent regimen for aggressive lymphoma * Participants who have received prior systemic therapy must have completed their last treatment prior to registration. Participants must have recovered from previous therapy * Steroid use for the control of non-Hodgkin lymphoma symptoms is allowable, but must be discontinued prior to Cycle 1, Day 1 * Participant must be \>= 18 years old * Participant must have Zubrod Performance Status of 0-3 * Participant must have a complete medical history and physical exam within 28 days prior to registration * Absolute neutrophil count \>= 1.0 x 10\^3/uL (within 28 days prior to registration) * If there is documented lymphomatous involvement of the bone marrow as assessed by bone marrow biopsy within 90 days prior to registration, participants must have: Absolute neutrophil count (ANC) \>= 0.75 x 10\^3/uL * Platelets \>= 75 x 10\^3/uL (within 28 days prior to registration) * If there is documented lymphomatous involvement of the bone marrow as assessed by bone marrow biopsy within 90 days prior to registration, participants must have: Platelets \>= 50 x 10\^3/uL * Aspartate aminotransferase (AST) =\< 3 x institutional upper limit of normal (IULN), alanine aminotransferase (ALT) =\< 3 x IULN (within 28 days prior to registration) unless due to Gilbert's disease, hemolysis, or lymphomatous involvement of liver. * Participants with lymphomatous involvement of the liver must have AST =\< 5 x IULN, ALT =\< 5 x IULN * Total bilirubin =\< 1.5 x IULN (within 28 days prior to registration) unless due to Gilbert's disease, hemolysis, or lymphomatous involvement of liver. * Participants with lymphomatous involvement of the liver must have total bilirubin =\< 5 x IULN * Participants must have a calculated creatinine clearance \>= 30 mL/min using the following Cockcroft-Gault Formula. This specimen must have been drawn and processed within 28 days prior to registration * Participants with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better * Participants must have recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities \> Grade 1) with the exception of alopecia * Participants with known human immunodeficiency virus (HIV)-infection must be on effective anti-retroviral therapy at randomization and have undetectable viral load test on the most recent test results obtained within 6 months prior to registration * Participants with evidence of chronic hepatitis B virus (HBV) infection must have undetectable HBV viral load on the most recent test results obtained within the last year and received suppressive therapy * Participants with a history of hepatitis C virus (HCV) infection must have an undetectable viral load. Participants currently being treated for HCV infection must have undetectable HCV viral load test on the most recent test results obtained within 28 days prior to registration * Participants must be able to swallow and retain orally administered medication and does not have any clinically significant gastrointestinal abnormalities that may alter absorption, such as malabsorption syndrome or major resection of the stomach or bowels * Participants must be offered the opportunity to participate in specimen banking. With participant consent, specimens must be collected and submitted via the Southwest Oncology Group (SWOG) Specimen Tracking System * Participants who can complete the FACT-Lym and PRO-CTCAE forms in English or Spanish must agree to participate in the patient-reported outcome study * Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines. * For participants with impaired decision-making capabilities, legally authorized representatives may sign and give informed consent on behalf of study participants in accordance with applicable federal, local, and central institutional review board (CIRB) regulations. Exclusion Criteria: * Participants must not have active lymphomatous involvement of the central nervous system (CNS) because the treatments used in this study are not effective to sufficiently penetrate the blood brain barrier * Participants must not have known abnormalities associated with myelodysplastic syndrome (MDS) (e.g., del 5q, chr 7 abn) and myeloproliferative neoplasms (MPN) (e.g., JAK2 V617F) observed in cytogenetic testing and deoxyribonucleic acid (DNA) sequencing. Testing is not required for eligibility determination * Participants must not have a known prior history of T-cell lymphoblastic lymphoma (T-LBL)/T-cell acute leukemia (T-ALL). Testing is not required for eligibility determination * Participants must not be a candidate based on investigator assessment to receive autologous stem cell transplant (ASCT) or must have declined ASCT. Participants who had disease progression after stem cell transplant or cellular therapy (such as chimeric antigen receptor (CAR) T-cell) are eligible * Participants must not have received prior treatment with tafasitamab and/or lenalidomide * Participants must not have had prior BTK inhibitor or tazemetostat * Participants must not have any known allergy or reaction to any component of tafasitamab, lenalidomide, tazemetostat or zanubrutinib * Participants must not be receiving direct vitamin K inhibitors or strong or moderate CYP3A inhibitors or inducers at the date of registration * Notes: Because the list of these agents is constantly changing, it is important to regularly consult a frequently updated medical reference * Participants must not have a prior or concurrent malignancy whose natural history or treatment (in the opinion of the treating physician) has the potential to interfere with the safety or efficacy assessment of the investigational regimen * Participants must not be pregnant or nursing and must follow the guidelines according to the lenalidomide Risk Evaluation and Mitigation Strategies (REMS) program. The effects of tazemetostat, zanubrutinib, lenalidomide and tafasitamab, and the combination of these drugs have not been studied on the developing human fetus are the effects are unknown. Individuals who are of reproductive potential must have agreed to use a highly effective contraceptive method with details provided as a part of the consent process. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential". In addition to routine contraceptive methods, "acceptable contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen

Interventions

PROCEDURE

Biospecimen Collection

PROCEDURE

Computed Tomography

DRUG

Lenalidomide

PROCEDURE

Magnetic Resonance Imaging

PROCEDURE

Positron Emission Tomography

OTHER

Quality-of-Life Assessment

OTHER

Questionnaire Administration

BIOLOGICAL

Tafasitamab

DRUG

Tazemetostat

DRUG

Zanubrutinib

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Conditions

Grade 3b Follicular LymphomaHigh Grade B-Cell LymphomaHigh Grade B-Cell Lymphoma With MYC and BCL2 and/or BCL6 RearrangementsRecurrent Diffuse Large B-Cell LymphomaRefractory Diffuse Large B-Cell LymphomaTransformed Non-Hodgkin Lymphoma

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