Acalabrutinib combined with venetoclax or obinutuzumab for treating chronic lymphocytic leukemia

Prospective Randomized Phase II Study of Acalabrutinib + Obinutuzumab or Venetoclax in Previously Untreated CLL

This study is testing if a new combination of two drugs, acalabrutinib with either venetoclax or obinutuzumab, can help people with chronic lymphocytic leukemia who haven't been treated before by reducing cancer cells in their bone marrow.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 52 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Ohio State University Comprehensive Cancer Center (Academic / other)
• Drugs / interventions: rituximab, obinutuzumab, acalabrutinib, chemotherapy, immunotherapy, prednisone
• Locations: 1 site (Columbus, Ohio)
• Trial ID: NCT05336812 on ClinicalTrials.gov

What this trial studies

This phase II trial investigates the effectiveness of acalabrutinib in combination with either venetoclax or obinutuzumab in patients with treatment-naive chronic lymphocytic leukemia (CLL). The study aims to evaluate whether this combination therapy can improve the rate of undetectable minimal residual disease in the bone marrow. Participants will receive acalabrutinib for one year, followed by a randomized addition of either venetoclax or obinutuzumab for six cycles. The trial also assesses safety, overall response rate, progression-free survival, and duration of response.

Who should consider this trial

Good fit: Ideal candidates include adults aged 18 and older who are newly diagnosed with chronic lymphocytic leukemia or small lymphocytic lymphoma and have not received prior treatment.

Not a fit: Patients who have previously undergone chemotherapy, immunotherapy, or targeted therapy for CLL may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could lead to improved disease management and longer remission periods for patients with chronic lymphocytic leukemia.

How similar studies have performed: Other studies have shown promising results with similar combination therapies in CLL, indicating potential for success in this approach.

Eligibility criteria

Inclusion Criteria:

* Men and women \>= 18 years of age
* Diagnosis of CLL/small lymphocytic lymphoma (SLL) meeting criteria established in the 2018 International Workshop (iw)CLL guidelines
* Must be treatment-naive: Received no prior chemotherapy, immunotherapy, or targeted therapy for the treatment of CLL, with the exceptions of palliative loco-regional radiotherapy, rituximab for autoimmune conditions, or corticosteroids for symptoms control
* Patients must meet criteria for treatment as defined by 2018 iwCLL guidelines which includes at least one of the following criteria:

  * Evidence of marrow failure as manifested by the development or worsening of anemia or thrombocytopenia (not attributable to autoimmune hemolytic anemia or thrombocytopenia)
  * Massive (\>= 6 cm below the costal margin), progressive or symptomatic splenomegaly
  * Massive nodes (\>= 10 cm) or progressive or symptomatic lymphadenopathy
  * Progressive lymphocytosis with a lymphocyte doubling time \< 6 months or an increase of \>= 50% over a 2 month period
  * Autoimmune anemia and/or thrombocytopenia that is poorly responsive to standard therapy
  * Symptomatic or functional extranodal involvement (e.g. skin, kidney, lung, spine)
  * Constitutional symptoms, which include any of the following:

    * Unintentional weight loss of 10% or more within 6 months
    * Significant fatigue
    * Fevers \> 100.5 degrees Fahrenheit (F) for 2 weeks or more without evidence of infection
    * Night sweats \>= 1 month without evidence of infection
* Eastern Cooperative Oncology Group (ECOG) performance status of =\< 2
* Adequate bone marrow independent of growth factor support or infusion support at screening unless evidence shows that the cytopenia(s) is due to marrow involvement by CLL/SLL and/or disease-related immune thrombocytopenia, or anemia. If cytopenias are due to disease in the bone marrow any degree of cytopenias are allowed. Patients with active uncontrolled autoimmune cytopenias are excluded
* Absolute neutrophil count (ANC) \>= 1000/mm\^3
* Platelets \>= 30,000/mm\^3
* Hemoglobin \>= 7 g/dL
* Total bilirubin =\< 2.0 x upper limit of normal (ULN) (excepting Gilbert's syndrome)
* Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 2.5 x ULN
* Creatinine clearance \>= 30 mL/min/1.73m\^2

  * Using 24-hour creatinine clearance or modified Cockcroft-Gault equation
* Woman of childbearing potential (WOCBP) who are sexually active must use highly effective methods of contraception during treatment and for at least 2 days after last acalabrutinib dose, 30 days after last venetoclax dose, and 6 months after last obinutuzumab dose
* Willing and able to participate in all required evaluations and procedures in this study protocol
* Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information

Exclusion Criteria:

* Patients with high-risk disease as defined by:

  * Presence of deletion 17p13 on cytogenetic analysis by fluorescent in situ hybridization (FISH)
  * Presence of TP53 mutation on next generation sequencing
  * Presence of complex karyotype on cytogenetic evaluation

    * Defined as \>= 3 karyotypic abnormalities
* Treatment with a moderate or strong CYP3A inhibitor or inducer within 7 days prior to first dose of acalabrutinib or venetoclax or need for treatment with a strong CYP3A inhibitor or inducer during the period or the study. Patients who have a need for treatment with a moderate CYP3A inhibitor or inducer during acalabrutinib or venetoclax dose escalation will also be excluded
* Known active involvement of the central nervous system by lymphoma or leukemia
* Subject with other malignancies that are associated with a life expectancy of \< 2 years or that would confound assessment of toxicity in this study
* Clinically significant cardiovascular disease such as symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of screening, or any Class 3 or 4 cardiac disease as defined by the New York Heart Association Functional Classification. Note: Subjects with controlled atrial fibrillation can enroll on study
* Is unable to swallow oral medication, or has significant gastrointestinal disease that would limit absorption of oral medication
* Known history of infection with human immunodeficiency virus (HIV)
* Subjects with active infections requiring intravenous (IV) antibiotic/antiviral therapy are not eligible for entry onto the study until resolution of the infection. Subjects on prophylactic antibiotics or antivirals are acceptable
* Known history of hypersensitivity or anaphylaxis to study drug(s) including active product or excipient components
* Active bleeding or history of bleeding diathesis (e.g., hemophilia or von Willebrand disease)
* Uncontrolled autoimmune hemolytic anemia (AIHA) or idiopathic thrombocytopenic purpura (ITP) unrelated to underlying CLL
* Patients with uncontrolled autoimmune disease requiring \> 20 mg of daily prednisone or equivalent
* Presence of a gastrointestinal ulcer diagnosed by endoscopy within 3 months before screening
* Requires or receiving anticoagulation with warfarin or equivalent vitamin K antagonists
* Prothrombin time (PT)/international normalized ratio (INR) or activated partial thromboplastin time (aPTT) (in the absence of lupus anticoagulant) \> 2 x ULN
* History of significant cerebrovascular disease/event, including stroke or intracranial hemorrhage, within 6 months before the first dose of study drug
* Major surgical procedure within 28 days of first dose of study drug. Note: If a subject had major surgery, they must have recovered adequately from any toxicity and/or complications from the intervention before the first dose of study drug
* Hepatitis B or C serologic status:

  * Subjects who are hepatitis B core antibody (anti-HBc) positive and who are hepatitis B surface antigen (HBsAg) negative will need to have a negative polymerase chain reaction (PCR) and must be willing to undergo deoxyribonucleic acid (DNA) PCR testing during the study to be eligible. Those who are HBsAg positive or hepatitis B PCR positive will be excluded
  * Subjects who are hepatitis C antibody positive will need to have a negative PCR result to be eligible. Those who are hepatitis C PCR positive will be excluded
* Breastfeeding or pregnant
* Vaccination with live vaccines 28 days prior to registration for study screening
* Concurrent participation in another therapeutic clinical trial

Where this trial is running

Columbus, Ohio

• Ohio State University Comprehensive Cancer Center — Columbus, Ohio, United States (Recruiting)

Study contacts

• Principal investigator: Kerry S Rogers, MD — Ohio State University Comprehensive Cancer Center
• Study coordinator: The Ohio State University Comprehensive Cancer Center

Conditions Chronic Lymphocytic Leukemia; Small Lymphocytic Lymphoma