Tirabrutinib maintenance therapy for patients with primary CNS lymphoma in remission

Tirabrutinib Maintenance Versus Placebo in Patients With Primary Central Nervous System Lymphoma in Complete Remission: a Randomized Phase II Study (JCOG2104)

This study is testing if taking tirabrutinib every day can help people with primary CNS lymphoma stay in remission longer after their initial treatment.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 92 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Kyorin University (Academic / other)
• Drugs / interventions: rituximab, chemotherapy, methotrexate, Prednisone, tirabrutinib
• Locations: 1 site (Tokyo)
• Trial ID: NCT06940791 on ClinicalTrials.gov

What this trial studies

This phase II trial evaluates the effectiveness of tirabrutinib maintenance therapy compared to a placebo in patients with primary central nervous system lymphoma (PCNSL) who have achieved complete remission after high-dose methotrexate-based chemotherapy. Participants will receive either tirabrutinib or a placebo daily until disease progression or unacceptable toxicity occurs. Regular clinic visits every four weeks will be conducted for checkups and drug prescriptions.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with newly diagnosed primary CNS lymphoma who have achieved complete remission after induction chemotherapy.

Not a fit: Patients with systemic lymphoma or those who have undergone whole-brain irradiation may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly improve progression-free survival for patients with primary CNS lymphoma.

How similar studies have performed: While similar approaches have been explored, this specific use of tirabrutinib in PCNSL is novel and has not been extensively tested.

Eligibility criteria

Inclusion Criteria:

1. Histopathological diagnosis of B cell lymphoma.
2. Newly-diagnosed PCNSL confined to the cerebrum, cerebellum and brainstem. Patients with or without interocular lymphoma are eligible.
3. Negative cerebrospinal fluid (CSF) cytology, or no evidence of leptomeningeal lymphomatosis in contrast-enhanced magnetic resonance imaging (MRI) of the brain and the whole spinal cord.
4. No evidence of systemic lymphoma before induction chemotherapy, confirmed by contrast-enhanced CT including the neck, chest, abdomen, pelvic cavity and groin, or whole-body positron-emission tomography (PET) and CT.
5. Patients with a single lesion, or multiple lesions, are eligible.
6. Patients 18 years old or older at the time of registration.
7. Eastern Cooperative Oncology Group performance status (ECOG PS) of 0, 1, 2.
8. Have completed either of the following methotrexate (MTX)-based chemotherapy i) R-MPV (rituximab, MTX, procarbazine and vincristine) ii) MPV (MTX, procarbazine and vincristine) iii) R-MP (rituximab, MTX and procarbazine) iv) MP (MTX and procarbazine) v) R-M (rituximab and MTX) vi) MTX monotherapy
9. Complete response (CR) or complete response unconfirmed (CRu) based on the International PCNSL Collaborative Group (IPCG) criteria.
10. Within 60 days from the last dose of induction or consolidation chemotherapy.
11. No treatment history of radiotherapy for PCNSL.
12. Refused to receive consolidation radiotherapy.
13. No treatment history of chemotherapy or radiotherapy, except for stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) for non-cancer diseases (such as arteriovenous malformations).
14. Adequate organ function. i) Neutrophil count \>=1,000/mm3 ii) Hemoglobin \>= 8.0 g/dl iii) Platelet count \>= 75,000/mm3 iv) AST \<=120 U/L v) ALT \<= 120 U/L vi) Total Bilirubin \<= 2.25 mg/dl vii) Creatinine \<= 1.5 mg/dL
15. Written informed consent.

Exclusion Criteria:

1. Synchronous or metachronous malignancies.
2. Infections requiring systemic treatment at the time of registration.
3. Body temperature \>=38 degree celsius at the time of registration.
4. Serious lung disorders, such as interstitial pneumonia, obstructive lung disease, hypersensitive pneumonitis, symptomatic bronchospasm) at the time of registration.
5. History or presence of aspergillus pneumonitis or pneumocystis pneumonia.
6. History of serious drug allergy or serious anaphylaxis.
7. Heart failure (\>= III in New York Heart Association functional classification), unstable angina pectoris, or history of myocardial infarction within the preceding 180 days prior to registration.
8. Treated by anticoagulants at the time of registration.
9. Treated by antiplatelets at the time of registration.
10. Uncontrolled autoimmune hemolytic anemia (AIHA) or idiopathic thrombocytopenic purpura (ITP).
11. Immune deficiency, such as acquired immunodeficiency syndrome (AIDS), X-linked agammaglobulinemia, chronic granulomatous disease, Wiskott-Aldrich syndrome, or any other iatrogenic immunosuppressive conditions.
12. Post organ transplant immunosuppression.
13. Prednisone use of \>10 mg/day for condition other than intracranial tumor, or regular use of immunosuppressants.
14. Uncontrolled diabetes mellitus.
15. Treated either by CYP3A4 inhibitors, CYP3A4 inducers, or P-gp inducers within 14 days prior to registration.
16. Gadolinium allergy.
17. Positive HIV antibody.
18. Positive HBs antigen.
19. Positive HBs antibody or HBc antibody, and HBV-DNA positive.
20. Positive HCV antibody.
21. Unable to take oral medicine,
22. Females during pregnancy, or within 28 days postpartum, or during lactation. Males who wish childbearing of his partner.
23. Prior history of treatment by BTK inhibitors.
24. Severe psychiatric disorders.

Where this trial is running

Tokyo

• Kyorin University Hospital — Tokyo, Japan (Recruiting)

Study contacts

• Study coordinator: Nobuyoshi Sasaki, M.D., Ph.D.

Conditions Primary Central Nervous System Lymphoma