Using acalabrutinib to treat chronic lymphocytic leukemia and small lymphocytic lymphoma

Prospective Phase 2 Study of the Effect of Acalabrutinib on Myocardium on Ibrutinib Exposed Patients With CLL

This study is testing if acalabrutinib can safely treat people with chronic lymphocytic leukemia or small lymphocytic lymphoma who can't tolerate ibrutinib, while also keeping an eye on their heart health.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 61 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Ohio State University Comprehensive Cancer Center (Academic / other)
• Drugs / interventions: ibrutinib, acalabrutinib, radiation
• Locations: 1 site (Columbus, Ohio)
• Trial ID: NCT06757647 on ClinicalTrials.gov

What this trial studies

This phase II trial evaluates the effectiveness of acalabrutinib in patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) who are intolerant to ibrutinib. The study focuses on assessing cardiac function through magnetic resonance imaging (MRI) and monitoring adverse events related to treatment. Patients will receive acalabrutinib orally twice daily, and various biomarkers will be measured to understand the drug's impact on heart health and cancer progression. The trial aims to provide a safer alternative for patients who experience cardiac side effects from ibrutinib.

Who should consider this trial

Good fit: Ideal candidates include adults aged 18 and older with a diagnosis of CLL/SLL who have experienced cardiac intolerance to ibrutinib.

Not a fit: Patients who have not been treated with ibrutinib or those with active uncontrolled autoimmune cytopenias may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a safer and effective option for patients with CLL/SLL who cannot tolerate ibrutinib due to cardiac issues.

How similar studies have performed: Other studies have shown promise with BTK inhibitors, but this specific approach with acalabrutinib in patients intolerant to ibrutinib is relatively novel.

Eligibility criteria

Inclusion Criteria:

* Men and women \>= 18 years of age
* Diagnosis of CLL/SLL meeting criteria as defined by International Workshop on Chronic Lymphocytic Leukemia (iWCLL) 2018 criteria
* CLL patients cardiac intolerant to current treatment with ibrutinib as defined by AF or other cardiac arrhythmias. Other ibrutinib-related intolerances will be excluded
* Eastern Cooperative Oncology Group (ECOG) performance status of =\< 2
* Absolute neutrophil count (ANC) \>= 1000/mm\^3 (Independent of growth factor support at screening unless due to marrow involvement by CLL/SLL and/or disease-related immune thrombocytopenia. If cytopenias are due to disease in the bone marrow any degree of cytopenias is allowed. Patients with active uncontrolled autoimmune cytopenias are excluded)
* Platelets \>= 30,000/mm\^3 (Independent of growth factor support at screening unless due to marrow involvement by CLL/SLL and/or disease-related immune thrombocytopenia. If cytopenias are due to disease in the bone marrow any degree of cytopenias is allowed. Patients with active uncontrolled autoimmune cytopenias are excluded)
* Total bilirubin =\< 1.5 x upper limit of normal (ULN) (excepting Gilbert's syndrome) (at screening)
* Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 2.5 x ULN (at screening)
* Creatinine clearance \>= 30 mL/min/1.73m\^2 (at screening)

  * 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 2 days after the last dose of acalabrutinib
* 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:

* Prior exposure to acalabrutinib for primary cohort and prior exposure to BTK inhibitor for pilot cohort
* Presence of C481S mutation or PCLG2 mutation
* Disease progression on ibrutinib
* History of prior malignancy that could affect compliance with the protocol or interpretation of results, except for the following:

  * Curatively treated basal cell carcinoma or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or carcinoma in situ of the prostate at any time prior to study
  * Other cancers not specified above that have been curatively treated by surgery and/or radiation therapy from which subject is disease-free for \>= 3 years without further treatment
* Clinically significant cardiovascular disease such as prior myocarditis, congestive heart failure, prior documented myocardial infarction (i.e., not self-reported), known infiltrative cardiomyopathy (ex. cardiac sarcoidosis, cardiac amyloidosis, etc.) or any class 3 or 4 cardiac disease as defined by the New York Heart Association Functional Classification. Note: Subjects with controlled, asymptomatic atrial fibrillation can enroll on study
* Prior allogeneic stem cell transplantation
* Prior cardiac transplantation
* Systemic or non-cancer targeted anti-inflammatory medications (i.e., steroids)
* Contradictions to MRI: non-compatible metal implant, weight \> 300 pounds (lbs.) (MRI scanner limit), severe claustrophobia, advanced or end-stage renal disease (ESRD) (contraindication to gadolinium), pregnancy, cognitive disabilities that may impair ability to comply with instructions or provide informed consent
* Has difficulty with or is unable to swallow oral medication or has significant. gastrointestinal disease that would limit absorption of oral medication
* Known history of infection with HIV or any active significant infection (e.g., bacterial, viral, or fungal) including subjects with positive cytomegalovirus \[CMV\] deoxyribonucleic acid \[DNA\] polymerase chain reaction \[PCR\])
* 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 AIHA (autoimmune hemolytic anemia) or ITP (idiopathic thrombocytopenic purpura)
* Presence of a gastrointestinal ulcer diagnosed by endoscopy within 3 months before screening
* Requires treatment with a strong cytochrome P450 3A4 (CYP3A4) inhibitor/inducer. The use of strong CYP3A inhibitors within 1 week or strong CYP3A inducers within 3 weeks of the first dose of study drug is prohibited
* 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
* Requires treatment with proton pump inhibitors (e.g., omeprazole, esomeprazole, lansoprazole, dexlansoprazole, rabeprazole, or pantoprazole). Note: Subjects receiving proton pump inhibitors who switch to H2-receptor antagonists or antacids are eligible for enrollment to this study
* 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
* Received a live virus vaccination within 28 days of first dose of study drug
* History of or ongoing confirmed progressive multifocal leukoencephalopathy (PML)
* Received any investigational drug within 30 days or 5 half-lives (whichever is shorter) before 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 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
* 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: Seema A Bhat, MD — Ohio State University Comprehensive Cancer Center
• Study coordinator: The Ohio State University Comprehensive Cancer Center

Conditions Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma