Epcoritamab Compared to Observation for Treating B-cell Lymphoma Patients Not in Complete Remission After CD19-directed CAR-T Therapy

ABSTRACT

ConditionDiffuse Large B-Cell Lymphoma, Not Otherwise Specified;Primary Mediastinal Large B-Cell Lymphoma;Transformed Indolent B-Cell Non-Hodgkin Lymphoma to Diffuse Large B-Cell Lymphoma

InterventionProcedure Biopsy;Procedure Biospecimen Collection;Procedure Computed Tomography;Biological Epcoritamab;Procedure Magnetic Resonance Imaging;Other Patient Observation;Procedure Positron Emission Tomography

Primary outcome:Objective status of complete response (CR)

Criteria
Inclusion Criteria

- Men and women >= 18 years of age

- Documented histological confirmation of diffuse large b-cell lymphoma not otherwise
specified [DLBCL NOS], primary mediastinal large b-cell lymphoma (LBCL), or
transformations of indolent B-cell lymphomas, according to the 5th edition of World
Health Organization (WHO) classification of lymphoid neoplasms, with CD20 positivity
as determined by assessment of tumor cells =< 6 months prior to registration pre-
CAR-T biopsy specimen by immunohistochemistry or flow cytometry

- Patients treated with the commercially available CD19-directed CAR-T products
axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), or lisocabtagene
maraleucel (liso-cel), and who have a partial response at day 30 +/- 7 days PET- CT
assessment based on Lugano criteria (Deauville score of 4 or 5)

- Documented measurable disease

- Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1, or 2. (Form is
available on the Academic and Community Cancer Research United [ACCRU] web site under
Study Resources -> Forms)

- Absolute neutrophil count (ANC) >= 1,000/mm^3, granulocyte colony stimulating factor
(G-CSF) allowed (obtained =< 14 days prior to registration)

- Platelet count >= 50,000/mm^3 (obtained =< 14 days prior to registration)

- Hemoglobin >= 7.0 g/dL if asymptomatic or hemoglobin > 8 if symptomatic; transfusion
support allowed, if necessary (obtained =< 14 days prior to registration)

- NOTE symptoms include shortness of breath, fatigue, lightheadedness

- Total bilirubin =< 1.5 x upper limit of normal (ULN) unless bilirubin rise is due to
Gilbert's syndrome or of non-hepatic origin or lymphoma involvement of the liver and
total bilirubin is =< 5 x ULN (obtained =< 14 days prior to registration)

- Alanine aminotransferase (ALT) and aspartate transaminase (AST) =< 3 x ULN (=< 5 x ULN
for patients with liver involvement) (obtained =< 14 days prior to registration)

- Calculated creatinine clearance must be >= 45 mL/min using the Crockcroft- Gault
formula (obtained =< 14 days prior to registration)

- NOTE If your site laboratory reports use different units of measurement than
what is required by the protocol eligibility requirements, please use the "Lab
Test Unit Conversion Worksheet" available on the ACCRU website under "General
Forms."

- Negative serum pregnancy test done =< 7 days prior to registration for a woman of
childbearing potential (WOCBP) only

- NOTE A WOCBP is a sexually mature female who

- Has not undergone a hysterectomy or bilateral oophorectomy; or

- Has not been naturally postmenopausal for at least 12 consecutive months
(i.e., has had menses at any time in the preceding 12 consecutive months)

- Provide informed written consent =< 28 days prior to registration

- Willing to return to enrolling institution for follow-up (during the active monitoring
phase of the study, i.e., active treatment and clinical follow-up)

- Willing to provide mandatory tissue specimens and blood specimens for correlative
research purposes

Exclusion Criteria

- Patients post CAR-T who have bulky disease defined as a disease focus >= 7.5cm in
diameter at day 30 +/- 7 days PET-CT assessment

- Patients post CAR-T who have progressive disease, stable disease or complete response
at day 30 +/- 7 days PET-CT assessment based on Lugano criteria

- Any of the following because this study involves an investigational agent whose
genotoxic, mutagenic, and teratogenic effect on the developing fetus and newborn are
unknown

- Pregnant persons

- Nursing persons

- Persons of childbearing potential who are unwilling to employ adequate
contraception (men and women)

- Any of the following prior therapies

- CD20xCD3 bispecific antibody at any point prior to registration

- CD20-targeted monoclonal antibody (e.g., rituximab, obinutuzumab or biosimilars)
=< 4 weeks prior to registration

- Ongoing cytokine release syndrome (CRS) or neurotoxicity post CAR-T

- Prior grade 4 CRS or neurotoxicity after most recently administered CAR-T

- Primary central nervous system (CNS) lymphoma or CNS involvement by lymphoma at
screening and based on clinical symptoms, MRI, or lumbar puncture

- Co-morbid systemic illness or other severe concurrent disease which, in the judgement
of the investigator, would make the patient inappropriate for entry into the study or
interfere significantly with the proper assessment of safety and toxicity of the
prescribed regimens

- Uncontrolled intercurrent illness including, but not limited to

- Ongoing or active infection requiring systemic treatment (excluding prophylactic
treatment) =< 14 days prior to registration, including COVID- 19 infection.

- NOTE If evidence of chronic hepatitis B virus (HBV) infection, HBV viral
load must be undetectable and on suppressive therapy.

- NOTE If history of treated hepatitis C virus (HCV) infection, HCV viral
load must be undetectable.

- NOTE Patients known to be human immunodeficiency virus (HIV) positive, but
stable on anti-retroviral therapy with an undetectable HIV viral load
pre-CART, are eligible for this trial.

- NOTE Simple urinary tract infection (UTI) and uncomplicated bacterial
pharyngitis are permitted if responding to active treatment

- NOTE Past COVID-19 infection may be a risk factor, but if resolved symptoms
and the subject is vaccinated, they may be enrolled

- Symptomatic congestive heart failure (New York Heart Association [NYHA] class 3
or 4)

- Unstable angina pectoris

- Unstable cardiac arrhythmia present =< 14 days prior to registration

- Psychiatric illness/social situations that would limit compliance with study
requirement

- History or presence of CNS disorder such as seizure disorder (not including
resolved childhood febrile seizures), cerebrovascular ischemia/hemorrhage (not
including transient ischemic attacks), cerebellar disease, or any autoimmune
disease with CNS involvement

- Receiving any other investigational agent which would be considered treatment for the
primary neoplasm =< 14