Plain English Summary
Trial website
Contact information
Type
Scientific
Primary contact
Miss Debbie Hamid
ORCID ID
http://orcid.org/0000-0003-2329-805X
Contact details
Southampton Clinical Trials Unit
Southampton General Hospital
MP131
Tremona Road
Southampton
SO16 6YD
United Kingdom
Additional identifiers
EudraCT number
2017-000302-37
ClinicalTrials.gov number
Protocol/serial number
35676
Study information
Scientific title
A phase IIa study of Rituximab and Varlilumab in relapsed or refractory B-cell malignancies (RiVa): a randomised controlled trial
Acronym
RiVa
Study hypothesis
Varlilumab enhances rituximab-mediated killing of tumour cells by increasing the number of immune effector cells.
Ethics approval
Not provided at time of registration - approval pending
Study design
Randomised; Interventional; Design type: Treatment, Drug, Immunotherapy
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Hospitals
Trial type
Treatment
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Condition
Specialty: Cancer, Primary sub-specialty: Lymphoma; UKCRC code/ Disease: Cancer/ Malignant neoplasms, stated or presumed to be primary, of lymphoid, haematopoietic and related tissu
Intervention
20 patients will be allocated to the high grade group (i.e. patients with DLBCL, follicular lymphoma grade 3b, transformed follicular lymphoma) and 20 patients to the low grade group (i.e. patients with follicular lymphoma grade 1, 2 or 3a, marginal zone lymphoma (MZL), mantle cell lymphoma (MCL), lymphoplasmacytic lymphoma (LPL)). In the high grade group 10 will be randomised to Arm A and 10 to Arm B. In the low grade group 10 will be randomised to Arm A and 10 to ARM.
Patients will receive 6 cycles of treatment, with administration of rituximab on day 1 of each cycle and of varlilumab on day 2 of cycles 1, 3 and 5. Each cycle is 2 weeks long.
Patients in Arm A: For Cycle 1 will receive Rituximab 375 mg/m2 IV on Day 1 and Varlilumab 3 mg/kg IV on Day 2. Thereafter every 2 weeks patients will Rituximab 375 mg/m2 IV for 12 weeks in cycle 2 and 6 on Day 1 and Varlilumab 3 mg/kg IV for 12 weeks.
Patients in Arm B: For Cycle 1 will receive Rituximab 375 mg/m2 on Day 1 and Varlilumab 3 mg/kg IV on Day 8. Thereafter every 2 weeks patients will receive Rituximab 375 mg/m2 IV for 12 weeks in cycle 2 and 6 on Day 1 and Varlilumab 3 mg/kg IV for 12 weeks.
Patients will then be followed up 2 weeks after they complete the trial treatment and every 2 months over a period of 12 months at 2, 4, 6, 8, 10 and 12 months.
Intervention type
Drug
Phase
Phase II
Drug names
Rituximab, varlilumab
Primary outcome measure
1. Safety: DLT and adverse events and grading of severity according to NCI CTCAE Version 4.03). Timepoint(s): during trial treatment and for 12 months after trial treatment
2. Efficacy: response in each case according to the Lugano Revised Response Criteria for Malignant Lymphoma; Timepoint(s): 2 weeks after treatment, and every 2 months after trial treatment up to 12 months
Secondary outcome measures
No secondary outcome measures
Overall trial start date
31/08/2017
Overall trial end date
30/09/2019
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Relapsed or refractory CD20+ B-cell lymphoma excluding chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL):
1.1. High grade subgroup: Diffuse large B-cell lymphoma, FL grade 3b, transformed FL
1.2. Low grade subgroup: All low grade CD20+ B-cell lymphoma subtypes excluding CLL/SLL (e.g. FL grade 1,2 or 3a, MCL, LPL)
2. Disease must be recurrent or treatment refractory, and received at least one line of treatment. Rituximab-refractory participants are eligible for the entry into the study as long as the tumour expresses CD20
3. At least one measurable lesion by CT scan (defined as >1.5 cm in one axis) that is also easily accessible for biopsy
4. Histological confirmation of relapse within 12 months of treatment
5. 16 years of age or older
6. Haematological and biochemical indices with the ranges shown below:
6.1. Haemoglobin (Hb) ≥ 90 g/L (red cell support is permissible)
6.2. Absolute neutrophil count (ANC) ≥1.0 x 109/L (or ≥0.5 x 109/L if bone marrow involvement) G-CSF support is not permissible at screening
6.3. Platelet count ≥75 x 109/L (or ≥30 x 109/L if bone marrow involvement)
6.4. Serum bilirubin ≤1.5 x upper limit of normal (ULN) unless raised due to Gilbert’s syndrome in which case up to 3 x ULN is permissible
6.5. Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≤ 2.5 x ULN unless raised due to hepatic involvement
6.6. Calculated creatinine clearance (Cockcroft-Gault formula) ≥30 ml/min (uncorrected value)
7. Ability to understand the purpose and risks of the study and provide written informed consent
8. Willing and able to participate in all required evaluations and procedures in this study protocol
9. Participants must be willing to participate in appropriate pregnancy prevention measures
9.1. Women of childbearing potential who have a negative serum or urine pregnancy test during screening (within 14 days prior to the start of trial treatment) and agree to use one highly effective form of contraception combined with an effective form of contraception (see below) effective from the first administration of all study drugs, throughout the trial and for 12 months after last dose all study drugs are considered eligible
9.2. Male participants with partners of child-bearing potential who agree to take measures not to father children by using one form of highly effective contraception from the first administration of all study drugs, throughout the trial and for 12 months after last dose of all study drugs are considered eligible. Male subjects must also refrain from donating sperm during this period. Contraception that is considered highly effective includes oral, injected or implanted progesterone-only hormonal contraception (with inhibition of ovulation); oral, intravaginal, or transdermal combined (oestrogen and progesterone containing) hormonal contraception (with inhibition of ovulation); an intra-uterine device (IUD); an intrauterine hormone releasing system (IUS); bilateral tubal occlusion; vasectomised partner or abstinence. Contraceptive methods considered to be effective include progesterone-only oral hormonal contraception, where inhibition of ovulation is not the primary mode of action; condom; cap, diaphragm or sponge with spermicidal gel
9.3. Men with pregnant or lactating partners must be advised to use barrier method contraception (for example: condom plus spermicidal gel) to prevent exposure to the foetus or neonate
10. Life expectancy ≥ 12 weeks
11. ECOG performance status 0-2
Participant type
Patient
Age group
Adult
Gender
Both
Target number of participants
Planned Sample Size: 40; UK Sample Size: 40
Participant exclusion criteria
1. Known central nervous system involvement by lymphoma, that is not in remission, are excluded from the study
2. History of other malignancy within the last 2 years except for:
2.1. Noninvasive malignancies such as adequately treated ductal carcinoma in situ of the breast, non-melanoma skin cancer or lentigo maligna, cervical carcinoma in situ and urothelial papillary noninvasive carcinoma or carcinoma in situ
2.2. Prostate intraepithelial neoplasia without evidence of prostate cancer
3. Receiving treatment (or within a month of) with chemotherapy, immunotherapy or immunosuppressive agents. This includes any systemic steroids at dose exceeding 10 mg prednisolone (or other steroid equivalent) within 2 weeks prior to first dose of varlilumab
4. Significant concurrent, uncontrolled medical condition that in the opinion of the investigator contraindicates participation in this study
5. Active and documented autoimmune disease (including, but not limited to, inflammatory bowel disease, coeliac disease, haemolytic anaemia, or immune thrombocytopenic purpura) prior to first dose of varlilumab
6. Active infection requiring systemic therapy
7. Women who are pregnant or lactating
8. Serological positivity for Hepatitis B, C, or known HIV infection. As per standard of care, the results of hepatitis serology should be known prior to commencement of immunochemotherapy
8.1. Positive test results for chronic HBV infection (defined as positive HBsAg serology and positive HBcAb) will not be eligible. Patients with occult or prior HBV infection (defined as negative HBsAg and positive HBcAb) will not be eligible. Patients who have protective titres of hepatitis B surface antibody (HBsAb) after vaccination will be eligible
8.2. Positive test results for hepatitis C (HCV antibody serology testing) will not be eligible
9. Previous recipient of an allogeneic bone marrow transplant at any time
10. Autologous bone marrow transplant within 100 days of first dosing
11. Systemic radiation therapy within 4 weeks or prior focal radiotherapy within 2 weeks prior to first dosing
12. Subjects known or suspected of being unable to comply with the protocol
13. Ongoing toxic manifestations of previous treatments. Exceptions are to this are alopecia or certain Grade 1-toxicities, which in the opinion of the Investigator should not exclude the patient
14. Uncontrolled congestive cardiac failure, cardiac ischaemia or cardiac arrhythmia. Clinically significant cardiac disease including unstable angina, acute myocardial infarction within six months prior to registration, congestive heart failure (NYHA III-IV)
15. Subjects with a known hypersensitivity to rituximab (≥Grade 3) or murine proteins, or any other excipients used in the formulation of rituximab
Recruitment start date
30/09/2017
Recruitment end date
30/03/2019
Locations
Countries of recruitment
United Kingdom
Trial participating centre
Southampton General Hospital
Tremona Road
Southampton
SO16 6YD
United Kingdom
Trial participating centre
Churchill Hospital
Old Road
Headington
Oxford
OX3 7LE
United Kingdom
Trial participating centre
Derriford Hospital
Derriford Road
Plymouth
PL6 8DH
United Kingdom
Trial participating centre
The Christie
550 Wilmslow Road
Withington
Manchester
MX20 4BX
United Kingdom
Funders
Funder type
Charity
Funder name
Cancer Research UK; Grant Codes: CRUKD/17/008
Alternative name(s)
CRUK
Funding Body Type
private sector organisation
Funding Body Subtype
other non-profit
Location
United Kingdom
Results and Publications
Publication and dissemination plan
Planned publication in a high impact peer review journal 1 year after overall trial end date.
IPD sharing statement
The datasets generated and/or analysed during the current study during this study will be included in the subsequent results publication.
Intention to publish date
30/09/2020
Participant level data
Other
Basic results (scientific)
Publication list
2018 protocol in: https://www.ncbi.nlm.nih.gov/pubmed/30413184