This study is NOT currently recruiting participants.
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are mature B cell malignancies. Patients with relapsed disease and 17p deletion have a particularly aggressive disease course. Standard chemoimmunotherapy regimens for patients with relapsed/refractory disease have resulted in few durable remissions.
B cell receptor (BCR) activation is a key pathway engaged in the pathogenesis of CLL as well as in the interaction of CLL cells with the tumor microenvironment that is required for survival of CLL cells. The more aggressive forms of CLL, such as patients with relapsed/refractory disease, are characterized by stronger B cell receptor (BCR) activation. Disruption of tumor microenvironment interactions and inhibition of BCR signaling are promising therapeutic strategies in CLL. Bruton s tyrosine kinase (BTK) is a key enzyme in BCR signaling. Ibrutinib is the first BTK inhibitor that has reached the clinic and is approved as therapy for relapsed/refractory CLL. The advent of kinase inhibitors such as ibrutinib has demonstrated significantly improved responses as second line therapies as well as improved responses in patients with 17p deletion compared to standard chemoimmunotherapy regimens with long (more than two years) durable remissions in the majority of patients.
ACP-196 is an orally available, new molecule that irreversibly inhibits BTK and shows encouraging activity and acceptable safety profile in nonclinical studies. ACP-196 has shown efficacy in 3 separate models of lymphoid malignancies. Currently, this molecule is in phase 1 studies for humans with reported high response rates in the first six patients included. We believe that ACP-196, a second generation BTK inhibitor is designed to be more potent, more specific, and could overcome limitations currently seen with ibrutinib.
This study will investigate the safety and efficacy of ACP-196 for patients with CLL/SLL that have relapsed/refractory disease or treatment na(SqrRoot) ve deletion 17p. The primary endpoint is the response to ACP- 196. Biological sampling from lymph nodes, bone marrow and peripheral blood early during treatment will be used to investigate BTK inhibition in the bone marrow and lymph node compartments, the main sides for CLL progression in addition to the
circulating tumor cells.
INCLUSION CRITERIA:
1. Men and women 18 years of age and older with histologically confirmed disease as defined by the following:
--CLL: clonal B-lymphocytosis >=5,000 cells/microL or SLL: lymphadenopathy with the tissue morphology of CLL but that are not leukemic, <5,000 cells/microL.
--Immunophenotypic profile or immunohistochemistry read by an expert pathologist as consistent with CLL. This will include CD5, CD19, and CD20 expression by the CLL cells typically also with CD23 expression, but CD23 negative cases may be included if there is no t11;14 translocation present.
2. Active disease as defined by at least one of the following (IWCLL consensus criteria):
--Weight loss >=10% within the previous 6 months
--Extreme fatigue
--Fevers of greater than 100.5 degrees Fahrenheit for >=2 weeks without evidence of infection
--Night sweats for more than 1 month without evidence of infection
--Evidence of progressive marrow failure as manifested by the development of, or worsening of, anemia and/or thrombocytopenia
--Massive or progressive splenomegaly
--Massive nodes or clusters or progressive lymphadenopathy
--Progressive lymphocytosis with an increase of >50% over a 2 month period, or an anticipated doubling time of less than 6 months
--Compensated autoimmune hemolysis
3. Relapsed/refractory CLL/SLL, or treatment naive subjects with deletion 17p, TP53 mutations, or NOTCH-1 mutation.
4. ECOG performance status of <=2
5. Absolute neutrophil count (ANC) > 500/microL, platelets > 30,000/microL
6. Female subjects who are sexually active and able to bear children must agree to use highly effective methods of contraception during the study and for 2 days after the last dose of study drug.
7. Willing and able to participate in all required evaluations and procedures in this study protocol including swallowing capsules or tablets without difficulty and serial biopsies
8. Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information (in accordance with national and local subject privacy regulations)
EXCLUSION CRITERIA:
1. Radiotherapy, radioimmunotherapy, biological therapy, chemotherapy, or investigational products in the 4 weeks prior to study drug administration.
2. Richter's transformation
3. Autoimmune hemolytic anemia or thrombocytopenia requiring steroid therapy
4. Steroids >=20 mg prednisone or equivalent for more than 3 days within the last 3 months.
5. Impaired hepatic function: total bilirubin >=1.5 x upper limit of normal (ULN) (unless due to Gilbert's syndrome), aspartate amino transferase (AST)/alanine aminotransferase (ALT) >=2.5 x institutional ULN, unless due to infiltration of the liver
6. Impaired renal function: estimated glomerular filtration rate (eGFR) <=50 as determined by CKD-EPI equation
7. Life-threatening illness, medical condition, or organ system dysfunction which, in the investigator's opinion, could compromise the subject's safety, interfere with the absorption or metabolism of acalabrutinib oral (PO), or put the study outcomes at undue risk
8. Concomitant immunotherapy, chemotherapy, radiotherapy, corticosteroids (at dosages equivalent to prednisone >20 mg/day), or experimental therapy
9. Active hepatitis B or hepatitis C infection
10. HIV infection
11. Female subjects: current pregnancy or unwilling to utilize effective contraceptive methods or refrain from pregnancy if of childbearing potential or currently breastfeeding
12. Psychiatric illness/social situations that would limit the subject's ability to tolerate and/or comply with study requirements.
13. Unable to understand the investigational nature of the study or give informed consent.
14. Individuals <18 years old
15. Known hypersensitivity to any component of acalabrutinib
16. Any prior therapy with other BTK inhibitors
17. Requires systemic anticoagulation with coumadin (warfarin)
18. Prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer from which the subject has been disease free for >=2 years or which will not limit survival to <2 years.
19. Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel or ulcerative colitis, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction
20. Grade >=2 toxicity (other than alopecia) continuing from prior anticancer therapy including radiation
21. History of stroke or intracranial hemorrhage within 6 months before signing the treatment consent form
22. Significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of signing the treatment consent form, or any Class 3 or 4 cardiac disease as defined by the New York Heart Association Functional Classification, or left ventricular ejection fraction (LVEF) <=40%
23. Requires treatment with strong or moderate CY3A4/5 inhibitors (unless no alternative is available)