New Options for Treating Patients with Ibrutinib Resistant Mantle Cell Lymphoma

Earlier today the prestigious journal Cancer Discovery published the results of our program’s latest work in mantle cell lymphoma. Although previous clinical trials have demonstrated the effectiveness of ibrutinib in treating patients with mantle cell lymphoma, researchers also noted that some patient’s lymphoma developed ibrutinib resistance during treatment. Our findings revealed some insight into why this resistance occurs and offers several potential treatment strategies for patients who develop ibrutinib resistanceBased on their findings,

“…the researchers devised two treatment strategies that they tested in lymphoma cell lines. Both involve serial use of two anti-cancer drugs — the first to weaken or “prime” the cancer cells, and the second to deliver an added impact. Both use the experimental agent palbociclib (which selectively inhibits two cell-cycle promoting proteins, CDK4 and CDK6) to slow down the cancer’s growth and sensitize cells to the killing power of a second drug.”

As the study’s lead researcher, Dr. Selina Chen-Kiang commented,

“While for many patients ibrutinib represents a valuable treatment option, it has limitations, and we have been able to demonstrate how novel therapy combinations that target the cancer’s resistance pathways might possibly work better.”

These results build on years of laboratory and clinical work at WCMC, and they highlight the need for further research such as our ongoing trial with ibrutinib plus palbociclib

If you have any questions please contact us and look to our clinical trials page for our ongoing trials.

For additional information see the press release from the American Association for Cancer Research.

 

 


Zydelig Approved by FDA for Patients with CLL, FL, & SLL

Earlier this afternoon the FDA announced the approval of Zydelig (idelalisib) for patients with relapsed chronic lymphocytic leukemia (CLL). Accelerated approval was also granted for the use of  Zydelig in patients with relapsed follicular B-cell non-Hodgkin lymphoma (FL) and relapsed small lymphocytic lymphoma (SLL). According to the FDA press release:

“Zydelig’s safety and effectiveness to treat relapsed CLL were established in a clinical trial of 220 participants who were randomly assigned to receive Zydelig and Rituxan or placebo and Rituxan. The trial was stopped for efficacy following the first pre-specified interim analysis point, which showed participants treated with Zydelig and Rituxan lived 10.7 months without their disease progressing (progression-free survival) compared to about 5.5 months for participants treated with placebo and Rituxan. Results from a second interim analysis continued to show a statistically significant improvement for Zydelig and Rituxan over placebo and Rituxan.”

“Zydelig’s safety and effectiveness to treat relapsed FL and relapsed SLL were established in a clinical trial with 123 participants with slow-growing (indolent) non-Hodgkin lymphomas. All participants were treated with Zydelig and were evaluated for complete or partial disappearance of their cancer after treatment (objective response rate, or ORR). Results showed 54 percent of participants with relapsed FL and 58 percent of participants with SLL experienced ORR.”

Commenting on this welcomed development Dr. Richard Furman said, “We are very excited to have idelalisib to add to our armentarium of agents that are now available for use and would like to thank all of the patients and their families who made this possible by participating in the clinical trials.” Look to this blog and our clinical trials page for further developments regarding the use of Zydelig in the treatment of CLL, FL, & SLL patients.


Two Newly Opened Clinical Trials Evaluate Idelalisib in Indolent non-Hodgkin Lymphoma

The Weill Cornell Lymphoma Program has recently opened two clinical trials evaluating the experimental drug idelalisib in previously treated indolent non-Hodgkin lymphomas (iNHL). The sponsor of the trials is Gilead Sciences.  The principal investigator at Weill Cornell is Dr. Peter Martin. For more information about the studies please call Amelyn Rodriguez, RN at (212) 746-1362 or e-mail Amelyn at amr2017@med.cornell.edu.

Idelalisib (GS-1101, previously CAL-101) works by blocking some of the cell functions that cause iNHL to grow and survive.

Gilead 0124: Idelalisib in Combination With Rituximab 

This study evaluates the effectiveness of idelalisib combined with rituximab in treating iNHL. Rituximab is FDA-approved for treating iNHL. It is possible that giving rituximab together with idelalisib may have more activity against iNHL than giving rituximab alone.

Key Eligibility

  • Men and women age 18 and older
  • B-cell indolent non-Hodgkin lymphoma (iNHL)
  • Have received prior therapy containing anti-CD20 antibody
  • iNHL is not refractory to rituximab

Click here for a detailed summary of this trial.

Gilead 0125: Idelalisib in Combination With Bendamustine and Rituximab

This study evaluates the effectiveness of idelalisib combined with bendamustine and rituximab. Rituximab and bendamustine are FDA-approved for treating iNHL. It is possible that giving rituximab and bendamustine together with idelalisib is more effective in treating iNHL than giving rituximab and bendamustine alone.

Key Eligibility

  • Men and women age 18 and older
  • B-cell indolent non-Hodgkin lymphoma
  • Have received prior therapy containing anti-CD20 antibody and chemotherapy
  • iNHL is not refractory to bendamustine

Click here for a detailed summary of this trial.


Idelalisib Study for CLL Patients Ended Early Due to Positive Findings

On October 9, Gilead Sciences Inc., announced an exciting new development for CLL patients. An independent Data Monitoring Committee (DMC) recommended that a Phase 3 study of Idelalisib in previously-treated CLL patients be ended early, due to evidence of efficacy. As Gilead noted,

“This DMC recommendation is based on a predefined interim analysis showing highly statistically significant efficacy for the primary endpoint of progression-free survival in patients receiving idelalisib plus rituximab compared to those receiving rituximab alone. The safety profile of idelalisib was acceptable and consistent with prior experience in combination with rituximab in previously treated CLL. Gilead has informed the U.S. Food and Drug Administration (FDA) of the plan to end the study and will engage in a dialogue with the FDA regarding a regulatory filing in CLL.”

Norbert W. Bischofberger, PhD, Gilead’s Executive Vice President , Research and Development and Chief Scientific Officer explained,

“This is the first Phase 3 study to report positive results for a new class of targeted therapies that inhibit B-cell receptor signaling as a major component of their mechanism of action, an important area of focus in the development of chemotherapy-free regimens in CLL and other B-cell malignancies. We extend thanks to the investigative sites and to the other research collaborators participating in this study, as well as to the patients who volunteered, and we look forward to sharing these data with the hematology community.”

Prominent researchers involved in this study include the Lymphoma Program’s Dr. Richard Furman. Further data from this study will be submitted for upcoming scientific conferences. Please look to this space to follow up with any further announcements regarding this new development.

 Gilead’s full press release can be found here.

New Clinical Trials: Innovative Approaches for Follicular Lymphoma

The Weill Cornell Lymphoma Program has recently opened two clinical trials sponsored by The Alliance for Clinical Trials in Oncology. These trials are notable for their innovative approach. As Lymphoma Program Director and current chair of the committee, Dr. John Leonard explained, “Under the leadership of Bruce Cheson, MD, the lymphoma committee has been focused on ‘biologic doublets’ with targeted agents, a treatment approach that has been quite innovative. Following up on his work we are now moving toward ‘targeted triplet therapy’ which is a first in lymphoma therapeutics. These are important steps as we move such ‘chemotherapy-free’ approaches more and more into standard treatment.”

A051103 – A Phase I Study of Rituximab, Lenalidomide, and Ibrutinib in Previously Untreated Follicular Lymphoma

In the first trial, principal investigator, Dr. Peter Martin seeks to evaluate the effect of rituximab, lenalidomide, and ibrutinib in untreated follicular lymphoma. For more information about the untreated follicular lymphoma trial, please call Amelyn Rodriguez, RN at (212) 746-1362 or e-mail Amelyn at amr2017@med.cornell.edu.

Key Eligibility
  • Untreated Follicular Lymphoma
  • No prior systemic therapy for non-Hodgkin lymphoma
  • Detailed eligibility reviewed when you contact the study team

Study Details

The purpose of the study is to test the combination of the drugs lenalidomide and ibrutinib (also called PCI-32765) at different dose levels, in combination with the drug rituximab. The study is evaluating the side effects and best dose of lenalidomide and ibrutinib for combination with rituximab in previously untreated follicular lymphoma.

Treatment Plan

Over the course of  each 28 day treatment cycle patients will receive lenalidomide by mouth every day on Days 1 through 21, ibrutinib by mouth on Days 1 through 28 of each cycle, and rituximab via infusion on Days 1, 8, 15, & 22 of Cycle 1 and during the first week of Cycle 4 & 6 & 10. 

Different dosses of lenalidomide and ibrutinib will be tested in small groups of participants.

A051202 – A Phase I Trial of Lenalidomide, Rituximab, and Idelalisib in Recurrent Follicular Lymphoma

In the second trial, principal investigator, Dr. John Leonard seeks to evaluate the effect of lenalidomide, rituximab, and idelalisib in recurrent follicular lymphoma. For more information about the recurrent follicular lymphoma trial, please call Amelyn Rodriguez, RN at (212) 746-1362 or e-mail Amelyn at amr2017@med.cornell.edu.

Key Eligibility
  • Men and women age 18 and older
  • Previously treated follicular lymphoma
  • Must have had prior treatment with rituximab either alone or in combination with chemotherapy
  • Detailed eligibility reviewed when you contact the study team

Study Details

The purpose of the study is to test the combination of the drugs lenalidomide and idelalisib at different dose levels, in combination with the drug rituximab. The study is evaluating the side effects and best dose of lenalidomide when given with rituximab and idelalisib in people with recurrent follicular lymphoma. Rituximab is FDA-approved for use in follicular lymphoma, but lenalidomide and idelalisib are not FDA-approved for treating follicular lymphoma.

Treatment Plans

Treatment cycles are 21 days long. Participants will receive lenalidomide by mouth once a day on Days 1 through 21, followed by one week off, of each cycle for 12 cycles, idelalisib by mouth twice a day for 12 cycles, and rituximab via infusion during Cycle 1 on Day 15 & 22, and on Day 1 of Cycle 2 for a total of 4 infusions.

Click here to view all current lymphoma trials at Weill Cornell Medical College


ASCO 2013: Idelalisib Effective in Combination Therapy for Indolent non-Hodgkin Lymphoma

Frequently Asked QuestionsBy John P. Leonard, MD

Idelalisib (previously called CAL-101 and GS-1101) is a first-in-class selective, oral inhibitor of the PI3K-delta enzymes that while essential to the process of activation, proliferation, and survival of B cells, is also hyperactive in B-cell malignancies. The treatment has previously shown considerable promise as a both a monotherapy and a combination therapy in recurrent non-Hodgkin lymphoma and a variety of other lymphomas.

At the recent annual meeting of the American Society of Clinical Oncology in Chicago, I presented updated results from a recent combination therapy study, contrasting the tolerability and activity of the PI3K-inhibitor idelalisib with rituximab and/or bendamustine in patients with previously treated indolent non-Hodgkin lymphoma.  From the 78 patients there was an overall response rate (ORR) was 81% with a complete response (CR) of 28%. The ORR/CR for idelalisib/rituximab was 77%/20%, idelalisib/bendamustine 85%/29%, and idelalisib/bendamustine/rituximab 79%/43%, with a progression free survival of 73% after 20 months.

The study concluded that idelalisib-based combination therapy deserves further clinical development as this combination therapy is highly active and well tolerated in patients with relapsed/refractory indolent non-Hodgkin lymphoma.

For a full listing of all current clinical trials underway in the Lymphoma Program, please click here.


New Clinical Trial: GS-1101 in Combination with Bendamustine and Rituximab for Previously Treated CLL

The Weill Cornell Lymphoma Program is now recruiting men and women with previously treated, recurrent chronic lymphocytic leukemia (CLL) for a clinical trial evaluating the experimental drug GS-1101 (also called Idelalisib, formerly called CAL-101), combined with bendamustine and rituximab, in treating CLL. The study sponsor is Gilead Sciences, Inc, and the principal investigator at Weill Cornell is Dr. Richard Furman. For more information about the study, please call Amelyn Rodgriguez, RN at (212) 746-1362 or e-mail Amelyn at amr2017@med.cornell.edu.

Key Eligibility
  • Age 18 and older
  • Diagnosis of B-cell chronic lymphocytic leukemia (CLL)
  • Previously treated for CLL
  • Detailed eligibility reviewed when you contact the study team
Study Details

GS-1101 (CAL-101) is a pill designed to block some of the cell functions that cause CLL to grow and survive and may help control the disease. Rituximab and bendamustine are approved by the FDA as a treatment for CLL. The study will help determine whether adding GS-1101 (CAL-101) to the standard treatment of rituximab and bendamustine will have a better effect on controlling CLL.

Study participants will be randomly assigned to one of two treatment groups:

  • Group A: GS-1101 and rituximab/bendamustine
  • Group B: Rituximab/bendamustine and placebo (an inactive pill that looks like GS-1101 but contains no medicine)

After 20 weeks of therapy with rituximab, bendamustine and GS-1101 or placebo, participants will continue with GS-1101 or placebo as long as their CLL is controlled.


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