Overview

Acalabrutinib and Venetoclax Treatment of Newly Diagnosed Patients With CLL at High Risk of Infection or Early Treatment

Status:
Recruiting
Trial end date:
2030-07-31
Target enrollment:
0
Participant gender:
All
Summary
Many patients with CLL have a weakened immune system due to their disease. It increases their risk of developing serious, treatment-requiring infections such as blood poisoning or pneumonia, which in the worst case may end with fatal outcomes. Serious infections due to CLL are responsible for one third of all deaths among CLL patients. PreVent-ACaLL study will investigate whether a combination of two known types of cancer drugs can reduce the risk of infection and thus mortality when given preventively to newly diagnosed CLL patients. A newly developed register-based computer model can predict which patients are at high risk in order to develop infections as a result of their CLL. A preventive treatment might be initiated before patients need chemotherapy. In this way, the cancer disease might be "reset" so that the immune system, which is inhibited by CLL, is restored and the risk of fatal infections is minimized.
Phase:
Phase 2/Phase 3
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Rigshospitalet, Denmark
Collaborators:
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Karolinska Institutet
Stichting Hemato-Oncologie voor Volwassenen Nederland
Treatments:
Acalabrutinib
Venetoclax
Criteria
Inclusion Criteria:

1. CLL diagnosed according to IWCLL criteria within one year prior to randomization

2. High risk of infection and/or progressive treatment within 2 years according to
CLL-TIM

3. IWCLL treatment indication not fulfilled

4. Life expectancy > 2 years

5. Age at least 18 years

6. Ability and willingness to provide written informed consent and adhere to study
procedures and treatment

7. Adequate bone marrow function as indicated by platelets above 100 x 10E9, hemoglobin
above 10 g/dL and neutrophils above 1 x 10E9

8. Creatinine clearance above 30 mL/min directly measured with 24hr urine collection or
calculated according to the modified formula of Cockcroft and Gault

9. Adequate liver function as indicated by a total bilirubin≤ 2 x, AST/ALT ≤ 2.5 x the
institutional ULN value, unless directly attributable to the patient's CLL or to
Gilbert's Syndrome.

10. Negative serological testing for hepatitis B (HBsAg negative and anti-HBc negative;
patients positive for anti-HBc may be included if PCR for HBV DNA is negative and
HBV-DNA PCR is performed every month until 12 months after last treatment cycle),
negative testing for hepatitis C RNA within 6 weeks prior to registration.

11. Eastern Cooperative Oncology Group Performance Status (ECOG) performance status 0-2.

12. 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 investigational drugs.

13. Willing and able to participate in all required evaluations and procedures in this
study protocol including swallowing capsules without difficulty.

14. 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:

1. Prior CLL treatment (including monoclonal antibodies, chemotherapy, small molecules)

2. Transformation of CLL (Richter's transformation)

3. Previous autoimmune disease as AIHA (autoimmune hemolytic anemia) or ITP (idiopathic
thrombocytopenic purpura) treated with immune suppression or uncontrolled AIHA or ITP

4. History of PML

5. Uncontrolled or active infection

6. Malignancies other than CLL requiring systemic therapies (except anti-hormonal
therapies) or considered to impact survival

7. Requirement of therapy with strong CYP3A4 and CYP3A5 inhibitors/inducers or
anticoagulant therapy with vitamin K antagonists

8. History of bleeding disorders or current platelet inhibitors or anticoagulant therapy

9. History of clinically significant cardiovascular disease such as arrhythmias,
congestive heart failure, or myocardial infarction within 6 months of screening, or
any Class 3 or 4 cardiac disease as defined by the New York Heart Association
Functional Classification, or corrected QT interval (QTc) > 480 msec at screening.

10. History of stroke or intracranial hemorrhage within 6 months prior to registration.

11. Use of investigational agents which might interfere with the study drug within 28 days
prior to registration.

12. Vaccination with live vaccines 28 days prior to registration.

13. Major surgery less than 30 days before start of treatment.

14. Known hypersensitivity to any active substance or to any of the excipients of one of
the drugs used in the trial.

15. Pregnant women and nursing mothers (a negative pregnancy test is required for all
women of childbearing potential within 7 days before start of treatment; further
pregnancy testing will be performed regularly).

16. Fertile men or women of childbearing potential unless: surgically sterile or ≥ 2 years
after the onset of menopause or willing to use two methods of reliable contraception
including one highly effective contraceptive method (Pearl Index <1) and one
additional effective (barrier) method during study treatment and for 18 months after
the end of study treatment.

17. Legal incapacity.

18. Persons who are in dependence to the sponsor or an investigator

19. Persons not considered fit for the trial by the investigator

20. Malabsorption syndrome, disease significantly affecting gastrointestinal function, or
resection of the stomach or small bowel that is likely to affect absorption,
symptomatic inflammatory bowel disease, partial or complete bowel obstruction, or
gastric restrictions and bariatric surgery, such as gastric bypass.

21. Presence of a gastrointestinal ulcer diagnosed by endoscopy within 3 months before
screening.

22. Requires treatment with a strong cytochrome P450 3A4 (CYP3A4) inhibitor/inducer.

23. Prothrombin time/INR or aPTT (in the absence of Lupus anticoagulant) > 2x ULN.

24. Requires treatment with proton pump inhibitors (eg, omeprazole, esomeprazole,
lansoprazole, dexlansoprazole, rabeprazole, or pantoprazole). Subjects receiving
proton pump inhibitors who switch to H2-receptor antagonists or antacids are eligible
for enrollment to this study.

25. Major surgical procedure within 7 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.

26. Breastfeeding or pregnant.