Principal Investigator
Enrollment Status
Clinical Trial ID
Clinical Trial Summary
This study will test the safety of ruxolitinib, given at one dose that does not change, and
duvelisib, given at different doses, to find out what effects, if any, the study treatment
has on people with relapsed or refractory NK-cell or T-cell lymphoma.
Phase
Phase 1
Funding Agency/Sponsor
Externally Peer-Reviewed
Disease
Lymphoma
Enrollment Eligibility
Inclusion Criteria:
a) Pathologically-confirmed mature T-cell lymphomas at the enrolling institution.
Permitted histologies include:
i) Stage ≥Ib CTCL, which has relapsed or progressed after at least two systemic therapies.
In order to ensure balanced enrollment for patients with systemic T-cell lymphoma and CTCL,
a maximum of 15 CTCL patients will be enrolled in expansion cohort.
ii) Systemic anaplastic large cell lymphoma that has relapsed after therapy containing
brentuximab vedotin.
iii) T-cell prolymphocytic leukemia (treatment naïve permitted)
For the following histologies, patients are required to have received at least 1 prior
therapy:
iv) T-cell large granular lymphocytic leukemia
v) Aggressive NK-cell leukemia
vi) Adult T-cell leukemia/lymphoma
vii) Extranodal NK/T- cell lymphoma, nasal type
viii) Enteropathy-associated T-cell lymphoma
ix) Monomorphic epitheliotropic intestinal t-cell lymphoma
x) Hepatosplenic T cell lymphoma
xi) Subcutaneous panniculitis-like T-cell lymphoma
xii) Primary cutaneous anaplastic large cell lymphoma
xiii) Primary cutaneous gamma/delta T-cell lymphoma
xiv) Primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma
xv) Peripheral T-cell lymphoma, not otherwise specified
xvi) Angioimmunoblastic T cell lymphoma
xvii) Follicular T-cell lymphoma
xviii) Nodal peripheral T-cell lymphoma wih T follicular helper phenotype
b) Age ≥18 years at time of enrollment
c) Performance status, as assessed in the ECOG grading system, ≤2
d) Laboratory criteria.
Laboratory criteria
i) For dose escalation phase:
1. Absolute neutrophil count ≥1.0 K/mcL (Note: growth factor is allowed)
2. Platelet count ≥80 K/μl or ≥50 K/μl if due to lymphoma
3. Calculated creatinine clearance ≥60mL/min by Cockcroft-Gault
4. Direct bilirubin ≤1.5x upper limit of normal (ULN) or ≤3x ULN if documented hepatic
involvement with lymphoma, or ≤5x ULN if history of Gilbert's syndrome; AST and ALT ≤
3x ULN; or ≤ 5x ULN if due to lymphoma involvement
ii) For dose expansion phase:
1. Absolute neutrophil count ≥1.0 K/mcL or ≥0.5 K/mcL if due to lymphoma or ≥0.0 K/mcL if
due to T-PLL or large granular lymphocytic leukemia (LGL) (Note: growth factor is
allowed).
2. Platelet count ≥80 K/μl or ≥50 K/μl if due to lymphoma
3. Calculated creatinine clearance ≥60mL/min by Cockcroft-Gault
4. Direct bilirubin ≤1.5x upper limit of normal (ULN) or ≤3x ULN if documented hepatic
involvement with lymphoma, or ≤5x ULN if history of Gilbert's syndrome; AST and ALT ≤
3x ULN; or ≤ 5x ULN if due to lymphoma involvement
e) Measurable disease, defined by at least one of the following:
°Revised International Working Group Classification for systemic lymphoma19
- Atypical T lymphocytes quantifiable by flow cytometry or morphology in the peripheral
blood or bone marrow
- mSWAT (Modified Severity Weighted Assessment Tool) >0
f) Ability to swallow pills
g) Women of reproductive potential* must have a negative serum or urine β human
chorionic gonadotropin (βhCG) pregnancy test within 14 days of initiating therapy. All
women of reproductive potential and all sexually active male patients must agree to
use adequate methods of birth control (e.g. latex condoms) throughout the study and
for 3 months after the last dose of study drug.
- A woman of reproductive potential is a sexually-mature woman who: has not
undergone a hysterectomy or bilateral oophorectomy; or has not been naturally
postmenopausal for at least 24 consecutive months (i.e. has had menses at any
time in the preceding 24 consecutive months).
- The effects of duvelisib on conception, pregnancy, and lactation are unknown. Since
duvelisib has not been evaluated in pregnant or nursing women, the treatment of
pregnant women or women of childbearing potential who are not using a highly effective
contraception is contraindicated.
Exclusion Criteria:
1. Any serious medical condition, laboratory abnormality, or psychiatric illness that
would prevent the subject from signing the informed consent form.
2. Pregnant women. (Lactating women must agree not to breast feed while taking study
medications).
3. Prior allogeneic stem cell transplant within 6 months of starting treatment or
patients with active GVHD requiring immunosuppression.
4. Prior use of duvelisib or ruxolitinib if either agent was discontinued due to
toxicity.
5. Previous systemic anti-cancer therapy for TCL within 14 days of initiating study drug
a. Patients who have received localized RT as part of their immediate prior therapy may be
allowed to enroll with shorter washout period after discussion with the MSK Principal
Investigator.
b. Systemic corticosteroids must be tapered to 20mg/day or less prednisone (or equivalent)
upon start of investigational treatment.
c. Topical steroids for CTCL is permitted on study.
f) Ongoing use of immunosuppressant medications, including corticosteroids greater than
20mg of prednisone or equivalent at the time of enrollment
g) History of chronic liver disease, veno-occlusive disease, or current alcohol abuse
h) Administration of a live vaccine within 6 weeks of first dose of study drug.
i) Prior surgery or gastrointestinal condition that may adversely affect drug absorption
(e.g., gastric bypass surgery, gastrectomy)
j) Patients with HIV infection if they meet either of the below criteria:
i. detectable viral load ii. undetectable viral load with CD4 count <200 or not taking
anti-retroviral medications.
k) Patients with chronic hepatitis B or C as defined by positive hepatitis B or C serology:
- Subjects with a negative HBsAg and a positive HBcAb require an undetectable/negative
hepatitis B DNA test (e.g., polymerase chain reaction [PCR] test) to be enrolled, and
must receive hepatitis B prophylaxis until at least 6 months after completion of study
drug(s).
l) Subjects with active CMV (defined as positive CMV PCR with clinical manifestations
consistent with active CMV infection) and requiring therapy. Carriers will be
monitored per institutional guidelines.
m) Unable or unwilling to receive prophylaxis against pneumocystis, herpes simplex
virus, or herpes zoster
g) Use of medications or consumption of foods that are strong inducers or inhibitors
of CYP3A
- Such agents must be discontinued at least 2 weeks prior to study intervention
- Patients who (after enrollment) require use of a strong CYP3A4 inhibitor to treat a
fungal/mold infection will require dose reductions n) Receipt of treatment for
tuberculosis within 2 years prior to enrollment
o) Receiving therapy for another primary malignancy (other than T-cell lymphoma).
- Patients with more than one type of lymphoma may be enrolled after discussion with the
MSK Principal Investigator.
- Early-stage cutaneous basal cell and squamous cell carcinomas are permissible
- Adjuvant or maintenance therapy to reduce the risk of recurrence of other malignancy
is potentially permissible after discussion with the MSK Principal Investigator.
p) Known central nervous system or meningeal involvement by TCL (in the absence of
symptoms, investigation into central nervous system involvement is not required).
q) Unstable or severe uncontrolled medical condition (e.g., unstable cardiac function,
unstable pulmonary condition) or any important medical illness that would, in the
Investigator's judgment, increase the risk to the patient associated with his or her
participation in the study.