225 Participants Needed

CAR T-Cell Therapy + Ibrutinib for Chronic Lymphocytic Leukemia

Recruiting at 59 trial locations
NP
Overseen ByNovartis Pharmaceuticals
Age: 18+
Sex: Any
Trial Phase: Phase 1 & 2
Sponsor: Novartis Pharmaceuticals
Must be taking: Ibrutinib
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

Trial Summary

What is the purpose of this trial?

This is a phase I/II study to evaluate the feasibility, safety and preliminary antitumor efficacy of rapcabtagene autoleucel (also known as YTB323). Rapcabtagene autoleucel will be investigated in combination with ibrutinib in chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) and as single agent in diffuse large B-cell lymphoma (3L+ DLBCL), adult acute lymphoblastic leukemia (ALL) and 1st Line High Risk Large B-Cell Lymphoma (1L HR LBCL).

Will I have to stop taking my current medications?

The trial does not specify if you need to stop all current medications, but you must not take targeted small molecule or kinase inhibitors within 2 weeks before a procedure called leukapheresis.

What data supports the effectiveness of the treatment CAR T-Cell Therapy + Ibrutinib for Chronic Lymphocytic Leukemia?

Research shows that using ibrutinib, a drug that helps improve T-cell function, can enhance the production and effectiveness of CAR T-cells in patients with chronic lymphocytic leukemia (CLL). This combination has shown promise in increasing the viability and function of these cells, potentially leading to better treatment outcomes for CLL patients.12345

Is CAR T-Cell Therapy + Ibrutinib safe for humans?

CAR T-cell therapies, like those from Novartis, have been approved for certain blood cancers and are generally considered safe, but they can cause side effects. Common side effects include cytokine release syndrome (a reaction that can cause fever and flu-like symptoms) and neurological effects, which are manageable with medical care.678910

What makes the CAR T-Cell Therapy + Ibrutinib treatment unique for chronic lymphocytic leukemia?

This treatment combines CAR T-cell therapy, which uses modified immune cells to target cancer, with ibrutinib, a drug that inhibits a protein important for cancer cell survival. The combination may enhance the effectiveness of CAR T-cell therapy and reduce severe side effects, offering a novel approach for patients who have not responded to other treatments.1112131415

Research Team

NP

Novartis Pharmaceuticals

Principal Investigator

Novartis Pharmaceuticals

Eligibility Criteria

This trial is for adults with certain blood cancers like CLL, SLL, DLBCL, and ALL. Participants must be in stable condition or partial remission after previous treatments (like ibrutinib for CLL/SLL), have not had prior CD19-directed therapy or genetically engineered cellular products, and can't have specific types of lymphoma or active CNS involvement.

Inclusion Criteria

My IPI score is between 3 and 5.
My PET scan shows cancer activity but not worsening after initial treatment.
My cancer has specific genetic changes in MYC, BCL2, or BCL6.
See 9 more

Exclusion Criteria

I have active lymphoma in my brain or spinal cord.
My condition has progressed from CLL to a more aggressive form.
There may be other specific requirements or restrictions that apply to this study.
See 6 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Phase I Treatment

Dose escalation and expansion of rapcabtagene autoleucel in combination with ibrutinib for CLL/SLL and as a single agent for DLBCL and ALL

24 months
Multiple visits for dose escalation and monitoring

Phase II Treatment

Continuation of rapcabtagene autoleucel treatment at recommended dose for DLBCL and LBCL

24 months
Regular visits for treatment and monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment

24 months
Regular follow-up visits

Long-term Follow-up

Post-study long-term follow-up for lentiviral vector safety

Up to 15 years

Treatment Details

Interventions

  • Ibrutinib
  • YTB323
Trial OverviewThe study tests Rapcabtagene autoleucel alone or with Ibrutinib on different blood cancers. It's to see if it's safe and effective. Phase I checks feasibility; phase II assesses how well the treatment works against these cancers.
Participant Groups
4Treatment groups
Experimental Treatment
Group I: CLL/SLLExperimental Treatment2 Interventions
Dose escalation and expansion of rapcabtagene autoleucel in combination with ibrutinib
Group II: Adult ALLExperimental Treatment1 Intervention
Dose escalation and expansion of rapcabtagene autoleucel single agent in adult ALL
Group III: 3L+ DLBCLExperimental Treatment1 Intervention
Dose escalation and expansion of rapcabtagene autoleucel single agent in 3L+ DLBCL
Group IV: 1L HR LBCLExperimental Treatment1 Intervention
Rapcabtagene autoleucel single agent in 1L HR LBCL

Find a Clinic Near You

Who Is Running the Clinical Trial?

Novartis Pharmaceuticals

Lead Sponsor

Trials
2,963
Recruited
4,275,000+
Founded
1996
Headquarters
Basel, Switzerland
Known For
Precision medicine
Top Products
Gleevec, Cosentyx, Entresto, Kisqali
Dr. Vas Narasimhan profile image

Dr. Vas Narasimhan

Novartis Pharmaceuticals

Chief Executive Officer since 2018

MD from Harvard Medical School

Dr. Shreeram Aradhye profile image

Dr. Shreeram Aradhye

Novartis Pharmaceuticals

Chief Medical Officer since 2021

MD

Findings from Research

Chimeric antigen receptor T (CART) cells targeting CD19 show promise in treating chronic lymphocytic leukemia (CLL), but their effectiveness is lower compared to other blood cancers, possibly due to impaired T-cell fitness in CLL patients.
The use of ibrutinib during CART cell production enhances the viability and expansion of CART cells from CLL patients, enriches them with less-differentiated T cell subsets, and improves their functionality by reducing exhaustion markers, suggesting a potential strategy to overcome treatment resistance.
Ibrutinib for improved chimeric antigen receptor T-cell production for chronic lymphocytic leukemia patients.Fan, F., Yoo, HJ., Stock, S., et al.[2021]
In a study of 42 patients with relapsed or refractory chronic lymphocytic leukemia (CLL), those treated with anti-CD19 CAR T cells showed a complete response (CR) rate of 28% and an overall response rate of 44% after 4 weeks, with a median overall survival of 64 months.
Achieving a complete response was linked to significantly longer overall survival and progression-free survival, indicating that the effectiveness of CAR T cell therapy is enhanced in patients who reach CR, regardless of whether they received a low or high dose.
Long-Term Outcomes From a Randomized Dose Optimization Study of Chimeric Antigen Receptor Modified T Cells in Relapsed Chronic Lymphocytic Leukemia.Frey, NV., Gill, S., Hexner, EO., et al.[2021]
In a phase 1 clinical trial involving 20 patients with relapsed or refractory chronic lymphocytic leukemia (CLL) and indolent B-cell non-Hodgkin lymphoma (B-NHL), CAR T-cell therapy combined with conditioning chemotherapy was found to be well-tolerated, with serious side effects like cytokine release syndrome occurring in only 10% of patients.
Among the CLL patients who received conditioning chemotherapy, 25% achieved complete remission, and all patients who reached this remission remained progression-free for a median follow-up of 53 months, indicating the potential for long-lasting treatment effects.
Safety and tolerability of conditioning chemotherapy followed by CD19-targeted CAR T cells for relapsed/refractory CLL.Geyer, MB., Rivière, I., Sénéchal, B., et al.[2021]

References

Ibrutinib for improved chimeric antigen receptor T-cell production for chronic lymphocytic leukemia patients. [2021]
Long-Term Outcomes From a Randomized Dose Optimization Study of Chimeric Antigen Receptor Modified T Cells in Relapsed Chronic Lymphocytic Leukemia. [2021]
Safety and tolerability of conditioning chemotherapy followed by CD19-targeted CAR T cells for relapsed/refractory CLL. [2021]
CAR-modified Cellular Therapies in Chronic Lymphocytic Leukemia: Is the Uphill Road Getting Less Steep? [2023]
CAR T-cell therapy for CLL: a new addition to our treatment toolbox? [2023]
Two-year follow-up of KTE-X19 in patients with relapsed or refractory adult B-cell acute lymphoblastic leukemia in ZUMA-3 and its contextualization with SCHOLAR-3, an external historical control study. [2023]
CAR T Cell Toxicity: Current Management and Future Directions. [2020]
FDA Approval Summary: Tisagenlecleucel for Treatment of Patients with Relapsed or Refractory B-cell Precursor Acute Lymphoblastic Leukemia. [2020]
Lisocabtagene maraleucel as second-line therapy in adults with relapsed or refractory large B-cell lymphoma who were not intended for haematopoietic stem cell transplantation (PILOT): an open-label, phase 2 study. [2022]
10.United Statespubmed.ncbi.nlm.nih.gov
Approval of brexucabtagene autoleucel for adults with relapsed and refractory acute lymphocytic leukemia. [2022]
11.United Statespubmed.ncbi.nlm.nih.gov
Single-agent ibrutinib versus chemoimmunotherapy regimens for treatment-naïve patients with chronic lymphocytic leukemia: A cross-trial comparison of phase 3 studies. [2021]
12.United Statespubmed.ncbi.nlm.nih.gov
Ibrutinib as a Bruton Kinase Inhibitor in the Management of Chronic Lymphocytic Leukemia: A New Agent With Great Promise. [2021]
Keeping a balance in chronic lymphocytic leukemia (CLL) patients taking ibrutinib: ibrutinib-associated adverse events and their management based on drug interactions. [2021]
14.United Statespubmed.ncbi.nlm.nih.gov
Ibrutinib May Boost Efficacy of CAR T Cells. [2019]
15.United Statespubmed.ncbi.nlm.nih.gov
Ibrutinib: a novel Bruton's tyrosine kinase inhibitor with outstanding responses in patients with chronic lymphocytic leukemia. [2021]