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It is a single arm, multicenter, phase 2 study to explore the efficacy and safety study of OR-MTX chemotherapy(Orelabrutinib, Rituximab and Methotrexate)as first-line regimens in the treatment of newly diagnosed primary central nervous system lymphoma. Objective response rate is the primary endpoint.
This is a single arm, multicenter, phase 2 study designed to evaluate the efficacy and safety of Orelabrutinib, rituximab and methotrexate as first-line regimens in the treatment of newly primary central nervous system lymphoma. A total of 28 patients plan to participate in this study to receive a total 6 cycles of induction chemotherapy followed by Orelabrutinib maintenance chemotherapy up to one year. After 6 cycles of induction chemotherapy, autologous Hematopoietic Stem Cell Transplantation (AHSCT) will be performed for transplantation eligible patients . Follow-ups should be taken up to the first 2 years. The primary endpoint is objective response rate (ORR) and secondary endpoint includes Progression free survival (PFS), overall survival (OS), and adverse events.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| OR-MTX | Experimental | Experimental arm will be treated with OR-MTX regimen(Orelabrutinib plus Rituximab and Methotrexate) for 6 cycles as initiate induction. After 6 cycles of induction chemotherapy, autologous Hematopoietic Stem Cell Transplantation (AHSCT) will be performed for transplantation eligible patients . Thereafter, Orelabrutinib maintenance chemotherapy will be given up to one year. Follow-ups should be taken up to the first 2 years. The primary endpoint is objective response rate (ORR) and secondary endpoint includes Progression free survival (PFS), overall survival (OS), and adverse events. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Orelabrutinib | Drug | Orelabrutinib will be given as 150 mg/d orally 72h after MTX infusion or MTX clearance, every 21 days for 6 cycles during induction treatment. Daily Orelabrutinb will be administered as maintenance treatment for up to 1 year or until disease progression, intolerable toxicity, death, informed consent withdrawal or lost of follow up (whichever occurs first). |
| Measure | Description | Time Frame |
|---|---|---|
| Objective response rate(ORR) | The objective response rate is defined as the proportion of patients with a response of complete response(CR) or partial response(PR). | At the end of Cycle 6 chemotheray (each cycle is 21 days) |
| Measure | Description | Time Frame |
|---|---|---|
| Progression free survival | From date of patients sign informed consent until the date of progression or death or the date of last follow-up time, whichever came first, assessed up to 2 years | 2years |
| Treatment-related adverse events |
| Measure | Description | Time Frame |
|---|---|---|
| ctDNA mutation and mean ctDNA concentration in serum and cerebrospinal fluid | Types of ctDNA mutations and frequency are measured by next generation sequencing. The mean ctDNA concentration is the concentration of ctDNA expressed as mean tumor molecules /ml at specific time points. | Baseline, every two months for up to 2 years after treatment |
Inclusion Criteria:
Histologically confirmed Primary Central Nervous System (CNS) lymphoma Age range 18-75 years old.
Eastern Cooperative Oncology Group performance status 0 to 3.
Previously untreated. Patients treated with steroid alone are eligible.
Measurable disease was defined as at least ≥1.0cm in short-diameter by MRI.
Life expectancy of ≥ 3 months (in the opinion of the investigator).
Participants must be able to understand and be willing to sign a written informed consent document.
Women of reproductive potential must agree to use highly effective methods of birth control during the period of therapy and for 6 months after the last dose of the study drug. Men who are sexually active must agree to use highly effective contraception during the period of therapy and for 6 months after the last dose.
Women of childbearing potential must have a negative plasma pregnancy test upon study entry.
Adequate renal function: Estimated glomerular filtration rate (GFR) or estimated creatinine clearance (CrCl) ≥ 50 mL/min;Serum creatinine ≤ 2 times the upper limit of normal.
Adequate liver functions: Transaminase (AST/ALT) < 3 X upper normal value & Bilirubin < 2 X upper normal value.
Adequate hematological function: hemoglobin ≥ 9 g/dL absolute neutrophil count (ANC) ≥ 1,500/μL and platelet count ≥ 75,000/μL.
Must be able to tolerate lumbar puncture and MRI/CT.
Ability to swallow oral medications.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Wenbin Qian, prof. | Contact | +8613605801032 | qianwb@zju.edu.cn | |
| Xianggui Yuan, MD | Contact | +8613989883884 | yuanxg@zju.edu.cn |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| 2nd Affiliated Hospital, School of Medicine, Zhejiang University | Recruiting | Hanzhou | Zhejiang | 310009 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40425940 | Derived | Xiao XB, Weng YQ, Jiang HW, Li X, Xie J, Bao CQ, Qian WB. Orelabrutinib combined with rituximab and high-dose methotrexate as induction therapy in newly diagnosed primary central nervous system lymphoma. Invest New Drugs. 2025 Jun;43(3):679-686. doi: 10.1007/s10637-025-01548-1. Epub 2025 May 27. |
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| ID | Term |
|---|---|
| C000729508 | orelabrutinib |
| D000069283 | Rituximab |
| D008727 | Methotrexate |
| ID | Term |
|---|---|
| D058846 | Antibodies, Monoclonal, Murine-Derived |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
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|
| Rituximab | Drug | 375mg/m2 intravenous infusion d1, every 3 weeks for 1 cycle, 6 cycles will be prescribed for induction therapy. |
|
| Methotrexate | Drug | 3.5g/m2 intravenous infusion for 4 hours in d1, every 21 days for 1 cycle, 6 cycles will be prescribed. |
|
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
| 1 year |
| The levels of cytokine concentration in serum and cerebrospinal fluid |
The levels of cytokine will be analyzed by ELISA in all patients recruited. The cytokine profile includes IL-6, IL-10, TNF-α, IFN-γ, IL-2 and IL-4 |
| Baseline, every two months for up to 2 years after treatment |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D000630 | Aminopterin |
| D011622 | Pterins |
| D011621 | Pteridines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |