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This is a multicenter, randomized, controlled, open-label Phase III clinical trial, aimed at evaluating the efficacy and safety of BEBT-908 combined with rituximab (R) compared to investigator-selected standard chemotherapy regimens [Standard of Care (SOC)] [i.e., rituximab-gemcitabine-oxaliplatin (R-GemOx) or rituximab-ifosfamide-carboplatin-etoposide (R-ICE)] for the treatment of relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL).
The study will recruit 416 subjects, who will be randomly assigned in a 1:1 ratio to either the experimental group (BEBT-908 combined with R) or the control group [investigator-selected standard chemotherapy regimen (R-GemOx or R-ICE)]. Approximately 208 subjects will be enrolled in the experimental group, and approximately 208 in the control group. The treatment cycle is 21 days, with a total of 8 treatment cycles. The experimental group will receive BEBT-908 + R treatment from cycles 1 to 8; participants who do not appear progressive disease (PD) after cycle 8 may continue to receive BEBT-908 and/or R treatment, entering a maintenance phase of up to 24 months. The control group will receive the investigator-selected SOC (i.e., R-GemOx or R-ICE) treatment from cycles 1 to 8, and will not receive further study medication after cycle 8.
Each subject's study process includes three phases: screening, treatment, and post-treatment follow-up. The screening phase can last up to 21 days. During the treatment phase, tumor assessments will be conducted every 6 weeks (±7 days) within the first 8 treatment cycles, and every 9 weeks (±7 days) after cycle 8.After the end of treatment, safety follow-up will be conducted on day 28 (+7 days) after the last dose, efficacy follow-up will be conducted every 9 weeks (±7 days), and survival follow-up will be conducted every 3 months (±2 weeks).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental Group (BEBT-908 Combined With R) | Experimental | Ifupinostat Hydrochloride for Injection,18.5mg/m^2 each time,is administered on days 1, 3, 5, 8, 10, and 12 of each cycle during cycles 1 to 8,with a 21-day cycle duration. After cycle 8, participants without PD enter a maintenance treatment phase that can last up to 24 months: Medication is administered on days 1, 3, 5, 8, 10, and 12 of each cycle, with a 21-day cycle duration, or as assessed by the investigator, medication is administered on days 1, 3, 5, 8, 10, and 12 of each cycle, with a 42-day cycle duration. Rituximab Injection,375 mg/m^2 each time,is administered on day 1 of each cycle during cycles 1 to 8. After cycle 8, medication is administered on day 1 of every third cycle, with a 21-day cycle duration. |
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| Control Group (R-GemOx or R-ICE) | Active Comparator | Rituximab Injection,375mg/m^2 each time,is administered on day 1 of each cycle,with a 21-day cycle duration, for a total of 8 treatment cycles. Gemcitabine Hydrochloride for Injection,1g/m^2 each time,is administered on day 2 of each cycle,with a 21-day cycle duration, for a total of 8 treatment cycles. Oxaliplatin Injection,100mg/m^2 each time,is administered on day 2 of each cycle, with a 21-day cycle duration, for a total of 8 treatment cycles. Etoposide Injection,100mg/m^2 each time,is administered on days 1, 2, and 3 of each cycle, with a 21-day cycle duration, for a total of 8 treatment cycles. Ifosfamide for Injection,5000mg/m^2 each time,is administered on day 2 of each cycle, with a 21-day cycle duration, for a total of 8 treatment cycles. Carboplatin Injection, with a single dose ≤800 mg [calculated based on area under the curve(AUC)=5],is administered on day 2 of each cycle, with a 21-day cycle duration, for a total of 8 treatment cycles. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ifupinostat Hydrochloride for Injection | Drug | Ifupinostat Hydrochloride for Injection,dosage of administration:18.5mg/m^2,frequency and duration of administration:Medication is administered on days 1, 3, 5, 8, 10, and 12 of each cycle,with a 21-day or 42-day cycle duration. |
| Measure | Description | Time Frame |
|---|---|---|
| Overall Survival (OS) | Defined as the time from the date of randomization to death due to any cause. | Up to 48 months |
| Measure | Description | Time Frame |
|---|---|---|
| Progression-Free Survival (PFS) | Defined as the time from randomization to tumor progression or death, whichever occurs first. | Up to 48 months |
| Overall Response Rate (ORR) | Defined as the proportion of subjects achieving complete response (CR) and partial response (PR) from the start of randomization to tumor progression among the total number of subjects. |
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Inclusion Criteria:
Peripheral blood:
Liver and kidney function:
Exclusion Criteria:
Known severe allergy to the study drug or any of its excipients;
Due to the potential genotoxicity, mutagenicity, and teratogenicity of the study drug, the following subjects should be excluded:
Primary central nervous system lymphoma;
DLBCL with active central nervous system brain metastases or meningeal involvement at the time of screening;
Other active malignant tumors that require treatment and may interfere with the study.
Treatment history before the trial:
After the previous treatment (chemotherapy or biological therapy), there are persistent Grade 2 or higher [Common Terminology Criteria for Adverse Events (CTCAE) V5.0 criteria] toxicities that have not stabilized at the time of enrollment (alopecia excluded);
There is an active clinical severe infection of Grade 2 or higher (CTCAE V5.0 criteria);
Co-morbid conditions:
Concurrent use of drugs that may cause QT interval prolongation or torsades de pointes;
Within 4 weeks prior to enrollment, currently receiving or requiring treatment with strong inhibitors or inducers of cytochrome P450 (CYP) 3A4 isoenzyme after enrollment (Within 4 weeks prior to enrollment and during the study period, subjects must not receive treatment with strong inhibitors or inducers of the cytochrome P450 (CYP) 3A4 isoenzyme. However, concurrent treatment with moderate or weak CYP3A4 inhibitors is permitted.);
Within 4 weeks prior to enrollment, participated in other clinical trials and used investigational drugs;
Any unstable condition or situation that may jeopardize the subject's safety and compliance with the study as judged by the investigator;
Subjects deemed unsuitable for treatment with this protocol by the investigator.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Kegang Jiang, Master | Contact | +86-18664786382 | kjiang@bebettermed.com |
| Name | Affiliation | Role |
|---|---|---|
| Yuankai Shi, Phd | Cancer Institute and Hospital, Chinese Academy of Medical Sciences | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cancer Hospital Chinese Academy of Medical Sciences | Recruiting | Beijing | Beijing Municipality | 100021 | China |
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Subjects will be randomly assigned in a 1:1 ratio to either the experimental group (BEBT-908 combined with R) or the control group [investigator-selected standard chemotherapy regimen (R-GemOx or R-ICE)].
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| Rituximab Injection | Drug | Rituximab Injection,dosage of administration:375 mg/m^2,frequency and duration of administration:Medication is administered on day 1 of each cycle or every third cycle, with a 21-day cycle duration. |
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| Gemcitabine Hydrochloride for Injection | Drug | Gemcitabine Hydrochloride for Injection,dosage of administration:1g/m^2,frequency and duration of administration:Medication is administered on day 2 of each cycle, with a 21-day cycle duration. |
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| Oxaliplatin Injection | Drug | Oxaliplatin Injection,dosage of administration:100mg/m^2,frequency and duration of administration:Medication is administered on day 2 of each cycle, with a 21-day cycle duration. |
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| Etoposide Injection | Drug | Etoposide Injection,dosage of administration:100mg/m^2,frequency and duration of administration:Medication is administered on days 1,2,and 3 of each cycle, with a 21-day cycle duration. |
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| Ifosfamide for Injection | Drug | Ifosfamide for Injection,dosage of administration:5000mg/m^2,frequency and duration of administration:Medication is administered on day 2 of each cycle, with a 21-day cycle duration. |
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| Carboplatin Injection | Drug | Carboplatin Injection,,dosage of administration:single dose ≤800 mg (calculated based on AUC=5),frequency and duration of administration:Medication is administered on day 2 of each cycle, with a 21-day cycle duration. |
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| Up to 48 months |
| Overall Response Rate After Completion of Treatment (ORR-EoT) | Defined as the proportion of subjects achieving complete response (CR) and partial response (PR) after the subject has completed eight cycles of treatment among the total number of subjects. | Up to 8 treatment cycles (Each cycle is 21 days.) |
| Clinical Benefit Rate (CBR) | Defined as the percentage of subjects achieving complete response (CR), partial response (PR), or stable disease (SD) from the start of randomization to the time of tumor progression. | Up to 48 months |
| Duration of Response (DoR) | Defined as the time interval from the first assessment of complete response (CR) or partial response (PR) to the occurrence of progressive disease (PD) or death due to any cause. | Up to 48 months |
| Occurrence of Adverse Events (AEs) | Occurrence of AEs will be graded according to the revised National Cancer Institute Common Terminology Criteria for Adverse Events Version 5.0 (NCI CTCAE V5.0). | Up to 48 months |
| ID | Term |
|---|---|
| D016403 | Lymphoma, Large B-Cell, Diffuse |
| ID | Term |
|---|---|
| D016393 | Lymphoma, B-Cell |
| D008228 | Lymphoma, Non-Hodgkin |
| D008223 | Lymphoma |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D008232 | Lymphoproliferative Disorders |
| D008206 | Lymphatic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| D007267 | Injections |
| C000623235 | BEBT-908 |
| D000069283 | Rituximab |
| D000093542 | Gemcitabine |
| D000077150 | Oxaliplatin |
| D005047 | Etoposide |
| D007069 | Ifosfamide |
| D016190 | Carboplatin |
| ID | Term |
|---|---|
| D004333 | Drug Administration Routes |
| D004358 | Drug Therapy |
| D013812 | Therapeutics |
| D058846 | Antibodies, Monoclonal, Murine-Derived |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D006571 | Heterocyclic Compounds |
| D003841 | Deoxycytidine |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D056831 | Coordination Complexes |
| D009930 | Organic Chemicals |
| D011034 | Podophyllotoxin |
| D013764 | Tetrahydronaphthalenes |
| D009281 | Naphthalenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D011083 | Polycyclic Compounds |
| D005960 | Glucosides |
| D006027 | Glycosides |
| D002241 | Carbohydrates |
| D003520 | Cyclophosphamide |
| D010752 | Phosphoramide Mustards |
| D009588 | Nitrogen Mustard Compounds |
| D009150 | Mustard Compounds |
| D006846 | Hydrocarbons, Halogenated |
| D063088 | Phosphoramides |
| D009943 | Organophosphorus Compounds |
| D010078 | Oxazines |
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