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BTK inhibitors and BCL-2 inhibitors have demonstrated significant clinical activity in mature B-cell malignancies, and combination therapy may provide improved clinical benefit. This is a multi-center, open-label, single-arm Phase Ib/II clinical study. The purpose of this clinical trial is to investigate the safety, tolerability, pharmacokinetics, and preliminary efficacy of Rocbrutinib, a fourth-generation Bruton tyrosine kinase inhibitor (BTKi), in combination with the BCL-2 inhibitor Lacutoclax in patients with mature B-cell malignancies. The Phase Ib will use a classic 3+3 dose-escalation design to evaluate dose-limiting toxicities (DLTs), determine the maximum tolerated dose (MTD), and identify the recommended dosing regimen. The Phase II portion is intended to further evaluate the efficacy and safety of the combination therapy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Lacutoclax+Rocbrutinib | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Lacutoclax+Rocbrutinib | Drug | Phase Ib dose-escalation study of Rocbrutinib in combination with Lacutoclax. Rocbrutinib will be administered at a fixed dose of 150 mg once daily (QD), while Lacutoclax will be dose-escalated. Initial dose levels include Lacutoclax 200 mg QD and 400 mg QD in 28-day treatment cycles.Treatment will continue until disease progression, unacceptable toxicity/intolerance, or completion of the protocol-defined treatment duration, whichever occurs first. In phase II, participants will receive Rocbrutinib monotherapy for 8-12 weeks prior to combination treatment. Upon initiation of combination therapy, Lacutoclax will undergo dose ramp-up to the target dose and will then be administered continuously at the target dose. Treatment will continue until disease progression, unacceptable toxicity/intolerance, or completion of the protocol-defined treatment duration, whichever occurs first. |
| Measure | Description | Time Frame |
|---|---|---|
| Phase Ib: Dose-limiting toxicity (DLT) | At the end of Cycle 1 (the length of cycle 1 is 28 days) | |
| Phase Ib: Maximum Tolerated Dose (MTD) | At the end of Cycle 1 (the length of cycle 1 is 28 days) | |
| Phase Ib: Adverse events as assessed by CTCAE v5.0 | From the first administration to 28 days after the last administration | |
| Phase Ib: Time to Maximum Plasma Concentration (Tmax) | From 1 hour prior to administration to 24 hours post-dose | |
| Phase Ib: Maximum Plasma Concentration (Cmax) | From 1 hour prior to administration to 24 hours post-dose | |
| Phase Ib: Area Under the Plasma Concentration-Time Curve from Time Zero to Time t (AUC0-t) | From 1 hour prior to administration to 24 hours post-dose | |
| Phase Ib: Half-life (t1/2) | From 1 hour prior to administration to 24 hours post-dose | |
| Phase II: Undetectable minimal residual disease (uMRD) rate assessed by flow cytometry | Up to approximately three years |
| Measure | Description | Time Frame |
|---|---|---|
| Phase II: Maximum Plasma Concentration (Cmax) | From 1 hour prior to administration to 24 hours post-dose | |
| Phase II: Time to Maximum Plasma Concentration (Tmax) | From 1 hour prior to administration to 24 hours post-dose |
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Inclusion Criteria:
Age ≥18 years, regardless of sex.
Ib: Histologically confirmed diagnosis of CLL/SLL (per 2018 iwCLL criteria) or B-cell malignancies (per 2022 WHO classification), including: MCL, DLBCL, FL, and WM. Must have received at least one prior line of systemic therapy, with documented disease progression or intolerance.
II: For Treatment-naïve (TN) CLL/SLL patients: Must meet iwCLL treatment indications and no prior systemic therapy. For R/R CLL/SLL patients: at least one prior systemic therapy with documented disease progression or intolerance.
Have at least one measurable lesion.
Phase Ib: ECOG performance status ≤1; phase II: ECOG performance status ≤2.
Life expectancy ≥ 12 weeks.
Adequate coagulation function, liver and kidney function, bone marrow hematopoietic function.
Male patients and female patients of childbearing potential must agree to use effective contraception during the study and for 90 days after the last dose of study treatment. Female patients of childbearing potential must have a negative pregnancy test before study treatment and must not be breastfeeding. Male patients must not donate sperm during the study and for 90 days after the last dose.
Participation is voluntary, requiring signed informed consent and compliance with the treatment regimen and visit schedule.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Lugui Qiu | Contact | +86-13821266636 | qiulg@ihcams.ac.cn |
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| Phase II: Area Under the Plasma Concentration-Time Curve from Time Zero to Time t (AUC0-t) | From 1 hour prior to administration to 24 hours post-dose |
| Phase II: Half-life (t1/2) | From 1 hour prior to administration to 24 hours post-dose |
| Overall Response Rate(ORR) | Up to approximately three years |
| Progression-free Survival(PFS) | Up to approximately three years |
| Overall Survival(OS) | Up to approximately three years |
| Phase II: Adverse events as assessed by CTCAE v5.0 | From the first administration to 28 days after the last administration |
| Complete Response Rate (CRR) | Up to approximately three years |
| Duration of Response (DOR) | Up to approximately three years |
| Phase Ib: Undetectable Minimal Residual Disease (uMRD) Rate assessed by flow cytometry | Up to approximately three years |
| ID | Term |
|---|---|
| D020522 | Lymphoma, Mantle-Cell |
| D016403 | Lymphoma, Large B-Cell, Diffuse |
| D008224 | Lymphoma, Follicular |
| D008258 | Waldenstrom Macroglobulinemia |
| D015451 | Leukemia, Lymphocytic, Chronic, B-Cell |
| ID | Term |
|---|---|
| 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 |
| D016393 | Lymphoma, B-Cell |
| D054219 | Neoplasms, Plasma Cell |
| D020141 | Hemostatic Disorders |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D010265 | Paraproteinemias |
| D001796 | Blood Protein Disorders |
| D006402 | Hematologic Diseases |
| D006474 | Hemorrhagic Disorders |
| D015448 | Leukemia, B-Cell |
| D007945 | Leukemia, Lymphoid |
| D007938 | Leukemia |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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