This trial will enroll patients with relapsed/refractory DLBCL and MCL, with the opportunity to receive single-agent glofitamab as early as the second-line. Patients will have superficially accessible disease to enable core-needle biopsy prior to therapy initiation, and on cycle 1 day 15 and cycle 2 day 1 of therapy administration to enable high throughput molecular profiling of disease and immune dynamics while on treatment.
Inclusion Criteria:
Exclusion Criteria:
Patients who meet any of the following criteria will be excluded from study entry:
Contraindication to any of the individual components of glofitamab or history of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies or known sensitivity or allergy to murine products
Any prior treatment with a BsAb targeting CD3 and CD20
Prior allogeneic hematopoietic stem cell transplantation or solid organ transplantation
Prior treatment with systemic immunotherapeutic agents, including but not limited to, radio-immuno-conjugates, antibody-drug conjugates, immune/cytokines and monoclonal antibodies (mAbs) (e.g., anti-cytotoxic T lymphocyte associated protein 4, anti-PD-1, and anti-PD-L1) within 4 weeks or five half-lives of the drug, whichever is shorter
Treatment with CAR-T therapy within 30 days prior to first dose of glofitamab
Any investigational therapy for the purposes of treating cancer within 28 days prior to the start of Cycle 1
Prior radiotherapy to the mediastinal/pericardial region Radiotherapy to non-target lesion sites will be permitted.
Corticosteroid use >50 mg/day of prednisone or equivalent, for purposes other than lymphoma symptom control
Participants receiving corticosteroid treatment with >50 mg/day of prednisone or equivalent for reasons other than lymphoma symptom control (e.g., rheumatoid arthritis) must be documented to be on a stable dose of at least 4 weeks duration prior to the start of Cycle 1.
Participants who require lymphoma symptom control during screening may receive steroids in the following manner:
History of other malignancy that could affect compliance with the protocol or interpretation of results:
Significant or extensive history of cardiovascular disease such as New York Heart Association Class III or IV cardiac disease or Objective Assessment Class C or D, myocardial infarction within the last 3 months prior to the start of Cycle 1, unstable arrhythmias, or unstable angina
Recent major surgery (within 4 weeks prior to the start of Cycle 1), other than for diagnosis
Current or past history of CNS disease, such as stroke, epilepsy, CNS vasculitis or neurodegenerative disease Participants with a history of stroke who have not experienced a stroke or transient ischemic attack in the past 2 years and have no residual neurological deficits, as judged by the investigator, are allowed.
Current or past history of CNS lymphoma
Known or suspected history of hemophagocytic lymphohistiocytosis (HLH)
Current or past history of Waldenström macroglobulinemia
History or presence of an abnormal ECG that is clinically significant in the investigator's opinion
Patients with known or suspected active infection, or reactivation of a latent infection, whether bacterial, viral (including, but not limited to, SARS-Cov-2, Epstein-Barr virus (EBV), cytomegalovirus (CMV), hepatitis B, and hepatitis C), fungal, mycobacterial, or other pathogens (excluding fungal infections of nail beds) or any major episode of infection requiring hospitalization or treatment with IV antibiotics (for IV antibiotics this pertains to completion of last course of antibiotic treatment) within 4 weeks of dosing
History of treatment-emergent immune-related adverse events associated with prior immunotherapeutic agents, as follows:
Clinically significant liver disease, including active viral or other hepatitis or cirrhosis
Illicit drug or alcohol abuse within 12 months prior to screening, in the investigator's judgment
Any of the following abnormal laboratory values (unless any of these abnormalities are due to underlying lymphoma):
Live, attenuated vaccine within 4 weeks before study treatment infusion on Day 1 of Cycle 1 or anticipation that such a live, attenuated vaccine will be required during the study. Live vaccines during the study and until participants B cells recover, are prohibited Influenza vaccination should be given during influenza season only. Participants must not receive live, attenuated influenza vaccine at any time during the study treatment period.
Suspected active or latent tuberculosis (as confirmed by a positive interferon-gamma release assay)
Positive test results for chronic hepatitis B infection (defined as positive hepatitis B surface antigen [HBsAg] serology) Participants with occult or prior hepatitis B infection (defined as positive total hepatitis B core antibody and negative HBsAg) may be included if hepatitis B virus (HBV) DNA is undetectable at the time of screening. Such participants must be willing to undergo HBV DNA testing on Day 1 of every cycle and every 3 months for at least 12 months after the final cycle of study treatment and appropriate antiviral therapy as indicated.
Positive test results for hepatitis C (hepatitis C virus [HCV] antibody serology testing) Participants positive for HCV antibody are eligible only if polymerase chain reaction (PCR) is negative for HCV RNA.
Positive test results for HTLV-1
Participants with a history of progressive multifocal leukoencephalopathy
Pregnancy or breastfeeding, or intention of becoming pregnant during the study or within 18 months after pretreatment with obinutuzumab or 2 months after the final dose of glofitamab, whichever is longer
Positive SARS-CoV-2 test within 7 days prior to enrollment. Rapid antigen test result is also acceptable.
Martine.VanVoorthuysen@mssm.edu
Participants will receive step-up dosing of IV infusion of glofitamab on cycle 1 day 8 (2.5 mg) and cycle 1 day 15 (10 mg), followed by full dose (30 mg) starting on cycle 2 (C2) day 1 (day 22 overall) and then days 1±3 of all subsequent 21 day cycles.
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A Study of Glofitamab and Lenalidomide in People With Mantle Cell Lymphoma
Treatment by a Bispecific CD3xCD20 Antibody for Relapse/Refractory Lymphomas After CAR T-cells Therapy
Glofitamab Combined With Lenalidomide in High Risk Patients With Relapsed or Refractory Mantle Cell Lymphoma
Feasibility Trial of Glofitamab in a Response Adapted Approach Incorporating Interim FDG PET and ctDNA to Optimize Primary Therapy of DLBCL (GRAIL)
Glofitamab Plus Polatuzumab Vedotin and Zuberitamab in Patients With Newly Diagnosed Diffuse Large B-cell Lymphoma