A Phase 1/2 Study of CAT-8015 in Adult Relapsed or Refractory B-Cell Non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia
The primary objectives of this study are to determine the maximum tolerated dose (MTD) or optimal biologic dose (OBD) and safety profile of CAT-8015 in participants with relapsed or refractory advanced B-cell NHL (diffuse large B-cell lymphoma \[DLBCL\], follicular lymphoma \[FL\], mantle cell lymphoma \[MCL\]) or CLL.
To determine the maximum tolerated dose (MTD) or optimal biologic dose (OBD) of CAT-8015 in participants with relapsed or refractory advanced B-cell NHL (DLBCL, FL, MCL) or CLL.
Sex: All, ages: 18 Years to 99 Years, accepts healthy volunteers
Inclusion Criteria:
* Written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization
* Participants must have histologically confirmed B-cell CLL, including small lymphocytic lymphoma (SLL), DLBCL, MCL, or FL
* B-cell NHL: a) Have previous confirmation of B-cell NHL b) Participants with DLBCL or MCL, must have relapsed or refractory disease after at least one prior regimen containing rituximab, either alone or in combination, and be ineligible for any available standard line of therapy known to be life-prolonging or life-saving c) Participants with FL, must have relapsed or refractory disease after at least two prior regimens, one of which included rituximab, either alone or in combination, and be ineligible for any available standard line of therapy known to be life-prolonging or life-saving d) Have measurable disease (at least one lesion greater than or equal to (≥) 20 millimeter (mm) in one dimension or ≥ 15 mm in two dimensions as measured by conventional or high resolution \[spiral\] computed tomography e) Not be a candidate for a hematopoietic stem cell (HSC) or bone marrow transplant
* B-cell CLL: a) Have previous confirmation of B-cell CLL with a characteristic immunophenotype by flow cytometry b) Have relapsed or refractory disease after at least 2 prior lines of treatment, at least 1 of which must have contained rituximab and be ineligible for any available standard line of therapy known to be life-prolonging or life-saving c) Not be a candidate for an HSC or BM transplant d) Have symptomatic disease that requires treatment
* Karnofsky Performance Status ≥ 70
* Life expectancy of ≥ 12 weeks
* Toxicities from previous cancer therapies must have recovered to Grade less than (<) 2
* Adequate hematological function defined as: a) Hemoglobin ≥ 9 g/dL b) Absolute neutrophil count ≥ 1500/mm\^3 c) Platelet count ≥ 75,000/mm\^3
* Prothrombin time-International Normalized Ratio/Partial thromboplastin time less than or equal to (≤) 1.5 × upper limit of normal (ULN), or for participants on anticoagulation therapy, status within therapeutic range
* Women of non-child-bearing potential or using effective contraception
* Male participants with partners of child-bearing potential must be surgically sterile or use a contraceptive method
Exclusion Criteria:
* Any available standard line of therapy known to be life-prolonging or life-saving
* Any concurrent chemotherapy, radiotherapy, immunotherapy, biologic, or hormonal therapy for treatment of cancer
* For CLL participants only, rapidly progressive disease that in the estimation of the investigator and sponsor would compromise ability to complete study therapy
* History of allergy or reaction to any component of the CAT-8015
* Receipt of any chemotherapy or small molecule targeted therapy or any biological- or immunological-based therapies for leukemia or lymphoma within 6 weeks
* Prior radiation therapy will not be excluded, providing the volume of bone marrow treated is less than 25 percent
* Any history of prior pseudomonas-exotoxin immunotoxin administration including CAT-8015, CAT-3888, or LMB-2
* History of other invasive malignancy within 5 years, with some exceptions
* Evidence of significant active infection requiring antimicrobial, antifungal, antiparasitic or antiviral therapy or for which other supportive care is given
* Autologous stem cell transplantation within 6 months prior to study entry
* Allogenic stem cell transplantation or any other organ transplant
* HIV-positive or AIDS, Hepatitis B or hepatitis C infection as defined by seropositive for hepatitis B (HBsAg) or hepatitis C and elevated liver transaminases
* Use of immunosuppressive medication other than steroids within 7 days, use of systemic steroids within 7 days before the first dose of CAT-8015 (inhaled and topical corticosteroids are permitted). Participants may take replacement doses of steroids (defined as ≤ 30 mg/day hydrocortisone or the equivalent) if on a stable dose for at least 2 weeks prior to the first dose of CAT-8015
* Documented current central nervous system involvement by leukemia or lymphoma
* Pregnancy or lactation, other severe, concurrent diseases
* Concurrent enrollment in another clinical study
Participant flow
| Milestone | CAT-8015 20 Microgram Per Kilogram (mcg/kg) | CAT-8015 30 Microgram Per Kilogram (mcg/kg) | CAT-8015 40 Microgram Per Kilogram (mcg/kg) | CAT-8015 50 Microgram Per Kilogram (mcg/kg) | CAT-8015 60 Microgram Per Kilogram (mcg/kg) |
|---|
| Started | 7 | 6 | 6 | 3 | 1 |
| Completed | 0 | 0 | 0 | 0 | 0 |
| Not completed | 7 | 6 | 6 | 3 | 1 |
Outcome results
- Maximum Tolerated Dose (MTD) (Primary), Number, mcg/Kg: CAT-8015 20 Microgram Per Kilogram (mcg/kg) NA; CAT-8015 30 Microgram Per Kilogram (mcg/kg) NA; CAT-8015 40 Microgram Per Kilogram (mcg/kg) NA; CAT-8015 50 Microgram Per Kilogram (mcg/kg) NA; CAT-8015 60 Microgram Per Kilogram (mcg/kg) NA
- Number of Participants With Dose Limiting Toxicities (DLTs) (Primary), Count of participants, Participants: CAT-8015 20 Microgram Per Kilogram (mcg/kg) 0; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 2; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 1; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 0; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 1
- Number of Participants With Treatment-Emergent Adverse Events (TEAEs) and Treatment-Emergent Serious Adverse Events (TESAEs) (Primary), Count of participants, Participants: CAT-8015 20 Microgram Per Kilogram (mcg/kg) 7; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 6; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 6; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 3; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 1
- Number of Participants With Clinically Significant Laboratory Abnormalities Recorded as Treatment-Emergent Adverse Events (TEAEs) (Primary), Count of participants, Participants: CAT-8015 20 Microgram Per Kilogram (mcg/kg) 0; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 3; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 3; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 0; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 1
- Number of Participants With Vital Signs Abnormalities Recorded as Treatment-Emergent Adverse Events (TEAEs) (Primary), Count of participants, Participants: CAT-8015 20 Microgram Per Kilogram (mcg/kg) 1; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 1; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 1; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 0; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 1
- Number of Participants With Electrocardiogram (ECG) Abnormalities Recorded as Treatment-Emergent Adverse Events (TEAEs) (Primary), Count of participants, Participants: CAT-8015 20 Microgram Per Kilogram (mcg/kg) 0; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 1; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 0; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 0; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 0
- Percentage of Participants With Complete Response (CR) (Secondary), Number, Percentage of Participants: Chronic Lymphocytic Leukemia 0; Diffuse Large B Cell Lymphoma 0; Mantle Cell Lymphoma 0; Follicular Lymphoma 0
- Duration of Complete Response (Secondary), Median, Months: Chronic Lymphocytic Leukemia NA (NA to NA); Diffuse Large B Cell Lymphoma NA (NA to NA); Mantle Cell Lymphoma NA (NA to NA); Follicular Lymphoma NA (NA to NA)
- Percentage of Participants With Partial Response (PR) (Secondary), Number, Percentage of Participants: Chronic Lymphocytic Leukemia 10; Diffuse Large B Cell Lymphoma 0; Mantle Cell Lymphoma 0; Follicular Lymphoma 0
- Percentage of Participants With Objective Response (OR) (Secondary), Number, Percentage of Participants: Chronic Lymphocytic Leukemia 10; Diffuse Large B Cell Lymphoma 0; Mantle Cell Lymphoma 0; Follicular Lymphoma 0
- Time to Response (TTR) (Secondary), Median, Months: Chronic Lymphocytic Leukemia 0.79 (0.79 to 0.79); Diffuse Large B Cell Lymphoma NA (NA to NA); Mantle Cell Lymphoma NA (NA to NA); Follicular Lymphoma NA (NA to NA)
- Duration of Objective Response (DOR) (Secondary), Median, Months: Chronic Lymphocytic Leukemia 7.66 (7.66 to 7.66); Diffuse Large B Cell Lymphoma NA (NA to NA); Mantle Cell Lymphoma NA (NA to NA); Follicular Lymphoma NA (NA to NA)
- Duration of Stable Disease (SD) (Secondary), Median, Months: Chronic Lymphocytic Leukemia 1.87 (0.79 to 8.41); Diffuse Large B Cell Lymphoma NA (NA to NA); Mantle Cell Lymphoma 0.95 (0.95 to 0.95); Follicular Lymphoma 4.67 (3.71 to 5.62)
- Maximum Plasma Concentration (Cmax) of Moxetumomab Pasudotox (Secondary), Mean, nanogram per milliliter (ng/mL): CAT-8015 20 Microgram Per Kilogram (mcg/kg) 283 +/- 159; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 452 +/- 141; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 589 +/- 366; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 769 +/- 221; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 818 +/- NA
- Area Under Concentration-Time Curve From Dosing Extrapolated to Infinity (AUCinf) of Moxetumomab Pasudotox (Secondary), Mean, hour*nanogram per milliliter (hr*ng/mL): CAT-8015 20 Microgram Per Kilogram (mcg/kg) 1120 +/- 928; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 1640 +/- 682; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 2050 +/- 1150; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 2320 +/- 1010; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 1810 +/- NA
- Clearance (CL) of Moxetumomab Pasudotox (Secondary), Mean, milliliter per hour per kilogram: CAT-8015 20 Microgram Per Kilogram (mcg/kg) 31.6 +/- 25.5; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 22.2 +/- 12.5; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 26.9 +/- 18.6; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 25.2 +/- 12.9; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 33.1 +/- NA
- Elimination Half Life (t1/2) of Moxetumomab Pasudotox (Secondary), Mean, hour: CAT-8015 20 Microgram Per Kilogram (mcg/kg) 1.55 +/- 1.10; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 1.87 +/- 0.985; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 1.68 +/- 0.726; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 1.87 +/- 0.586; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 0.901 +/- NA
- Number of Participants With Positive Anti-Drug Antibody (Secondary), Count of participants, Participants: CAT-8015 20 Microgram Per Kilogram (mcg/kg) 5; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 4; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 5; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 2; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 0
- Number of Participants With CD22 Expression Levels (Secondary), Count of participants, Participants: Chronic Lymphocytic Leukemia 8; Diffuse Large B Cell Lymphoma 5; Mantle Cell Lymphoma 2; Follicular Lymphoma 1
- Number of Capillary Leak Syndrome (CLS) Participants With Weight Changes, Albumin, Hypotension, Edema, Hypoxia, and Pulmonary Adverse Events (AEs) (Secondary), Count of participants, Participants: CAT-8015 20 Microgram Per Kilogram (mcg/kg) 1; CAT-8015 30 Microgram Per Kilogram (mcg/kg) 0; CAT-8015 40 Microgram Per Kilogram (mcg/kg) 1; CAT-8015 50 Microgram Per Kilogram (mcg/kg) 0; CAT-8015 60 Microgram Per Kilogram (mcg/kg) 0
- 1 more outcome measures not shown.
Adverse events
Time frame: From Screening (Day -28) to Post Therapy Day 30
| Arm | Deaths | Serious adverse events | Other adverse events |
|---|
| CAT-8015 20 Microgram Per Kilogram (mcg/kg) | 0 | 0/7 (0.0%) | 7/7 (100.0%) |
| CAT-8015 30 Microgram Per Kilogram (mcg/kg) | 0 | 3/6 (50.0%) | 6/6 (100.0%) |
| CAT-8015 40 Microgram Per Kilogram (mcg/kg) | 0 | 2/6 (33.3%) | 6/6 (100.0%) |
| CAT-8015 50 Microgram Per Kilogram (mcg/kg) | 0 | 0/3 (0.0%) | 3/3 (100.0%) |
| CAT-8015 60 Microgram Per Kilogram (mcg/kg) | 0 | 1/1 (100.0%) | 1/1 (100.0%) |
Serious adverse events by term
| Term | Organ system | CAT-8015 20 Microgram Per Kilogram (mcg/kg) | CAT-8015 30 Microgram Per Kilogram (mcg/kg) | CAT-8015 40 Microgram Per Kilogram (mcg/kg) | CAT-8015 50 Microgram Per Kilogram (mcg/kg) | CAT-8015 60 Microgram Per Kilogram (mcg/kg) |
|---|
| Lung infection | Infections and infestations | 0/7 | 0/6 | 1/6 | 0/3 | 0/1 |
| Blood creatinine increased | Investigations | 0/7 | 0/6 | 0/6 | 0/3 | 1/1 |
| Diffuse large b-cell lymphoma | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | 0/7 | 1/6 | 0/6 | 0/3 | 0/1 |
| Tumour associated fever | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | 0/7 | 1/6 | 0/6 | 0/3 | 0/1 |
| Renal failure acute | Renal and urinary disorders | 0/7 | 0/6 | 0/6 | 0/3 | 1/1 |
| Acute respiratory distress syndrome | Respiratory, thoracic and mediastinal disorders | 0/7 | 1/6 | 0/6 | 0/3 | 0/1 |
| Capillary leak syndrome | Vascular disorders | 0/7 | 0/6 | 1/6 | 0/3 | 0/1 |
Other adverse events by term
| Term | Organ system | CAT-8015 20 Microgram Per Kilogram (mcg/kg) | CAT-8015 30 Microgram Per Kilogram (mcg/kg) | CAT-8015 40 Microgram Per Kilogram (mcg/kg) | CAT-8015 50 Microgram Per Kilogram (mcg/kg) | CAT-8015 60 Microgram Per Kilogram (mcg/kg) |
|---|
| Anaemia | Blood and lymphatic system disorders | 0/7 | 3/6 | 3/6 | 0/3 | 1/1 |
| Neutropenia | Blood and lymphatic system disorders | 1/7 | 1/6 | 0/6 | 0/3 | 0/1 |
| Thrombocytopenia | Blood and lymphatic system disorders | 0/7 | 2/6 | 0/6 | 0/3 | 0/1 |
| Vision blurred | Eye disorders | 1/7 | 0/6 | 0/6 | 0/3 | 1/1 |
| Abdominal pain | Gastrointestinal disorders | 0/7 | 1/6 | 1/6 | 1/3 | 0/1 |
| Constipation | Gastrointestinal disorders | 0/7 | 1/6 | 2/6 | 1/3 | 1/1 |
| Diarrhoea | Gastrointestinal disorders | 1/7 | 0/6 | 3/6 | 0/3 | 0/1 |
| Dyspepsia | Gastrointestinal disorders | 0/7 | 0/6 | 1/6 | 1/3 | 0/1 |
| Flatulence | Gastrointestinal disorders | 0/7 | 1/6 | 1/6 | 0/3 | 0/1 |
| Nausea | Gastrointestinal disorders | 2/7 | 0/6 | 2/6 | 2/3 | 0/1 |
| Vomiting | Gastrointestinal disorders | 0/7 | 1/6 | 2/6 | 1/3 | 0/1 |
| Chills | General disorders | 0/7 | 1/6 | 1/6 | 0/3 | 0/1 |
| Face oedema | General disorders | 2/7 | 1/6 | 0/6 | 1/3 | 1/1 |
| Fatigue | General disorders | 5/7 | 0/6 | 4/6 | 0/3 | 0/1 |
| Oedema peripheral | General disorders | 4/7 | 1/6 | 3/6 | 2/3 | 1/1 |
| Pain | General disorders | 0/7 | 1/6 | 0/6 | 0/3 | 1/1 |
| Pyrexia | General disorders | 0/7 | 1/6 | 1/6 | 0/3 | 0/1 |
| Urinary tract infection | Infections and infestations | 0/7 | 1/6 | 1/6 | 0/3 | 0/1 |
| Alanine aminotransferase increased | Investigations | 1/7 | 1/6 | 0/6 | 1/3 | 1/1 |
| Aspartate aminotransferase increased | Investigations | 1/7 | 1/6 | 0/6 | 1/3 | 0/1 |
| Blood alkaline phosphatase increased | Investigations | 0/7 | 0/6 | 0/6 | 1/3 | 1/1 |
| Blood creatinine increased | Investigations | 1/7 | 2/6 | 0/6 | 0/3 | 0/1 |
| Electrocardiogram qt prolonged | Investigations | 2/7 | 0/6 | 0/6 | 0/3 | 0/1 |
| Neutrophil count decreased | Investigations | 1/7 | 0/6 | 0/6 | 1/3 | 1/1 |
| Platelet count decreased | Investigations | 0/7 | 0/6 | 1/6 | 0/3 | 1/1 |
| Decreased appetite | Metabolism and nutrition disorders | 2/7 | 0/6 | 0/6 | 0/3 | 0/1 |
| Hypercalcaemia | Metabolism and nutrition disorders | 0/7 | 1/6 | 0/6 | 0/3 | 1/1 |
| Hyperglycaemia | Metabolism and nutrition disorders | 0/7 | 1/6 | 1/6 | 0/3 | 0/1 |
| Hyperkalaemia | Metabolism and nutrition disorders | 0/7 | 1/6 | 1/6 | 0/3 | 0/1 |
| Hypernatraemia | Metabolism and nutrition disorders | 2/7 | 0/6 | 1/6 | 0/3 | 1/1 |
| Hypertriglyceridaemia | Metabolism and nutrition disorders | 0/7 | 3/6 | 0/6 | 1/3 | 1/1 |
| Hyperuricaemia | Metabolism and nutrition disorders | 1/7 | 0/6 | 0/6 | 0/3 | 1/1 |
| Hypoalbuminaemia | Metabolism and nutrition disorders | 2/7 | 1/6 | 2/6 | 0/3 | 1/1 |
| Hypocalcaemia | Metabolism and nutrition disorders | 0/7 | 1/6 | 2/6 | 0/3 | 1/1 |
| Hypokalaemia | Metabolism and nutrition disorders | 0/7 | 0/6 | 1/6 | 1/3 | 1/1 |
| Hyponatraemia | Metabolism and nutrition disorders | 0/7 | 1/6 | 3/6 | 0/3 | 1/1 |
| Hypophosphataemia | Metabolism and nutrition disorders | 0/7 | 0/6 | 1/6 | 1/3 | 0/1 |
| Back pain | Musculoskeletal and connective tissue disorders | 1/7 | 2/6 | 0/6 | 0/3 | 0/1 |
| Musculoskeletal chest pain | Musculoskeletal and connective tissue disorders | 0/7 | 1/6 | 1/6 | 1/3 | 0/1 |
| Myalgia | Musculoskeletal and connective tissue disorders | 1/7 | 0/6 | 1/6 | 1/3 | 0/1 |
| Pain in extremity | Musculoskeletal and connective tissue disorders | 0/7 | 0/6 | 1/6 | 1/3 | 0/1 |
| Dizziness | Nervous system disorders | 1/7 | 1/6 | 2/6 | 1/3 | 0/1 |
| Headache | Nervous system disorders | 1/7 | 2/6 | 1/6 | 2/3 | 1/1 |
| Insomnia | Psychiatric disorders | 0/7 | 2/6 | 0/6 | 0/3 | 0/1 |
| Haematuria | Renal and urinary disorders | 0/7 | 1/6 | 1/6 | 0/3 | 1/1 |
| Cough | Respiratory, thoracic and mediastinal disorders | 1/7 | 0/6 | 3/6 | 0/3 | 0/1 |
| Dyspnoea | Respiratory, thoracic and mediastinal disorders | 0/7 | 1/6 | 2/6 | 1/3 | 0/1 |
| Capillary leak syndrome | Vascular disorders | 1/7 | 0/6 | 1/6 | 0/3 | 0/1 |
| Haematoma | Vascular disorders | 1/7 | 0/6 | 1/6 | 0/3 | 0/1 |
| Hypertension | Vascular disorders | 0/7 | 2/6 | 1/6 | 0/3 | 0/1 |
| Hypotension | Vascular disorders | 1/7 | 1/6 | 1/6 | 0/3 | 1/1 |