Brentuximab vedotin for Classical Hodgkin lymphoma|Relapsed or refractory classical Hodgkin lymphoma

Inclusion criteria

• {"criterion_text":"-Cohort-1: ruxolitinib + brentuximab 1.This cohort is open to adult patients with CD30+ cHL relapsed or refractory after autologous stem cell transplantation (ASCT), or after at least two previous lines of treatment if ASCT or polichemotherapy do not represent treatment options (as per AIFA label of brentuximab).\n-Cohort-1: ruxolitinib + brentuximab_2. Even when fulfilling the criteria of point 1 above, patients cannot be enrolled if: i) They had previously received an allotransplant (as they would be blocked by the AIFA registry for brentuximab); ii) or they can receive less than 8 infusions of brentuximab through the AIFA registry (due to previous infusions of the drugs through the registry); iii) or they had progressed on brentuximab after activating the AIFA registry for this drug (because progression on brentuximab recorded in the AIFA registry would block further requests of the drug through this registry). However, patients fulfilling the criteria of point 1 above can be enrolled if they progressed on brentuximab before activating the AIFA registry (as no record of progression would be present in this registry and the patients might benefit from combining ruxolitinib to brentuximab).\n-Cohort-1: ruxolitinib + brentuximab_3. If complying with the criteria of points 1 and 2 above, patients progressing after previous treatment in Cohort-2 may be enrolled in Cohort-1 upon decision of the Sponsor in conjunction with the clinical investigator(s).\n-Cohort-1: ruxolitinib + brentuximab_ 4. If complying with the criteria of points 1 and 2 above, patients taken off Cohort-2 due to important toxicity from pembrolizumab may be enrolled in Cohort-1, upon decision of the Sponsor in conjunction with the clinical investigator(s), as long as they have not responded (i.e., no PR or CR) to the treatment received in Cohort- 2.\n-Cohort-2: ruxolitinib + pembrolizumab 1. This cohort is open to adult patients with relapsed or refractory cHL previously treated with both ASCT or with at least two prior therapies when ASCT is not a treatment option (as per AIFA label of pembrolizumab).\n-Cohort-2: ruxolitinib + pembrolizumab_ 2. Patients fulfilling the criteria of point 1 above can be enrolled even if they had previously received an allotransplant (which does not block the AIFA registry for pembrolizumab), but they cannot be enrolled if they had previously received a PD1 or PDL1 inhibitor (which blocks the AIFA registry)\n-Cohort-2: ruxolitinib + pembrolizumab_ 3. If complying with the criteria of points 1 and 2 above, patients progressing after previous treatment in Cohort-1 may be enrolled in Cohort-2 upon decision of the Sponsor in conjunction with the clinical investigator(s).\n-Cohort-2: ruxolitinib + pembrolizumab_ 4. If complying with the criteria of points 1 and 2 above, patients taken off Cohort-1 due to important toxicity from brentuximab may be enrolled in Cohort-2, upon decision of the Sponsor in conjunction with the clinical investigator(s), as long as they have not responded (i.e., no PR or CR) to the treatment received in Cohort- 1\n-≥ 18 years of age\n-Immuno-histologically proven diagnosis of classical Hodgkin lymphoma\n-At least one measurable tumor lesion on PET-CT\n-Availability of the whole paraffin block (or, less preferably, at least 30 paraffin sections) of an adequately sized excisional tumor biopsy (archival and/or newly performed) for mandatory centralized assessment of response biomarkers\n-Availability of a baseline whole-blood sample of 40 ml for mandatory centralized assessment of response biomarkers\n-ECOG performance status: 0-1 for Cohort-1; 0-2 for Cohort-2 (as per AIFA registry)\n-Life expectancy ≥ 5 months\n-Any prior anti-lymphoma treatment (e.g., chemotherapy, radiotherapy, immunotherapy, investigational agents) must have been completed at least 4 weeks prior to initiation of study medication, except if no response to, or progression on, this treatment is already manifestly evident earlier\n-Signed informed consent prior to performing any study-related procedures"}

Exclusion criteria

• {"criterion_text":"-Previous treatment of cHL with ruxolitinib or another JAK inhibitor received before enrollment in the trial\n-Refractory nausea and vomiting, malabsorption, external biliary shunt, or significant bowel resection that would preclude adequate absorption. Patients must be able to swallow capsules.\n-CNS involvement by lymphoma\n-Currently uncontrolled active infection\n-Other severe, acute or chronic medical or psychiatric condition or laboratory abnormality that may, in the judgment of the clinical investigator and/or the Sponsor, increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, or may make the patient inappropriate for entry into this study\n-Pregnant or lactating females, or patients who are not willing to use an adequate method of birth control until 6 month after the last dose of brentuximab or pembrolizumab\n-Inability to comply with other requirements of the protocol\n-[for Cohort-2 only] Therapy with systemic immunosuppressive agents (which would be blocked by the AIFA registry of pembrolizumab, except for doses ≤ 10 mg/day of prednisone or equivalent corticosteroids) must have been stopped since at least 2 weeks\n-[for Cohort-2 only] Previous treatment with a PD1/PDL1 inhibitor, as per AIFA registry on pembrolizumab\n-[for Cohort-2 only] Symptomatic interstitial lung disease or active autoimmune disease (except for vitiligo, type-1 diabetes, hypothyroidism secondary to autoimmune thyroiditis requiring hormonal replacement therapy, and psoriasis not requiring systemic treatmentystemic treatment), as per AIFA registry of pembrolizumab; or active graft-versus-host disease after allo-transplantation."}

Primary endpoints

• {"endpoint_text":"-The primary endpoint in each cohort is to meet or exceed, according to a perprotocol analysis, a pre-determined rate of CR during, or at the end of, ruxolitinib treatment (i.e., obtained either at the interim disease evaluation during ruxolitinib treatment or at the end of ruxolitinib treatment, in comparison to the baseline disease status). The rate of CR has been set at ≥40% in both Cohorts to improve on the historical CR rates, in rela","definition_or_measurement_approach":"Complete response (CR) assessed per-protocol either at interim disease evaluation during ruxolitinib treatment or at the end of ruxolitinib treatment compared to baseline disease status; a pre-determined CR rate threshold of ≥40% in each cohort."}

Secondary endpoints

• {"endpoint_text":"-To describe the type, incidence, grade and relationship to the study drugs of adverse events (AE) occurring in each cohort.","definition_or_measurement_approach":"Safety assessment: type, incidence, grade and causality relationship of AEs to study drugs (standard AE reporting and grading)."}
• {"endpoint_text":"-To determine the rates of partial response (PR) and stable disease (SD) observed during ruxolitinib treatment and/or at the end of ruxolitinib treatment.","definition_or_measurement_approach":"Response rates (PR, SD) measured during ruxolitinib treatment and/or at end of treatment compared to baseline per protocol disease response criteria."}
• {"endpoint_text":"-To determine the rate of CR, PR and SD observed while patients are off ruxolitinib and may continue brentuximab (Cohort-1) or pembrolizumab (Cohort- 2) on study.","definition_or_measurement_approach":"Response rates (CR, PR, SD) assessed after ruxolitinib discontinuation in patients continuing brentuximab or pembrolizumab on study."}
• {"endpoint_text":"-To assess the rate of successful hematopoietic stem cell harvesting and bridging to transplantation in both cohorts.","definition_or_measurement_approach":"Rate of successful hematopoietic stem cell collection and successful bridging to transplantation as recorded during study follow-up."}
• {"endpoint_text":"-To assess the specific type, efficacy and toxicity of subsequent treatments that the patients might receive after those planned in the current study","definition_or_measurement_approach":"Description and assessment of type, efficacy and toxicity of subsequent (post-study) treatments received by patients."}
• {"endpoint_text":"-To assess the survival of patients: Progression-free survival, i.e. from start of treatment until date of progression; Overall survival, i.e. from start of treatment until death from any cause; Disease-specific survival, i.e. from start of treatment until death due to the disease or to its treatment; Treatment-free survival, i.e. from the end of study treatment until the beginning of a new treatment","definition_or_measurement_approach":"Survival endpoints defined explicitly: PFS measured from start of treatment to progression; OS from start to death from any cause; Disease-specific survival from start to death due to disease or its treatment; Treatment-free survival from end of study treatment to start of new treatment."}
• {"endpoint_text":"-To identify potential biomarkers of response through centralized analysis (at the Sponsor institution) of: Genetic and protein studies on archival and/or newly performed biopsies (e.g., genetic lesions of JAK-STAT pathway members; expression of PDL1, MHC-II, MHC-I and phosphorylated STAT transcription factors); Genetic and chemokine (e.g., TARC) studies on liquid biopsies taken before, during and after the study treatments.","definition_or_measurement_approach":"Centralized biomarker analyses on tissue and liquid biopsies (genetic lesions of JAK-STAT pathway members; expression of PDL1, MHC-II, MHC-I, phosphorylated STATs; genetic and chemokine studies such as TARC) performed at Sponsor institution on samples collected before, during and after treatment."}

Italy

Earliest CTIS Part Ii Submission Date

22-01-2025

Latest Decision Or Authorization Date

23-01-2026

Processing Time Days

366

Number Of Sites

12

Number Of Participants

48

Primary sponsor

Full Name

Universita' Degli Studi Di Perugia

Organisation Type

Educational Institution

Country Of Registered Address

Italy