Inclusion criteria, exclusion criteria and study summary
This is a phase II,multicentre,single arm,open label pilot study to assess the safety and efficacy of acalabrutinib in combination with rituximab for previously untreated elderly frail mantle cell lymphoma patients. Patients will receive acalabrutinib and rituximab for up to six cycles. The cycle length is 28 days. Specifically,patients will receive acalabrutinib,orally,at a dose of 100 mg twice daily for 28 days and rituximab 375 mg/m2 intravenously on day 1 (+/-3) of each cycle.* Patients with any degree of response at the Week 12 (end of cycle 3) and Week 24 assessments (end of cycle 6) will continue with acalabrutinib monotherapy at a dose of 100 mg twice daily until disease progression,the development of unacceptable toxicity or any other reason (whichever occurs sooner). * Note: Acalabrutinib may be administered at a dose of 100 mg od po for cycle 1 day 1-7 at the local investigator’s discretion. The dose should be escalated to full dose (100 mg bd) by day 8 cycle 1 if no toxicity is seen. If a patient experiences toxicity during 100 mg od po for cycle 1 day 1-7,the case will be discussed with the Trial Management Group to decide if acalabrutinib should be continued. Rituximab may be administered subcutaneously at a flat dose of 1400 mg from cycle 2 onwards following an intravenous dose of 375 mg/m2 in cycle 1. Consideration to split the first dose of rituximab at cycle 1 in the minority of MCL patients presenting with a white cell count of > 25 x 109/L and splitting 25 mg/m2 on D1 and 350 mg/m2 on D2 of cycle 1. Primary objective: To determine the efficacy of acalabrutinib in combination with rituximab,in terms of disease response (overall response rate),at 6 months Secondary objectives: To determine the effect of acalabrutinib in combination with rituximab on progression free survival (PFS),overall survival (OS) and quality of life (QoL) To determine the best response rate and duration of response To assess the safety and toxicity of acalabrutinib in combination with rituximab Exploratory biological study objectives: Molecular features associated with clinical response To explore non-invasive molecular tumour profiling using cell-free DNA samples collected at screening To track dynamic changes in the circulating tumour DNA profile during therapy using a combination of deep targeted sequencing,shallow whole genome sequencing and epigenetic approaches To correlate the dynamic circulating tumour DNA profile with clinical outcomes