This is a prospective, phase 2, multicenter, open-label, single-arm study. Primary objective is to assess the efficacy of loncastuximab tesirine given as consolidation therapy after salvage immunochemotherapy in BTKi (Bruton Tyrosine Kinase inhibitors) -treated (or BTKi intolerant) R/R (Relapse or Refractory) MCL (Mantle Cell Lymphoma) patients. The sponsor of this clinical trial is Fondazione Italiana Linfomi - ETS (FIL ETS).
Histologically documented diagnosis of MCL as defined in the 2017 edition of the World Health Organization (WHO) classification
Age ≥ 18 and < 85 years
Relapsed/Refractory disease after one, two, three or four lines of treatment
Bendamustine-naive or relapsed after at least one year after the last cycle of a bendamustine-containing regimen
Subjects who have received a bendamustine containing regimen and relapsed less than one year after the end of treatment.
Known history of hypersensitivity to human antibodies.
Allogenic stem cell transplant within 6 months prior to start of first study drug.
Allogenic stem cell transplant with active / uncontrolled graft-versus-host disease.
Single group
Consolidation with ADCT-402 (loncastuximab tesirine) after salvage immunochemotherapy at standard dose (R-BAC, Rituximab - Bendamustine, Ara-C))
DrugStandard Induction phase (cycle 1-2 of R-BAC every 28 days according to the following schedule): * Rituximab 375 mg/m2 i.v. Day 1 * Bendamustine 70 mg/m2, Days 2 and 3 * Cytarabine 500 mg/m2, Day 2-4 After restaging at the End of Induction (EOI) patients with CR (complete response), PR (partial response) or SD (stable disease) will receive: CONSOLIDATION PHASE: * 2 infusions of loncastuximab tesirine at a dose of 150 microgram/kg every three weeks followed by * 2 infusions of loncastuximab tesirine at a dose of 75 microgram/kg every three weeks
Consolidation with ADCT-402 (loncastuximab tesirine) after salvage immunochemotherapy at reduced dose (R-BAC, Rituximab - Bendamustine, Ara-C)
DrugReduced Induction phase (cycle 1-2 with two different schedules for patients deemed FRAIL or UNFIT for standard induction therapy,based on protocol dose and as per medical judgment are allowed). * Rituximab 375 mg/m2 i.v. Day 1 * Bendamustine 70 mg/m2, Days 2 and 3 * Cytarabine 500 mg/m2, Day 2 and 3 or * Rituximab 375 mg/m2 i.v. Day 1 * Bendamustine 100 mg, Days 2 and 3 * Cytarabine 500 mg, Day 2 and 3 After restaging at the End of Induction (EOI) patients with CR (complete response), PR (partial response) or SD (stable disease) will receive: CONSOLIDATION PHASE: * 2 infusions of loncastuximab tesirine at a dose of 150 microgram/kg every three weeks followed by * 2 infusions of loncastuximab tesirine at a dose of 75 microgram/kg every three weeks
Progression-Free Survival (PFS)
The length of time during and after the treatment that patients live with the disease, but it does not get worse. Progression-Free Survival (PFS) will be defined from the date of enrollment and the first documentation of recurrence, progression or death from any cause. Responding patients and patients who are lost to follow up will be censored at their last assessment date. PFS will be assessed on an ITT (Intention to Treat) basis.
Overall Survival (OS)
The percentage of patients alive. The endpoint is defined as the time between the start of treatment until death from any cause; patients who are lost at follow up will be censored at their last assessment date. Analysis will be performed on an ITT (Intention to Treat) basis.
Overall Response Rate (ORR)
Overall response rate (ORR) is defined as the proportion of patients who have a complete response (CR), or partial response (PR) or stable disease (SD) to therapy. Overall Response Rate (ORR) will be defined according to the Lugano 2014 criteria. The best overall response will be defined as the best response between the date of beginning of therapy and the last restaging. Patients without response assessment (due to whatever reason) will be considered as non-responders.
Duration of Response (DOR)
The length of time that the disease continues to respond to treatment without growing or spreading. It is also defined as the time from the first documentation of tumor response (CR/PR) to disease progression or death according to Lugano 2014 Criteria. Analysis will be performed on an ITT (Intention to Treat) basis.
Event-Free Survival (EFS)
The measure of time after treatment that patients have not have cancer come back or get worse. It is also defined as the time from start of treatment to disease progression, death, or discontinuation of treatment for any reason (e.g. toxicity, patient preference), or initiation of a new treatment without documented progression. Analysis will be performed on an ITT (Intention to Treat) basis.
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