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Ibrutinib Followed by BR (Bendamustine and Rituximab) as a Time-Limited Therapy for Waldenström Macroglobulinemia

NCT07169565 · Status: NOT_YET_RECRUITING · Phase: PHASE1 · Type: INTERVENTIONAL · Enrollment: 21

Last updated 2025-09-11

No results posted yet for this study

Summary

This is a two-part, non-randomized, open-label Phase I clinical study. The research consists of:

1. A 3+3 dose-escalation phase to determine the Maximum Tolerated Dose (MTD) and Recommended Phase II Dose (RP2D) of the I+BR regimen in Waldenström Macroglobulinemia (WM) patients;
2. A dose-expansion phase to evaluate the safety, tolerability, and efficacy of the time-limited regimen at the MTD/RP2D.

Key Study Design Details:

Pre-enrollment \& Eligibility:

* Patients undergo efficacy and tolerability assessment before enrollment.
* Eligible patients receive I+BR therapy.

Treatment Regimen:

* Bendamustine: Tested at three dose levels (70 mg/m², 60 mg/m², and 50 mg/m²) based on prior IBR data in B-cell lymphomas. A 3+3 dose de-escalation design is employed.
* Fixed Doses:

* Ibrutinib: 420 mg/day
* Rituximab: 375 mg/m²

Part I (3+3 Dose Escalation):

* Start with 3 patients receiving bendamustine 70 mg/m².
* After 1 treatment cycle:

* Assess Dose-Limiting Toxicity (DLT) (DLT criteria defined separately).
* Patients without DLT proceed to 2 additional cycles of IBR.
* After 3 total cycles:

* Efficacy assessment is performed.
* Patients achieving minimal response (MR) or better (i.e., MR, PR, VGPR, CR) receive 1 cycle of BR, then cease treatment and enter follow-up.
* Patients failing to achieve ≥MR are withdrawn.
* Primary Objective: Evaluate safety and identify MTD.

Part II (Dose Expansion):

* Enroll 15 additional patients at MTD/RP2D.
* Objectives:

* Further assess safety and efficacy;
* Monitor IgM rebound within 2 months after completing therapy (3 cycles I+BR → 1 cycle BR);
* Explore correlations between biomarkers and clinical outcomes.

Terminology Notes:

* I+BR: Ibrutinib + Bendamustine/Rituximab
* DLT: Dose-Limiting Toxicity
* MTD: Maximum Tolerated Dose
* RP2D: Recommended Phase II Dose
* Efficacy thresholds: MR (Minimal Response), PR (Partial Response), VGPR (Very Good Partial Response), CR (Complete Response)
* Time-limited therapy: Fixed-duration treatment designed to avoid indefinite dosing.

Conditions

  • Waldenström Macroglobulinemia (WM)

Interventions

DRUG

Ibrutinib

Oral Bruton's tyrosine kinase (BTK) inhibitor administered at a fixed dose of 420 mg once daily. Capsules must be swallowed whole with water; do not open, break, or chew. If a dose is missed by ≤6 hours, take immediately; if \>6 hours, skip the dose and resume normal schedule the next day. Avoid grapefruit and Seville oranges (moderate CYP3A inhibitors). Treatment duration: 3 cycles (28 days/cycle) or until disease progression/unacceptable toxicity. Dose reduction is mandated for specific toxicities: 420 mg → 280 mg → 140 mg → discontinuation (per protocol-specified criteria). Use with caution in hepatic impairment (Child-Pugh A: reduce to 80 mg/day; Child-Pugh B/C: contraindicated).

DRUG

Bendamustine

Intravenous alkylating agent dosed via a 3+3 dose de-escalation design (70 mg/m² → 60 mg/m² → 50 mg/m²). Infused over 60-120 minutes on Days 1-2 of each 28-day cycle for 3 cycles. Starting dose: 70 mg/m² (Dose Level 1); dose reduction triggered by Dose-Limiting Toxicity (DLT) events per protocol. In the dose-expansion phase, all subjects receive the MTD/RP2D established in Part 1. Concomitant live vaccines are prohibited. Dose delays (≤4 weeks) and reductions are required for Grade ≥3 hematologic/non-hematologic toxicities.

DRUG

Rituximab

Intravenous anti-CD20 monoclonal antibody administered at a fixed dose of 375 mg/m² on Day 0 of each 28-day cycle for 3 cycles. Initial infusion starts at 50 mg/hour; if tolerated, increase by 50 mg/hour every 30 minutes (maximum: 400 mg/hour). Subsequent infusions start at 100 mg/hour with the same escalation. Premedication with acetaminophen and an antihistamine is required prior to each infusion. Permanently discontinue for Grade 4 infusion-related reactions or severe/life-threatening toxicity.

Sponsors & Collaborators

  • Institute of Hematology & Blood Diseases Hospital, China

    lead OTHER

Study Design

Allocation
NA
Purpose
TREATMENT
Masking
NONE
Model
SINGLE_GROUP

Eligibility

Min Age
18 Years
Max Age
75 Years
Sex
ALL
Healthy Volunteers
No

Timeline & Regulatory

Start
2025-09-01
Primary Completion
2028-09-01
Completion
2028-09-01

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Drugs

Read the full study record

This page highlights key information. For complete eligibility criteria, study locations, investigator contacts, and the full protocol, visit the original record on ClinicalTrials.gov.

View NCT07169565 on ClinicalTrials.gov