Acalabrutinib for Chronic Graft-versus-Host Disease
This phase II trial studies how well acalabrutinib works in treating patients with chronic graft versus host disease. Acalabrutinib may be an effective treatment for graft-versus-host disease caused by a stem cell transplant.
Primary: Determine the best overall response rate to acalabrutinib in patients who require second or later line therapy for chronic GVHD. Secondary: Describe the safety and tolerability of acalabrutinib in the chronic GVHD population; Determine the duration of response, among patients achieving a complete or partial response; Determine the change in patient-reported outcomes, specifically the Lee cGVHD Symptom Scale score and the PROMIS-29, between enrollment and follow-up; Determine the failure-free survival (FFS) (duration of relapse-free survival without adding another systemic treatment for chronic GVHD); Determine organ-specific response rates; Store peripheral blood mononuclear cells and plasma for future biologic studies.
ACP-196 (Acalabrutinib); Acalabrutinib ()
- Men and women >18 years of age.
- Moderate-severe chronic GVHD, diagnosed per the 2014 NIH criteria
- Progression or recurrence of active chronic GVHD signs/symptoms after treatment with steroids
- Karnofsky Performance Status >70%
- Woman of childbearing potential (WOCBP) who are sexually active must use highly effective methods of contraception during treatment and for 2 days after the last dose of acalabrutinib.
- Men must refrain from sperm donation during the study.
- Willing and able to participate in all required evaluations and procedures in this study protocol including swallowing tablets without difficulty.
- Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information
- Hospitalization for evaluation or management of an infection within the last 8 weeks
- Change in immunosuppressive regimen within the 2 weeks prior to enrollment
- Treatment of chronic GVHD with ibrutinib
- Received any investigational drug within 30 days or 5 half-lives (whichever is shorter) before first dose of study drug.
- Recurrent or prior malignancy (or any other malignancy that requires active treatment), except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer from which the subject has been disease free for ≥ 2 years.
- Clinically significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of screening, or any Class 3 or 4 cardiac disease as defined by the New York Heart Association Functional Classification. Subjects with controlled, asymptomatic atrial fibrillation during screening can enroll on study.
- Has difficulty with or is unable to swallow oral medication, or has significant gastrointestinal disease that would limit absorption of oral medication.
- Received a live virus vaccination within 28 days of first dose of study drug.
- Known history of infection with HIV
- Uncontrolled, active significant infection (eg, bacterial, viral, fungal or progressive multifocal leukoencephalopathy).
- Known history of drug-specific hypersensitivity or anaphylaxis to study drug (including active product or excipient components).
- Active bleeding, history of bleeding diathesis (eg, hemophilia or von Willebrand disease).
- Uncontrolled AIHA (autoimmune hemolytic anemia) or ITP (idiopathic thrombocytopenic purpura).
- Requires treatment with a strong cytochrome P450 3A4 (CYP3A4) inhibitor/inducer.
- Requires warfarin or equivalent vitamin K antagonist.
- History of significant cerebrovascular disease or event, including stroke or intracranial hemorrhage, within 6 months before the first dose of study drug.
- Major surgical procedure within 30 days of first dose of study drug. Note: If a subject had major surgery, they must have recovered adequately from any toxicity and/or complications from the intervention before the first dose of study drug.
- Hepatitis B or C serologic status: subjects who are hepatitis B core antibody (anti-HBc) positive and who are surface antigen negative will need to have a negative polymerase chain reaction (PCR). Those who are hepatitis B surface antigen (HBsAg) positive or hepatitis B PCR positive will be excluded. Subjects who are hepatitis C antibody positive will need to have a negative PCR result. Those who are hepatitis C PCR positive will be excluded.
- Child-Pugh score of C for hepatic impairment.
- Abnormal liver function tests with total bilirubin >2 mg/dL or ALT > 2 x upper limit of normal, unless abnormalities are due to liver GVHD, in which case total bilirubin >3 mg/dL or ALT 5 x upper limit of normal are exclusions.
- Absolute neutrophil count > Platelet count > Glomerular filtration rate > Breastfeeding or pregnant.
- Concurrent participation in another clinical trial and receiving a non-FDA approved medication
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