Overview

This research study is a Phase 1/2 clinical trial testing the safety, tolerance and efficacy of the drug Acalabrutinib for people with recurrent or refractory central nervous system lymphoma (CNSL).

Eligibility

Inclusion Criteria:

• Participants must be able to understand and willing to sign a written informed consent document.
• Participant must have signed and dated an IRB/IEC approved written informed consent form in accordance with regulatory and institutional guidelines. This must be obtained before the performance of any protocol-related procedures that are not part of normal subject care.
• Participant must be willing and able to comply with scheduled visits, treatment schedule, laboratory tests, and other requirements of the study.
• Participants must be at least 18 years old on day of signing informed consent.
• Participants must have a ECOG Performance Status 0-1 (see Appendix A).
• Life expectancy of > 3 months (in the opinion of the investigator).
• Participants with recurrent or refractory (R/R) must have histologically confirmed DLBCL CNS lymphoma (from brain biopsy, CSF or vitreous biopsy for PCNSL/PVRL, and includes PCNSL and SCNSL) for Phase I; R/R histologically confirmed DLBCL PCNSL (from brain biopsy only) for Phase II. Participants must have received at least 1 line of CNS-directed prior therapy. There is no maximum limit on the number of prior therapies.
• Confirmation of availability of sufficient tissue from brain biopsy for correlative studies is required prior to enrollment (for phase II only).

        The following amount of archived tissue is required: At least 10 but up to 20 unstained
        formalin-fixed, paraffin-embedded (FFPE) slides. Histologically confirmed tissue will be
        required from the time of relapse or at the time of initial surgery.
          -  Participants must have recovered to ≤ grade 1 or pre-treatment baseline from
             clinically significant toxic effects of prior therapy.
          -  Participants must be able to undergo MRI.
          -  Participants must demonstrate adequate as defined below (all screening labs should be
             performed within 14 days of registration but before 1st dose of study drug):
               -  Hematology
                    -  White Blood Count (WBC) ≥ 2 K/µL
                    -  Platelet count ≥ 100 K/µL
                    -  Absolute Neutrophil Count ≥ 1.5 K/µL
                    -  Hemoglobin > 9.0 g/dL or ≥ 5.6 mmol/L (Criteria must be met without
                       erythropoietin dependency and without packed red blood cell (pRBC)
                       transfusion within last 2 weeks)
                    -  Serum creatinine ≤1.5 x institutional ULN OR Measured or calculated
                       creatinine clearance ≥30 mL/min for participant with creatinine levels >1.5
                       × institutional ULN (Creatinine clearance should be calculated per
                       institutional standard)
                    -  Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 x
                       ULN (≤5 × ULN for participants with liver metastases)
                    -  Total bilirubin (TBILI) ≤ 1.5 x institutional ULN (except subjects with
                       Gilbert Syndrome who must have a total bilirubin level of < 3.0 x
                       institutional ULN) OR Direct bilirubin ≤ULN for participants with total
                       bilirubin levels >1.5 × ULN)
          -  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. For male subjects with a pregnant or non-pregnant WOCBP partner, no
             contraception measures are required. Highly effective methods of contraception
             include:
               -  Combined (estrogen and progestogen containing) hormonal contraception associated
                  with inhibition of ovulation, which may be oral, intravaginal, or transdermal
               -  Progestogen-only hormonal contraception associated with inhibition of ovulation,
                  which may be oral, injectable, or implantable
               -  Intrauterine device (IUD) or intrauterine hormone-releasing system (IUS)
               -  Bilateral tubal occlusion
               -  Vasectomy of a female subject's male partner (with medical assessment and
                  confirmation of vasectomy surgical success)
               -  Sexual abstinence (only if refraining from heterosexual intercourse during the
                  entire period of risk associated with the study treatments)
        Exclusion Criteria:
          -  Participants unable to undergo MRI brain.
          -  Participants with > Grade 2 intracranial hemorrhage.
          -  Participants with active systemic disease.
          -  Participants with uncontrolled intercurrent illness.
          -  Participants with prior exposure to BTK inhibitors
          -  Prior malignancy (or any other malignancy requiring 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 ≥ 3 years.
          -  Participants who have received prior systemic anti-cancer therapy including
             investigational agents or radiotherapy within 4 weeks prior to dosing. OR 5
             half-lives, whichever is shorter Note: Participants must have recovered from all AEs
             due to previous therapies to ≤Grade 1 or baseline. Participants with ≤Grade 2
             neuropathy may be eligible.
          -  Clinically significant cardiovascular disease such as 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 or corrected QT interval (QTc) > 480 msec at screening.
             Note: Subjects with controlled, asymptomatic atrial fibrillation 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.
          -  Known history of infection with HIV, prior history of PML or any active significant
             infection (eg, bacterial, viral, or fungal).
          -  Known history of hypersensitivity or anaphylaxis to acalabrutinib including active
             product or excipient components.
          -  Active bleeding or 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 or receiving anticoagulation with warfarin or equivalent vitamin K
             antagonists.
          -  Prothrombin time (PT)/INR or aPTT (in the absence of lupus anticoagulant) >2x ULN.
          -  History of significant cerebrovascular disease/event, including stroke or intracranial
             hemorrhage, within 6 months before the first dose of study drug.
          -  Major surgical procedure within 28 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 hepatitis B surface antigen (HBsAg) negative will need
             to have a negative polymerase chain reaction (PCR) and must be willing to undergo DNA
             PCR testing during the study to be eligible. Those who are 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
             to be eligible. Those who are hepatitis C PCR positive will be excluded.
          -  Breast feeding or pregnant
          -  Concurrent participation in another therapeutic trial.
          -  Liver cirrhosis categorized at Child Pugh Score C.
          -  Uncontrolled hypertension despite optimal medical management.