Abstract
BackgroundOver 12,000 new cases of B-cell malignancies are diagnosed in the UK each year, with diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) being the most common subtypes. Standard frontline therapy consists of immunochemotherapy with a CD20 monoclonal antibody (mAb), such as rituximab, delivered in combination with multi-agent chemotherapy. Despite being considered a treatable and potentially curable cancer, approximately 30% of DLBCL cases will relapse after frontline therapy. Advanced stage FL is incurable and typically has a relapsing and remitting course with a frequent need for re-treatment. Based on supportive preclinical data, we hypothesised that the addition of varlilumab (an anti-CD27 mAb) to rituximab (an anti-CD20 mAb) can improve the rate, depth and duration of the response of rituximab monotherapy in patients with relapsed or refractory B-cell malignancies.Methods/designCombination treatment of varlilumab plus rituximab, in two different dosing regimens, is being tested in the RIVA trial. RIVA is a two-stage open-label randomised phase IIa design in up to 40 patients with low- or high-grade relapsed or refractory CD20+ B-cell lymphoma. The study is open to recruitment in the UK. Enrolled patients are randomised 1:1 to two different experimental varlilumab to rituximab combinations.The primary objective is to determine the safety and tolerability of the combination and the anti-tumour activity (response) in relapsed or refractory B-cell malignancies. Secondary objectives will include an evaluation of the duration of the response and overall survival. Tertiary translational objectives include assessment of B-cell depletion, changes in immune effector cell populations, expression of CD27 as a biomarker of response and pharmacokinetic properties. Analyses will not be powered for formal statistical comparisons between treatment arms.DiscussionRIVA will determine whether the combination of rituximab and varlilumab in relapsed or refractory B-cell malignancies is active and safe prior to future phase II/III trials.Trial registrationEudraCT, 2017–000302-37. Registered on 16 January 2017. ISRCTN, ISRCTN15025004. Registered on 16 August 2017.
Highlights
Over 12,000 new cases of B-cell malignancies are diagnosed in the UK each year, with diffuse large Bcell lymphoma (DLBCL) and follicular lymphoma (FL) being the most common subtypes
RIVA will determine whether the combination of rituximab and varlilumab in relapsed or refractory B-cell malignancies is active and safe prior to future phase II/III trials
Standard frontline therapy for most B-cell malignancies consists of immunochemotherapy with rituximab, a CD20 monoclonal antibody, delivered in combination with multi-agent chemotherapy, which has been shown to increase responses by up to 20% in FL and DLBCL [3,4,5,6]
Summary
Over 12,000 new cases of B-cell malignancies are diagnosed in the UK each year, with diffuse large Bcell lymphoma (DLBCL) and follicular lymphoma (FL) being the most common subtypes. Standard frontline therapy for most B-cell malignancies consists of immunochemotherapy with rituximab, a CD20 monoclonal antibody (mAb), delivered in combination with multi-agent chemotherapy, which has been shown to increase responses by up to 20% in FL and DLBCL [3,4,5,6]. It is employed as a single agent in some indolent lymphomas [7]
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