AZD2014 Plus Novel Anti-Cancer Agents in Relapsed or Refractory Diffuse Large B-Cell Lymphoma

This is a modular, Phase I/IIa, open-label, multicentre study of AZD2014, administered orally, in combination with up to 2 novel anti-cancer agents, to patients with different subtypes of relapsed or refractory DLBCL. Module 1 will assess the combination of AZD2014 and ibrutinib in patients with non-GCB DLBCL and will consist of 2 parts. Part A will be a Phase I dose-finding study in which the safety and tolerability of the combination will be assessed. Part B will be a Phase IIa single-arm dose-expansion phase to assess the efficacy of the combination. Part A will follow a Continuous Reassessment Method (CRM) based on a Bayesian Adaptive Design to identify the AZD2014/ibrutinib dose combinations where the incidence of dose-limiting toxicity (DLT) is less than 33% during the first cycle. It is anticipated that approximately 30 evaluable patients with non-GCB DLBCL who are not eligible for stem cell transplant may be enrolled. The total number of patients, however, will depend upon the number of cohorts necessary to establish a tolerated combination dose. Determination of tolerated doses will be primarily based on the DLTs seen in Cycle 1. Each cycle will be 28 days. Part A will also include an assessment of single- and multiple-dose pharmacokinetics of the combination of AZD2014 and ibrutinib. In Part B approximately 50 evaluable patients with non-GCB DLBCL will be enrolled. Patients will receive AZD2014 and ibrutinib at the doses established in Part A in 28-day cycles until there is unacceptable toxicity, disease progression, or the patient withdraws consent. Assessment for response or progressive disease will occur after Cycle 3 and every 3 cycles through the first year, and then every 6 cycles (6 months) thereafter. In Part B, predictive power monitoring will be used, which could result in stopping Part B for futility. An administrative interim analysis of overall response rate will be conducted thereafter for internal decision making, and the primary analysis will be conducted following data analysis at the primary data cut-off date. The criteria for success will be based on a confidence interval (CI) approach. Part B will also include an assessment of the impact of repeat intermittent treatment of AZD2014 at the MTD on the pharmacokinetics (PK) of ibrutinib in a sub-group of 9 patients (Part B1). The remaining 41 patients (Part B2) will have sparse PK sampling. In order to be eligible for Module 1 participants must have pathologically confirmed DLBCL of non-GCB subtype. Participants meeting any of the following criteria may not be enrolled in Module 1: 1. Previous treatment with a Bruton's tyrosine kinase (BTK) inhibitor and/or mammalian target of rapamycin (mTOR) pathway inhibitors. 2. History of severe allergic or anaphylactic reactions to kinase inhibitors or history of hypersensitivity to active or inactive excipients of ibrutinib or drugs with a similar chemical structure or class to ibrutinib. 3. Recent infection requiring systemic treatment that was completed within 14 days prior to the first dose of study drug.