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Efficacy, pharmacokinetics, and safety of the biosimilar CT-P10 in comparison with rituximab in patients with previously untreated low-tumour-burden follicular lymphoma: a randomised, double-blind, parallel-group, phase 3 trial
M. Ogura, JM. Sancho, SG. Cho, H. Nakazawa, J. Suzumiya, G. Tumyan, JS. Kim, A. Lennard, J. Mariz, N. Ilyin, W. Jurczak, A. Lopez Martinez, O. Samoilova, E. Zhavrid, E. Yañez Ruiz, M. Trneny, L. Popplewell, B. Coiffier, C. Buske, WS. Kim, SJ....
Language English Country England, Great Britain
Document type Clinical Trial, Phase III, Comparative Study, Journal Article, Randomized Controlled Trial
- MeSH
- Safety * MeSH
- Biosimilar Pharmaceuticals adverse effects pharmacokinetics pharmacology therapeutic use MeSH
- Double-Blind Method MeSH
- Lymphoma, Follicular drug therapy metabolism pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Antibodies, Monoclonal, Murine-Derived adverse effects pharmacokinetics pharmacology therapeutic use MeSH
- Disease-Free Survival MeSH
- Rituximab adverse effects pharmacokinetics pharmacology therapeutic use MeSH
- Tumor Burden * drug effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase III MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
BACKGROUND: Studies in patients with rheumatoid arthritis and advanced follicular lymphoma have shown that CT-P10, a rituximab biosimilar, has equivalent or non-inferior efficacy and pharmacokinetics to rituximab. We aimed to assess the therapeutic equivalence of single-agent CT-P10 and rituximab in patients with newly diagnosed low-tumour burden follicular lymphoma. METHODS: In this ongoing, randomised, double-blind, parallel-group, active-controlled, phase 3 trial, adult patients (≥18 years) with stage II-IV low-tumour-burden follicular lymphoma were randomly assigned (1:1) using an interactive web or voice response system stratified by region, stage, and age to CT-P10 or US-sourced rituximab. Patients received CT-P10 or rituximab (375 mg/m2 intravenous) on day 1 of four 7-day cycles (induction period). Patients who had disease control after the induction period continued to a maintenance period of CT-P10 or rituximab administered every 8 weeks for six cycles and, if completed, a second year of maintenance therapy of additional CT-P10 (every 8 weeks for six cycles) was offered. The study was partially unmasked after database lock (Feb 23, 2018) for all data up to 7 months (before cycle 3 of the maintenance period). The primary endpoint was the proportion of patients who achieved an overall response by 7 months in the intention-to-treat population. Efficacy equivalence was shown if the two-sided 90% CIs for the treatment difference in the proportion of responders between CT-P10 and rituximab was within the equivalence margin of 17%. This trial is registered with ClinicalTrials.gov, number NCT02260804. FINDINGS: Between Nov 9, 2015, and Jan 4, 2018, 402 patients were assessed for eligibility, of whom 258 were randomly assigned: 130 to CT-P10 and 128 to rituximab. 108 (83%) of 130 patients assigned to CT-P10 and 104 (81%) of 128 assigned to rituximab achieved an overall response by month 7 (treatment difference estimate 1·8%; 90% CI -6·43 to 10·20). Therapeutic equivalence was shown (90% CIs were within the prespecified margin of 17%). The most common grade 3 or 4 treatment-emergent adverse events were decreased neutrophil count (two grade 3 in the CT-P10 group) and neutropenia (one in each group); all other grade 3 or 4 treatment-emergent adverse events occurred in one patient each. Six (5%) of 130 patients who received CT-P10 and three (2%) of 128 who received rituximab experienced at least one treatment-emergent serious adverse event. INTERPRETATION: CT-P10 was equivalent to rituximab in terms of efficacy and was well tolerated. CT-P10 monotherapy is suggested as a new therapeutic option for patients with low-tumour-burden follicular lymphoma. FUNDING: Celltrion, Inc.
Celltrion Inc Incheon South Korea
Comprehensive Cancer Center Ulm University Hospital of Ulm Ulm Germany
Department of Haematology and Oncology Kasugai Municipal Hospital Kasugai Japan
Department of Haematology Jagiellonian University Kraków Poland
Department of Hematology Hospices Civils de Lyon Lyon France
Department of Hematology Hospital Arnau de Vilanova Valencia Spain
Department of Hematology Nizhniy Novgorod Region Clinical Hospital Nizhniy Novgorod Russia
Department of Hematology Shinshu University School of Medicine Matsumoto Japan
Department of Internal Medicine Universidad de la Frontera Temuco Chile
Department of Medicine Charles University General Hospital Prague Prague Czech Republic
Department of Onco Hematology Portuguese Institute of Oncology Porto Portugal
Northern Institute for Cancer Care Newcastle University Newcastle upon Tyne UK
School of Medicine Fujita Medical University Toyoake Japan
Shimane University Hospital Innovative Cancer Center Oncology Hematology Izumo Japan
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- $a Ogura, Michinori $u Department of Haematology and Oncology, Kasugai Municipal Hospital, Kasugai, Japan; School of Medicine, Fujita Medical University, Toyoake, Japan.
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- $a BACKGROUND: Studies in patients with rheumatoid arthritis and advanced follicular lymphoma have shown that CT-P10, a rituximab biosimilar, has equivalent or non-inferior efficacy and pharmacokinetics to rituximab. We aimed to assess the therapeutic equivalence of single-agent CT-P10 and rituximab in patients with newly diagnosed low-tumour burden follicular lymphoma. METHODS: In this ongoing, randomised, double-blind, parallel-group, active-controlled, phase 3 trial, adult patients (≥18 years) with stage II-IV low-tumour-burden follicular lymphoma were randomly assigned (1:1) using an interactive web or voice response system stratified by region, stage, and age to CT-P10 or US-sourced rituximab. Patients received CT-P10 or rituximab (375 mg/m2 intravenous) on day 1 of four 7-day cycles (induction period). Patients who had disease control after the induction period continued to a maintenance period of CT-P10 or rituximab administered every 8 weeks for six cycles and, if completed, a second year of maintenance therapy of additional CT-P10 (every 8 weeks for six cycles) was offered. The study was partially unmasked after database lock (Feb 23, 2018) for all data up to 7 months (before cycle 3 of the maintenance period). The primary endpoint was the proportion of patients who achieved an overall response by 7 months in the intention-to-treat population. Efficacy equivalence was shown if the two-sided 90% CIs for the treatment difference in the proportion of responders between CT-P10 and rituximab was within the equivalence margin of 17%. This trial is registered with ClinicalTrials.gov, number NCT02260804. FINDINGS: Between Nov 9, 2015, and Jan 4, 2018, 402 patients were assessed for eligibility, of whom 258 were randomly assigned: 130 to CT-P10 and 128 to rituximab. 108 (83%) of 130 patients assigned to CT-P10 and 104 (81%) of 128 assigned to rituximab achieved an overall response by month 7 (treatment difference estimate 1·8%; 90% CI -6·43 to 10·20). Therapeutic equivalence was shown (90% CIs were within the prespecified margin of 17%). The most common grade 3 or 4 treatment-emergent adverse events were decreased neutrophil count (two grade 3 in the CT-P10 group) and neutropenia (one in each group); all other grade 3 or 4 treatment-emergent adverse events occurred in one patient each. Six (5%) of 130 patients who received CT-P10 and three (2%) of 128 who received rituximab experienced at least one treatment-emergent serious adverse event. INTERPRETATION: CT-P10 was equivalent to rituximab in terms of efficacy and was well tolerated. CT-P10 monotherapy is suggested as a new therapeutic option for patients with low-tumour-burden follicular lymphoma. FUNDING: Celltrion, Inc.
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- $a Sancho, Juan Manuel $u Hematology Department, The Catalan Institute of Oncology-The Josep Carreras Leukaemia Research Institute, Hospital Germans Trias i Pujol, Badalona, Spain.
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