Resumen del Estudio
Este estudio clínico de fase avanzada está diseñado para pacientes con Leucemia Linfocítica Crónica (LLC) o Linfoma Linfocítico Pequeño (LLP) cuya enfermedad ha regresado (recaída) o no ha respondido a tratamientos previos (refractaria). El objetivo principal es comparar una nueva combinación de medicamentos totalmente orales (Nemtabrutinib y Venetoclax) frente al tratamiento estándar actual que incluye infusiones intravenosas (Venetoclax y Rituximab). Los investigadores evaluarán si la combinación de Nemtabrutinib (un inhibidor de BTK de nueva generación) junto con Venetoclax es capaz de mantener la enfermedad controlada por más tiempo y con seguridad aceptable en comparación con la terapia habitual. Es una oportunidad relevante para pacientes que buscan alternativas terapéuticas de segunda línea.
Criterios de Elegibilidad
Resumen de Elegibilidad:Pueden participar adultos con diagnóstico confirmado de LLC/LLP que hayan recibido al menos una terapia previa y presenten recaída o enfermedad refractaria. Se permiten pacientes con Hepatitis B o C controlada (carga viral indetectable). No pueden participar quienes tengan transformación de Richter, afectación del sistema nervioso central, infecciones activas graves, o hayan recibido inhibidores de BCL-2 en los últimos 12 meses.
- Confirmed diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and active disease clearly documented to initiate therapy
- Deletion (Del) (17p) status, tumor protein 53 (TP53) mutation status, and immunoglobulin heavy chain gene (IGHV) mutation status results required before randomization for Part 2 participants only
- Relapsed or refractory to at least 1 prior available therapy
- Have at least 1 marker of disease burden
- Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2 within 7 days before randomization
- Has a life expectancy of at least 3 months
- Has the ability to swallow and retain oral medication
- Participants who are hepatitis B surface antigen (HBsAg) positive are eligible if they have received hepatitis B virus (HBV) antiviral therapy for at least 4 weeks and have undetectable HBV deoxyribonucleic acid (DNA) viral load before randomization
- Participants with history of hepatitis C virus (HCV) infection are eligible if HCV ribonucleic acid (RNA) viral load is undetectable at screening
- Participants with human immunodeficiency virus (HIV) who meet ALL eligibility criteria
- Participants with adequate organ function with specimens collected within 7 days before the start of study intervention
- If capable of producing sperm, participant agrees to eliminate Nemtabrutinib: 12 days, Venetoclax: 1 month (30 days), Rituximab (rituximab biosimilar): not applicable; abstains from penile-vaginal intercourse as their preferred and usual lifestyle; OR uses prescribed contraception
- Participant assigned female sex at birth are eligible to participate if not pregnant or breastfeeding and are not a person of childbearing potential (POCBP) OR is a POCBP and uses a contraceptive method that is highly effective, has a negative highly sensitive pregnancy test, and abstains from breastfeeding
- Has an active hepatitis B virus/ hepatitis C virus (HBV/HCV) infection
- Has gastrointestinal (GI) dysfunction that may affect drug absorption
- Has a known additional malignancy that is progressing or has required active treatment within the past 2 years
- Has diagnosis of Richter Transformation or active central nervous system (CNS) involvement by CLL/SLL
- Has an active infection requiring systemic therapy, such as intravenous (IV) antibiotics, during screening
- HIV-infected participants with a history of Kaposi's sarcoma and/or Multicentric Castleman's Disease and/or acquired immune deficiency syndrome (AIDS)-defining opportunistic infection in the past 12 months before screening
- Clinically significant cardiovascular disease
- Has a known allergy/sensitivity to nemtabrutinib or contraindication to venetoclax/rituximab (or rituximab biosimilar), or any of the excipients
- Has history of severe bleeding disorders (eg, hemophilia)
- Has received prior systemic anticancer therapy within 5 half-lives or 4 weeks (if prior therapy was a monoclonal antibody) before randomization
- Has received prior B-cell lymphoma 2 inhibitor(s) (BCL2i) within ≤ 12 months before randomization or has received prior radiotherapy within 2 weeks of start of study intervention, or radiation related toxicities, requiring corticosteroids
- Is currently being treated with p-glycoprotein (P-gp) substrates with a narrow therapeutic index, cytochrome P450 3A (CYP3A) strong or moderate inducers or CYP3A strong inhibitors.
- Has received a live or live attenuated vaccine within 30 days before the first dose of study intervention
- Has received an investigational agent or has used an investigational device within 4 weeks before study intervention administration
- Has a known psychiatric or substance use disorder that would interfere with the participant's ability to cooperate with the requirements of the study
- Participants who have not adequately recovered from major surgery or have ongoing surgical complications