Copanlisib and Ibrutinib in Treating Patients with Recurrent or Refractory Mantle Cell Lymphoma

Inclusion Criteria

• Patient is able and willing to adhere to the study visit schedule and other protocol requirements.
• Patient has histologically confirmed diagnosis of relapsed/refractory (R/R) mantle cell lymphoma who has received at least 1 line of therapy.
• Autologous stem cell transplant recipients must have adequate bone marrow recovery and transfusion independent.
• Patients may have been previously treated with Bruton's tyrosine kinase (BTK) or phosphoinositide 3-kinase inhibitor (PI3K) inhibitors: * If BTK/PI3K inhibitors were part of their last treatment, patients must have had a best response of stable disease or better.
• Patient has at least one measurable lesion (>= 2 cm) according to Response Evaluation Criteria in Lymphoma (RECIL) criteria.
• Patient has an Eastern Cooperative Oncology Group (ECOG) performance status =< 2.
• Absolute neutrophil count (ANC) >= 1 x 10^9/L, independent of growth factor support for 14 days unless there is bone marrow involvement. For patients with bone marrow involvement, ANC >= 500/uL independent of growth factor support for 14 days.
• Platelets >= 100 x 10^9/L, or >= 50 x 10^9/L if bone marrow involvement and independent of transfusion support for 14 days in either situation.
• Hemoglobin (Hgb) >= 9.0 g/dL (no red blood cell [RBC] transfusion within past 14 days).
• International normalized ratio (INR) =< 1.5
• Serum Creatinine =< 1.5 x upper limit of normal (ULN) or creatinine clearance >= 25 mL/min as determined by the Cockcroft-Gault equation or a 24 hour urine collection.
• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< ULN (or =< 3 x ULN if liver involved with disease).
• Total serum bilirubin =< ULN (or =< 1.5 x ULN if documented hepatic involvement; or total bilirubin =< 3 x ULN with direct bilirubin =< 1.5 x ULN in patients with documented Gilbert’s syndrome).
• Lipase =< 1.5 x ULN.
• Left ventricular ejection fraction (LVEF) >= 50%.
• Hemoglobin A1c =< 8.5%.

Exclusion Criteria

• Patient has a history of non-compliance to medical regimen or inability to grant consent.
• Patient is concurrently using other approved or investigational antineoplastic agent with the exception of BTK or PI3K inhibitors in patients who had these agents as the last line of treatment * Patients on BTK or PI3K inhibitors will be continued on therapy as they transition to protocol therapy.
• Patient has not recovered to grade 1 or better (except alopecia) from related side effects of any prior antineoplastic therapy.
• Patient has had major surgery or a wound that has not fully healed within 4 weeks of starting study drugs.
• Patients who have had chemotherapy or radiotherapy within 2 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 2 weeks earlier.
• Patients who have undergone an allogenic hematopoietic stem cell transplant.
• Patient has active or history of central nervous system (CNS) disease or meningeal involvement.
• Patient has history of clinically significant interstitial lung disease and/or lung disease that severely impairs lung function (as judged by the investigator).
• Patient has history of stroke or intracranial hemorrhage =< 6 months from starting study drugs.
• Patient has impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of study drug (e.g., ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection).
• Patient has clinically significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of screening, or any class 3 (moderate) or class 4 (severe) cardiac disease as defined by the New York Heart Association Functional Classification, left ventricular ejection fraction (LVEF) < 50% as determined by multiple gated acquisition (MUGA) scan or echocardiogram (ECHO), unstable angina pectoris, symptomatic pericarditis, corrected QT interval by Fridericia's correction formula (QTcF) > 480 msec on the screening electrocardiography (ECG) (using the QTcF formula).
• Patient has a concurrent active malignancy. Malignancies treated with a curative intent with an expected life expectancy >= 5 years or a non-competing life expectancy risk are eligible (i.e. adequately treated basal or squamous cell carcinoma, non-melanomatous skin cancer, early stage breast cancer, treated prostate cancer or any other cancer from which the patient has been disease free for >= 3 years).
• Patient with known history of human immunodeficiency virus (HIV), or any uncontrolled active systemic infection.
• Patient has cytomegalovirus (CMV) viremia (peripheral blood CMV polymerase chain reaction [PCR] positive), acute viral hepatitis (typically defined by elevated AST/ALT), or a history of chronic or active hepatitis B virus [HBV] or hepatitis C virus [HCV] infection. HBV infection is defined as having hepatitis B serum antigen (HBsAg) and/or hepatitis B core antibody (HBcAb) positive test with concurrent detectable HBV DNA levels. HCV infection is defined as detectable HCV RNA levels.
• Patient requires treatment with a strong or moderate cytochrome P450 (CYP) 3A4 inhibitors, and inducers, and the treatment cannot be discontinued or switched to a different medication prior to starting study drug. Moderate and strong CYP modulators (inducers and inhibitors) should have a washout period of at least 5-6 half-lives before initiating ibrutinib or copanlisib.
• Patients with known bleeding diathesis (e.g. von Willebrand ‘s disease) or hemophilia.
• Patient is currently receiving warfarin or other vitamin K antagonist. Therapy with heparin, low molecular weight heparin (LMWH), or fondaparinux is allowed.
• Patients with Child Pugh class B or C hepatic cirrhosis.
• Patients with any life threatening illness, medical condition or organ system dysfunction that in the opinion of the investigator could compromise the subject’s safety, interfere with absorption of metabolism of study drugs or put the study outcomes at undue risk.