A Study of Epcoritamab and Ibrutinib in People With Relapsed or Refractory Central Nervous System Lymphoma (CNSL)

Inclusion Criteria

• >/= 18 years of age on the day of consenting to the study
• Histologically documented diffuse large b cell lymphoma (DLBCL) at enrolling institution (biopsy or CSF samples in PCNSL; biopsy of CNS or non-CNS sample in SCNSL)
• Participants must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
• Absolute neutrophil count (ANC) ≥ 1 x 10^9/L
• Platelets ≥ 75 x 10^9/L and no platelet transfusion within the past 21 days prior to study consent
• Hemoglobin (Hgb) ≥ 8 g/dL and no red blood cell (RBC) transfusion within the past 21 days prior to study consent
• International Normalized Ratio (INR) ≤ 1.5 and PTT (aPTT) ≤ 1.5 times the upper limit of normal (unless receiving anticoagulation)
• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 times the upper limit of normal
• Serum bilirubin ≤ 1.5 times the upper limit of normal; or total bilirubin ≤ 3 times the upper limit of normal with direct bilirubin within the normal range in patients with well documented Gilbert Syndrome
• Creatinine clearance (CLCr) ≥ 30 ml/min (based on the following formular Creatinine clearance= ([140-age]*wt)/(creatinine*72); multiply by 0.85 for women)
• Women of reproductive potential must agree to use highly effective methods of birth control during the period of therapy and for 30 days after the last dose of the study drug. Men who are sexually active must agree to use highly effective contraception during the period of therapy and for 3 months after the last dose
• Female subjects of childbearing potential must have a negative serum pregnancy test upon study entry
• Patients must be able to tolerate MRI/CT scans
• Due to the nature of this disease, we will allow patients with impaired decision-making ability to enroll into all cohorts

Exclusion Criteria

• Newly diagnosed PCNSLs or SCNSLs and patients with non-CNS disease are excluded
• Patients with existing chronic moderate and severe hepatic impairment (Child-Pugh class B or C) are excluded
• Patient is concurrently using other approved or investigational antineoplastic agents
• Patient has an active concurrent malignancy requiring active therapy
• Patient has received chemotherapy, monoclonal antibodies or targeted anticancer therapy ≤ 4 weeks or 5 half-lives, whichever is shorter, or 6 weeks for nitrosourea or mitomycin-C prior to starting the study drug, or the patient has not recovered from the side effects of such therapy
• Patient has received external beam radiation therapy to the CNS within 21 days of the first dose of the study drug
• Patient requires more than 8 mg of dexamethasone daily or the equivalent
• Patient is using warfarin or any other warfarin-derivative anticoagulant or vitamin K antagonists. Patients must be off warfarin-derivative anticoagulants for at least seven days prior to starting the study drug. Low molecular weight heparin is allowed. Patients with congenital bleeding diathesis are excluded
• Subject has consumed grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges), or starfruit for at least 3 days prior to cycle 1 day 1
• Patient is taking a drug known to be a moderate or strong inhibitor or inducers of the P450 isoenzyme CYP3A. Participants must be off P450/CYP3A inhibitors and inducers for at least 5 half-lives or at least two weeks, whichever is shorter, prior to starting the study drug
• Patient is using systemic immunosuppressant therapy, including cyclosporine A, tacrolimus, sirolimus, and other such medications, or chronic administration of > 5 mg/day of prednisone or the equivalent (for more than 12 months). Participants must be off of immunosuppressant therapy for at least 28 days prior to the first dose of the study drug
• Patient has significant abnormalities on screening electrocardiogram (EKG) and active and significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure, hypertension, valvular disease, pericarditis, or myocardial infarction within 6 months of screening
• Patient has an ejection fraction of < 50%
• Patient has a known bleeding diathesis (e.g. von Willebrand’s disease) or hemophilia
• Patient is documented to have human immunodeficiency virus (HIV) infection
• Patient is documented to have a history of active or chronic infection with hepatitis C virus (HCV) or hepatitis B virus (HBV) as determined by serologic tests
• Patient is known to have an uncontrolled active systemic infection
• Patient is unable to swallow capsules or has a disease or condition significantly affecting gastrointestinal function, such as malabsorption syndrome, resection of the stomach or small bowel, or complete bowel obstruction
• Patient has a life-threatening illness, medical condition, or organ system dysfunction that, in the opinion of the investigator, could compromise the subject’s safety or put the study outcomes at undue risk
• Patient has not received vaccination with live vaccines within 28 days prior to first dose of study drug or is expected to need any live vaccination during study participation including at least 3 months following the last dose of study treatment. * Note: COVID-19 non-replicating adenoviral vaccines are permitted with a minimum period of 3 days between the vaccine and a dose of study drug. It is highly recommended that every patient enrolled onto this trial has updated vaccination status (e.g. flu, hepatitis, polio, pertussis, tetanus; when is doubt please contact the principal investigator (PI) or side-PI)
• Women who are pregnant or nursing (lactating), where pregnancy is defined as a state of a female after conception until the termination of gestation, confirmed by a positive serum Human Chorionic Gonadotropin (hCG) laboratory test of > 5 mIU/mL