Mosunetuzumab and Polatuzumab Vedotin for Relapsed/Refractory Follicular Lymphoma
This study is testing two medications, mosunetuzumab and polatuzumab vedotin, for patients with follicular lymphoma that has returned (relapsed) or hasn't responded to previous treatments (refractory). Mosunetuzumab is a type of antibody that may help stop cancer cells from growing. Polatuzumab vedotin is another antibody linked to a powerful drug, which helps it target and kill cancer cells more effectively. Researchers want to see if giving these two medications together can kill more cancer cells. The study aims to enroll 41 participants aged 18 and older. Success will be measured by how many patients have a complete response (meaning all signs of cancer disappear) and by tracking any side effects.
- Study design
- This is a phase II interventional study, meaning all participants will receive the study medications. It plans to enroll 41 participants.
- What's involved
- You would provide a tissue sample from a biopsy, undergo blood draws, and have CT or PET/CT scans and MRI scans. Treatment involves intravenous (IV) polatuzumab vedotin every 21 days for up to 6 cycles.
- Compensation
- Not stated in the trial record.
- Follow-up
- Your complete response will be measured for up to 36 months after your last dose of study treatment.
AI-generated from the public study record. Only the study team can confirm whether you're eligible — confirm details with them before making decisions.
NCT06453044
Mosunetuzumab and Polatuzumab Vedotin for the Treatment of Patients With Relapsed or Refractory Grade 1-3a Follicular Lymphoma
Recruiting
PHASE2Ages 18+InterventionalTreatmentCity of Hope Medical CenterInvestigator-initiated
~41 participants
Updated 2025-09-24 on ClinicalTrials.gov
What's tested:Biospecimen CollectionComputed TomographyMagnetic Resonance ImagingMosunetuzumabPolatuzumab VedotinPositron Emission Tomography
At a glance
Recruiting sites
1 of 2 listed sites are recruiting right now
RecruitingSuspended, closed, or not yet open
What they're measuring
Incidence of grade 3 or higher adverse events (AEs)
Measured over Up to completion of first 2 cycles of treatment - each cycle is 28 days
+1 more outcome measured
Conditions
Where it's being run
2 sites across 1 statesCalifornia2
Study leadership
- Matthew Mei, MD · PRINCIPAL_INVESTIGATOR · City of Hope Medical Center
Who to contact
Opens a ready-to-send draft in your own email app — review before sending.
Do you actually qualify for this trial?
Add a private profile and we'll compare every criterion below against your situation — and tell you which ones are met, uncertain, or excluding.
Eligibility criteria
Inclusion
Documented informed consent of the participant and/or legally authorized representative
Assent, when appropriate, will be obtained per institutional guidelines
Be willing to provide tissue from a fresh core or excisional biopsy (performed as standard of care) of a tumor lesion prior to starting study therapy or from diagnostic tumor biopsies
If unavailable, exceptions may be granted with study principal investigator (PI) approval
Age: ≥ 18 years
Eastern Cooperative Oncology Group (ECOG) ≤ 2
Histologically confirmed diagnosis of follicular lymphoma grade 1-3a according to the World Health Organization (WHO) classification. Note: A history of diffuse large B-cell lymphoma (DLBCL) and/or grade 3b follicular lymphoma is allowed (follicular large B-cell lymphoma in the WHO 5th classification of mature B-cell lymphoma) but these cannot be present at the time of study enrollment. Enrollment of any such cases on this study must receive prior approval by the study PI
Relapsed/ refractory disease after at least one prior line of therapy. Relapse must have been confirmed histologically
Tumor must be positive for CD20 by immunohistochemistry or flow cytometry after the most recent therapy. Note: As a pan-B marker, CD79B+ is nearly always present and is not a criterion for inclusion
Active disease requiring treatment per treating physician's decision
Radiographically measurable disease by Lugano criteria (e.g., one or more nodal sites of disease ≥ 1.5 cm and/or at least one extranodal site of disease ≥ 1.0 cm in longest dimension)
Fully recovered from the acute toxic effects (except alopecia) to ≤ grade 1 to prior anti-cancer therapy
WITHOUT BONE MARROW INVOLVEMENT BY LYMPHOMA: Absolute neutrophil count (ANC) ≥ 1,000/mm\^3. NOTE: Growth factor is not permitted within 7 days of ANC assessment unless cytopenia is secondary to disease involvement
WITH BONE MARROW INVOLVEMENT BY LYMPHOMA AND/OR DISEASE-RELATED NEUTROPENIAS: ANC ≥ 500/mm\^3. NOTE: Growth factor is not permitted within 7 days of ANC assessment unless cytopenia is secondary to disease involvement
WITHOUT BONE MARROW INVOLVEMENT BY LYMPHOMA: Platelets ≥ 75,000/mm\^3. NOTE: Platelet transfusions are not permitted within 7 days of platelet assessment unless cytopenia is secondary to disease involvement
WITH BONE MARROW INVOLVEMENT BY LYMPHOMA AND/OR DISEASE-RELATED CYTOPENIAS: Platelets ≥ 50,000/mm\^3. NOTE: Platelet transfusions are not permitted within 7 days of platelet assessment unless cytopenia is secondary to disease involvement
Hemoglobin ≥ 8 g/dL. NOTE: Red blood cell transfusions are not permitted within 7 days of hemoglobin assessment unless cytopenia is secondary to disease involvement
Total bilirubin ≤ 1.5 x upper limit of normal (ULN). If hepatic involvement by lymphoma, or Gilbert's disease: ≤ 3 x ULN
Aspartate aminotransferase (AST) ≤ 2.5 x ULN. If hepatic involvement by lymphoma: AST ≤ 5 x ULN
Alanine aminotransferase (ALT) ≤ 2.5 x ULN. If hepatic involvement by lymphoma: ALT ≤ 5 x ULN
Creatinine clearance of ≥ 40 mL/min per 24 hour urine test or the Cockcroft-Gault formula
IF NOT RECEIVING ANTICOAGULANTS: International normalized ratio (INR) OR prothrombin (PT) ≤ 1.5 x ULN
IF ON ANTICOAGULANT THERAPY: PT must be within therapeutic range of intended use of anticoagulants
IF NOT RECEIVING ANTICOAGULANTS: Activated partial thromboplastin time (aPTT) ≤ 1.5 x ULN
IF ON ANTICOAGULANT THERAPY: aPTT must be within therapeutic range of intended use of anticoagulants
WOMEN OF CHILDBEARING POTENTIAL (WOCBP): Negative urine or serum pregnancy test. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
Agreement by females of childbearing potential to abstain from heterosexual intercourse or use two adequate method of birth control, including at least 1 method with a failure rate of \< 1% per year, for at least 28 days prior to day 1 of cycle 1, during the treatment period (including periods of treatment interruption), until 3 months after the final dose mosunetuzumab, 3 months after the last dose of polatuzumab vedotin, and 3 months after the last dose of tocilizumab (if applicable). Women must refrain from donating eggs during this same period. Agreement by males to abstain from heterosexual intercourse or use a condom with female partners of childbearing potential or pregnant female partners during the treatment period and until 5 months after the last dose of polatuzumab vedotin, and 2 months after the last dose of tocilizumab (if applicable). Men must refrain from donating sperm during this same period
Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for \> 1 year (women only) with no identified cause other than menopause
Examples of contraceptive methods with a failure rate of \< 1% per year include bilateral tubal ligation, male sterilization, established proper use of hormonal contraceptives that inhibit ovulation, hormone releasing intrauterine devices, and copper intrauterine devices. The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or post-ovulation methods) and withdrawal are not acceptable methods of contraception
Exclusion
Prior treatment with mosunetuzumab or other CD20-directed bispecific antibodies. Prior exposure to 2 or less doses without evidence of resistance is allowed
Prior treatment with polatuzumab vedotin or with an antibody-drug conjugate containing monomethyl auristatin E (MMAE). Prior exposure to 2 or less doses without evidence of resistance is allowed
Allogeneic stem cell transplant within 2 years prior to day 1 of protocol therapy, requires immunosuppression, or has evidence of active-versus-host-disease
Patients who had an allogeneic transplant \> 2 years prior to day 1 of protocol therapy must additionally have been stable off immunosuppressive agents for ≥ 2 months
Autologous stem cell transplant within 100 days prior to day 1 of protocol therapy
Chimeric antigen receptor (CAR)-T therapy within 30 days prior to day 1 of protocol therapy
Prior use of any anti-lymphoma treatment with monoclonal antibody, radioimmunoconjugate or antineoplastic drug conjugate (ADC) within 4 weeks prior to day 1 of protocol therapy
Treatment with any chemotherapeutic agent, or treatment with any other anti-cancer agent (investigational or otherwise) within 4 weeks or 5 half-lives of the drug, whichever is shorter, prior to day 1 of protocol therapy
Treatment with radiotherapy within 2 weeks prior to day 1 of protocol therapy
If patients have received radiotherapy within 4 weeks prior to prior to day 1 of protocol therapy, patients must have at least one measurable lesion outside of the radiation field. Patients who have only one measurable lesion that was previously irradiated but subsequently progressed are eligible
Live vaccine within 30 days prior to day 1 of protocol therapy
Systemic immunosuppressive therapy (including, but not limited to, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor \[TNF\] agents) with the exception of corticosteroid treatment for lymphoma symptom control must be tapered down to ≤ 10 mg/day prednisone or equivalent 14 days prior to day 1 of protocol therapy. Exceptions are:
Inhaled or topical steroids
Use of mineralocorticoids for management of orthostatic hypotension
Use of physiologic doses of corticosteroids for management of adrenal insufficiency
Use of 4 or less pulsed doses of steroids (i.e. dexamethasone) for urgent stabilization of lymphoma or symptom management
Grade ≥ 2 peripheral neuropathy
History of severe allergic or anaphylactic reaction to humanized, chimeric or murine monoclonal antibodies (or recombinant antibody-related fusion proteins)
History of solid organ transplantation
History of progressive multifocal leukoencephalopathy (PML)
Known or suspected history of hemophagocytic lymphohistiocytosis (HLH)
Significant active pulmonary disease (e.g., bronchospasm and/or obstructive pulmonary disease)
Pneumonitis or interstitial lung disease requiring ongoing corticosteroid or immunosuppression and/or requirement for supplemental oxygen
Patients with any other history of pneumonitis or interstitial lung disease may be eligible after discussion with the study PI
Positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen or polymerase chain reaction (PCR) test within 7 days prior to day 1 of protocol therapy
Clinically significant uncontrolled illness
Known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of nail beds) at study enrollment or any major episode of infection requiring treatment with IV antibiotics or hospitalization (relating to the completion of the course of antibiotics) within 2 weeks prior to the first study treatment administration
Known active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Patients with past HBV infection (defined as negative hepatitis B surface antigen \[HBsAg\] and positive hepatitis B core antibody \[HBcAb\]) are eligible if HBV deoxyribonucleic acid (DNA) is undetectable. Patients who are positive for HCV antibody are eligible if PCR is negative for HCV ribonucleic acid (RNA). Testing to be done only in patients suspected of having infections or exposures
Known active human immunodeficiency virus (HIV) infection. Subjects who have an undetectable or unquantifiable HIV viral load with CD4 \> 200 and are on highly active antiretroviral therapy (HAART) medication are allowed. Testing to be done only in patients suspected of having infections or exposures
Known or suspected chronic active Epstein-Barr virus (EBV) infection
Known active central nervous system (CNS) involvement by lymphoma, including leptomeningeal involvement
Previously treated CNS involvement including disease with leptomeningeal involvement, is acceptable. Patients should be neurologically stable prior to study entry, and receiving a stable or decreasing corticosteroid dose
History of CNS disease which was symptomatic or required treatment in the past 1 year, such as stroke, epilepsy, CNS vasculitis or neurodegenerative disease
Symptomatic cardiac disease such as New York Heart Association class III or IV (including symptomatic ventricular dysfunction, symptomatic coronary artery disease, and symptomatic arrhythmias), cerebrovascular event/stroke or myocardial infarction within the past 6 months
Clinically significant history of liver disease, including viral or other hepatitis, or cirrhosis
Active autoimmune disease requiring systemic treatment
History of autoimmune disease, including, but not limited to, myasthenia gravis, myositis, autoimmune hepatitis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener granulomatosis, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis
Patients with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone may be eligible
Patients with controlled type 1 diabetes mellitus who are on an insulin regimen are eligible for the study
Patients with a history of rheumatoid arthritis, Sjögren syndrome, systemic lupus erythematosus may be eligible after discussion with the study PI
Patients with a history of disease-related immune thrombocytopenic purpura, autoimmune hemolytic anemia, or other stable autoimmune diseases may be eligible after discussion with the study PI
Recent major surgery (within 4 weeks) prior to start of protocol therapy, other than for diagnosis
History of another primary malignancy that has not been in remission for at least 2 years, with the following exceptions:
Adequately treated non-melanoma skin cancer or lentigo maligna (melanoma in situ) without evidence of disease
Adequately treated in situ carcinomas (e.g. cervical, esophageal) without evidence of disease
Asymptomatic prostate cancer managed with a watch-and-wait strategy
If the malignancy is expected to not require any treatment for at least 2 years (this exception should be discussed with the study PI)
Concomitant investigational therapeutic therapy or within 7 days prior to initiation of study treatment
FEMALES ONLY: Pregnant or breastfeeding
Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures
Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)
What this trial measures
- Incidence of grade 3 or higher adverse events (AEs)Up to completion of first 2 cycles of treatment - each cycle is 28 days
Unacceptable toxicity will be defined as events occurring during the first 2 cycles of treatment that is at least possibly related to study treatment. Observed toxicities will be summarized by type, severity, and attribution.
- Complete response (CR) rateUp to 36 months after last dose of protocol therapy
CR rate will be defined as the proportion of response-evaluable participants that achieve a best response of CR after the start of protocol therapy and prior to disease progression and/or start of other anti-lymphoma therapy. CR rate will be estimated along with the 95% exact binomial confidence interval.