Testing the Safety of Anti-Cancer Drug, CX-5461 (Pidnarulex), in Treating Lymphoma With Specific Changes in the MYC Gene

Launched by NATIONAL CANCER INSTITUTE (NCI) · Jul 16, 2025

Keywords

ClinConnect Summary

This clinical trial is studying a new anti-cancer drug called CX-5461 (Pidnarulex) to see if it is safe and effective for treating certain types of aggressive lymphoma, which is a cancer of the lymphatic system. Specifically, it focuses on patients with forms of lymphoma that involve changes in a gene called MYC, including Burkitt lymphoma and other high-grade B-cell lymphomas. The drug works by blocking enzymes that cancer cells need to grow, and this early-phase trial aims to find the best dose, check for side effects, and see how well the treatment works.

Patients who might be eligible are adults (18 years or older) who have one of these lymphoma types and have already tried at least one treatment that did not cure their cancer or stop it from growing. Participants should be in relatively good health aside from their lymphoma and must agree to use birth control during the study and for some time after, as the effects of the drug on unborn babies are unknown. During the trial, patients will receive CX-5461 and have regular check-ups to monitor their health, side effects, and how their lymphoma responds to the drug. It’s important to note that this study is not yet recruiting, and people who are pregnant, breastfeeding, or taking certain medications may not be eligible.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Patients must have one of the following subtypes of aggressive B-cell non-Hodgkin lymphomas: double-expressor lymphoma (DEL), high-grade B-cell lymphoma (HGBL) with MYC and BCL2 and/or BCL6 rearrangement, or Burkitt lymphoma (BL). Eligible patients must have received at least one prior line of treatment and must have disease for which no standard curative or palliative treatment options exist or remain effective
• • Age ≥ 18 years. Because no dosing or adverse event (AE) data are currently available on the use of CX-5461 (Pidnarulex) in patients \< 18 years of age, children are excluded from this study
• • Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (Karnofsky ≥ 60%). ECOG 3 is allowed if directly related to lymphoma per treating provider
• • Absolute neutrophil count ≥ 1,000/mcL
• • Platelets ≥ 50,000/mcL
• • Total bilirubin ≤ 1.5 institutional upper limit of normal (ULN)
• • Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase \[SGOT\])/ alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase \[SGPT\]) ≤ 3 × institutional upper limit of normal (ULN)
• • Glomerular filtration rate (GFR) ≥ 60 mL/min/1.73 m\^2
• • Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial
• • For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
• • Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
• • Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
• • Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class II or better
• • Patients with cytopenia related to abnormal bone marrow function in the setting of bone marrow involvement with lymphoma or post chimeric antigen receptor (CAR) T-cell are allowed to enroll if deemed safe by treating provider
• • Patients without clinical evidence of central nervous system (CNS) lymphoma
• • The effects of CX-5461 (Pidnarulex) on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) 14 days prior to study entry and for the duration of study participation and for at least 6 months after the last dose of study drug. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Women should not breastfeed while taking CX-5461 (Pidnarulex) and for 6 months after cessation of treatment. Men treated or enrolled on this protocol must also agree to use adequate contraception 14 days prior to the study, for the duration of study participation, and 6 months after completion of CX-5461 (Pidnarulex) administration. Women of childbearing age should not donate egg(s) and men should not donate sperm for the duration of study participation and 6 months after completion of the last dose CX-5461 (Pidnarulex)
• • Willingness to provide blood and biopsy samples for research purposes
• • Ability to understand and the willingness to sign a written informed consent document
• Exclusion Criteria:
• • Patients must have recovered from clinically significant adverse events (AEs) of their most recent cancer immunotherapy to grade 1 or less (with the exception for alopecia or lymphopenia)
• • Eligibility of subjects receiving any medications or substances known to affect or with the potential to affect the activity of CX-5461 (Pidnarulex) will be determined based on their potential to interact with the CYP3A4 isozyme. Specifically, subjects taking strong CYP3A4 inhibitors or strong CYP3A4 inducers will be excluded from participation in the trial. For medications or substances not listed, or in cases of uncertainty, the Principal Investigator may consult with a medical expert or a pharmacologist to make an informed decision regarding eligibility
• • Patients who are receiving any other investigational agents
• • History of allergic reactions attributed to compounds of similar chemical or biologic composition to CX-5461 (Pidnarulex)
• • Patients with uncontrolled intercurrent illness or any other significant condition(s) that would make participation in this protocol unreasonably hazardous
• • Pregnant women are excluded from this study because CX-5461 (Pidnarulex) is an agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for AEs in nursing infants secondary to treatment of the mother with CX-5461 (Pidnarulex), breastfeeding should be discontinued if the mother is treated with CX-5461 (Pidnarulex)