Lenalidomide and Melphalan in Treating Patients With Previously Untreated Multiple Myeloma
RATIONALE: Lenalidomide may stop the growth of multiple myeloma by blocking blood flow to the cancer. It may also stimulate the immune system in different ways and stop cancer cells from growing. Drugs used in chemotherapy, such as melphalan, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving lenalidomide together with melphalan may kill more cancer cells.
PURPOSE: This randomized phase II trial is studying the side effects and best dose of lenalidomide when given together with melphalan and to see how well they work in treating patients with multiple myeloma.
Multiple Myeloma and Plasma Cell Neoplasm
|Study Design:||Allocation: Randomized
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Randomized Phase II Dose Finding Study of Revlimid™ and Melphalan in Patients With Previously Untreated Multiple Myeloma|
- Incidence of dose-limiting toxicity within first 3 courses of treatment [ Designated as safety issue: Yes ]
- Toxicity [ Designated as safety issue: Yes ]
- Disease response after 2 courses, 6 courses, 12 courses, and 6 months of maintenance therapy [ Designated as safety issue: No ]
- Time to progression [ Designated as safety issue: No ]
- Overall survival [ Designated as safety issue: No ]
- Duration of disease-free interval [ Designated as safety issue: No ]
- Time to dose modification [ Designated as safety issue: No ]
- Time to dose discontinuation [ Designated as safety issue: No ]
|Study Start Date:||December 2005|
|Study Completion Date:||June 2008|
- Evaluate the tolerability of 2 different doses of lenalidomide when administered with melphalan in patients with previously untreated multiple myeloma who are not planning to undergo future autologous stem cell transplantation.
- Characterize the toxicity profile of lenalidomide in combination with melphalan.
- Determine tumor response in these patients after 2 and 12 courses of induction therapy with lenalidomide and melphalan and after 6 months of maintenance therapy with dexamethasone.
- Determine progression-free and overall survival of these patients.
- Determine time to dose modification and time to dose discontinuation in these patients.
- Examine wnt pathway inhibition in response to lenalidomide on pre- and post-treatment bone marrow and blood samples using enzyme-linked immunosorbent assay (ELISA), gene expression profiling, drosophila-based chemical genetics, and surface-enhanced laser desorption/ionization mass spectrometry (SELDI MS) proteomics.
OUTLINE: This is a multicenter, randomized, open-label, dose-finding study of lenalidomide.
Prior to randomization, 6 patients receive oral lenalidomide at a lower dose (same dose to be used in arm I) once daily on days 1-21 and oral melphalan once daily on days 1-4. Treatment repeats every 28 days for 3 courses. If no unacceptable toxicity occurs, the trial will proceed and randomization will occur.
Induction therapy: Patients are randomized to 1 of 2 dose levels of lenalidomide.
- Arm I: Patients receive oral lenalidomide once daily on days 1-21 and oral melphalan once daily on days 1-4.
- Arm II: Patients receive oral lenalidomide as in arm I, but at a lower dose, and melphalan as in arm I, but at a higher dose.
Treatment in both arms repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. After 12 courses of induction therapy, patients in both arms without progressive disease proceed to maintenance therapy.
- Maintenance therapy: Patients receive oral dexamethasone once daily on days 1-4. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed at 4 weeks and then every 2 months thereafter.
PROJECTED ACCRUAL: A total of 92 patients will be accrued for this study.
|Tom Baker Cancer Centre - Calgary|
|Calgary, Alberta, Canada, T2N 4N2|
|Cross Cancer Institute at University of Alberta|
|Edmonton, Alberta, Canada, T6G 1Z2|
|Canada, British Columbia|
|British Columbia Cancer Agency - Centre for the Southern Interior|
|Kelowna, British Columbia, Canada, V1Y 5L3|
|Canada, New Brunswick|
|Moncton, New Brunswick, Canada, E1C 6Z8|
|Canada, Nova Scotia|
|Nova Scotia Cancer Centre|
|Halifax, Nova Scotia, Canada, B3H 1V7|
|Margaret and Charles Juravinski Cancer Centre|
|Hamilton, Ontario, Canada, L8V 5C2|
|London Regional Cancer Program at London Health Sciences Centre|
|London, Ontario, Canada, N6A 4L6|
|Algoma District Cancer Program at Sault Area Hospital|
|Sault Ste. Marie, Ontario, Canada, P6A 2C4|
|Humber River Regional Hospital - Weston|
|Toronto, Ontario, Canada, M9N 1N8|
|Princess Margaret Hospital|
|Toronto, Ontario, Canada, M5G 2M9|
|Hopital Charles Lemoyne|
|Greenfield Park, Quebec, Canada, J4V 2H1|
|Hopital Notre-Dame du CHUM|
|Montreal, Quebec, Canada, H2L 4M1|
|McGill Cancer Centre at McGill University|
|Montreal, Quebec, Canada, H2W 1S6|
|Allan Blair Cancer Centre at Pasqua Hospital|
|Regina, Saskatchewan, Canada, S4T 7T1|
|Study Chair:||Darrell White, MD||Nova Scotia Cancer Centre|