Denosumab Compared to Zoledronic Acid in the Treatment of Bone Disease in Patients With Multiple Myeloma

Study Description

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Brief Summary:

The purpose of this study is to determine if denosumab is non-inferior to zoledronic acid in the treatment of bone disease from multiple myeloma.

Condition or disease	Intervention/treatment	Phase
Cancer; Hematologic Malignancies; Multiple Myeloma; Oncology; Bone Metastases; Multiple Myeloma Bone Lesions	Drug: Denosumab; Drug: Zoledronic acid; Drug: Placebo to Denosumab; Drug: Placebo to zoledronic acid	Phase 3

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	1718 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose:	Supportive Care
Official Title:	A Randomized, Double-Blind, Multicenter Study of Denosumab Compared With Zoledronic Acid in the Treatment of Bone Disease in Subjects With Newly Diagnosed Multiple Myeloma
Actual Study Start Date :	May 17, 2012
Actual Primary Completion Date :	July 19, 2016
Estimated Study Completion Date :	February 1, 2019

Arms and Interventions

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Arm	Intervention/treatment
Active Comparator: Zoledronic acid; Participants received zoledronic acid 4 mg intravenously plus placebo to denosumab subcutaneous injection once every 4 weeks until the required number of events was reached.	Drug: Zoledronic acid; Administered by intravenous infusion over 15 minutes once every 4 weeks; Other Name: Zometa® Drug: Placebo to Denosumab; Administered by subcutaneous injection once every 4 weeks.
Experimental: Denosumab; Participants received denosumab 120 mg subcutaneous injection and placebo to zoledronic acid intravenously once every 4 weeks until the required number of events was reached.	Drug: Denosumab; Administered by subcutaneous injection once every 4 weeks.; Other Names: XGEVA®; AMG 162 Drug: Placebo to zoledronic acid; Administered by intravenous infusion over 15 minutes once every 4 weeks

Outcome Measures

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Primary Outcome Measures :

1. Time to First On-study Skeletal Related Event [ Time Frame: From randomization until the data cut-off date of 19 July 2016; median time on study was 17.6 and 17.3 months in each treatment group respectively. ]
   A skeletal-related event (SRE) is defined as one of the following: pathologic fracture (vertebral or non-vertebral), radiation therapy to bone (including the use of radioisotopes), surgery to bone, or spinal cord compression. Time to first on-study SRE is defined as the time interval (in days) from the randomization date to the date of first occurrence of on-study SRE. If there was no known event, and the participant was monitored for any one of the four SRE components, time to first on-study SRE was censored at the end of the treatment phase date or the primary analysis data cut-off date, whichever came first.
2. Percentage of Participants With an On-study Skeletal Related Event [ Time Frame: From randomization until the data cut-off date of 19 July 2016; median time on study was 17.6 and 17.3 months in each treatment group respectively. ]
   A skeletal-related event (SRE) is defined as one of the following: pathologic fracture (vertebral or non-vertebral), radiation therapy to bone (including the use of radioisotopes), surgery to bone, or spinal cord compression.
3. Kaplan-Meier Estimate of Percentage of Participants With an On-study Skeletal Related Event [ Time Frame: From randomization until the data cut-off date of 19 July 2016; median time on study was 17.6 and 17.3 months in each treatment group respectively. The Kaplan-Meier estimate at weeks 25, 49 and 109 is reported. ]
   A skeletal-related event (SRE) is defined as one of the following: pathologic fracture (vertebral or non-vertebral), radiation therapy to bone (including the use of radioisotopes), surgery to bone, or spinal cord compression.

Secondary Outcome Measures :

1. Time to First On-study Skeletal Related Event - Superiority Analysis [ Time Frame: From randomization until the data cut-off date of 19 July 2016; median time on study was 17.6 and 17.3 months in each treatment group respectively. ]
   A skeletal-related event (SRE) is defined as one of the following: pathologic fracture (vertebral or non-vertebral), radiation therapy to bone (including the use of radioisotopes), surgery to bone, or spinal cord compression. Time to first on-study SRE is defined as the time interval (in days) from the randomization date to the date of first occurrence of on-study SRE. If there was no known event, and the participant was monitored for any one of the four SRE components, time to first on-study SRE was censored at the end of the treatment phase date or the primary analysis data cut-off date, whichever came first.
2. Time to First and Subsequent On-Study Skeletal Related Event - Number of Events Per Patient [ Time Frame: From randomization until the data cut-off date of 19 July 2016; median time on study was 17.6 and 17.3 months in each treatment group respectively. ]

   A skeletal-related event (SRE) is defined as one of the following: pathologic fracture (vertebral or non-vertebral), radiation therapy to bone (including the use of radioisotopes), surgery to bone, or spinal cord compression. Time to first on-study SRE is defined as the time interval (in days) from the randomization date to the date of first occurrence of on-study SRE. Time to a subsequent SRE is defined, similarly to the time to first on-study SRE, as the time interval from the randomization date to the date of a subsequent occurrence of on-study SRE, which had to be at least 21 days after the previous SRE.

   A multiple event analysis was used, which accounts for both the absolute number of SREs and for the time between two consecutive events, and therefore, provides a more sensitive assessment of the risk of experiencing an SRE. The average number of events per patient is reported.

3. Time to First and Subsequent On-Study Skeletal Related Event - Number of Events [ Time Frame: From randomization until the data cut-off date of 19 July 2016; median time on study was 17.6 and 17.3 months in each treatment group respectively. ]

   A skeletal-related event (SRE) is defined as one of the following: pathologic fracture (vertebral or non-vertebral), radiation therapy to bone (including the use of radioisotopes), surgery to bone, or spinal cord compression. Time to first on-study SRE is defined as the time interval (in days) from the randomization date to the date of first occurrence of on-study SRE. Time to a subsequent SRE is defined, similarly to the time to first on-study SRE, as the time interval from the randomization date to the date of a subsequent occurrence of on-study SRE, which had to be at least 21 days after the previous SRE.

   A multiple event analysis was used, which accounts for both the absolute number of SREs and for the time between two consecutive events, and therefore, provides a more sensitive assessment of the risk of experiencing an SRE. The total number of events is reported.

4. Overall Survival [ Time Frame: From randomization until the data cut-off date of 19 July 2016; median time on study was 17.6 and 17.3 months in each treatment group respectively. ]
   Overall survival was defined as the time interval (in days) from the randomization date to the date of death. If a participant was still alive at the primary analysis data cut-off date or was lost to follow-up by the primary analysis data cut-off date, survival time was censored at their last contact date or the primary analysis data cut-off date, whichever was first.
5. Percentage of Participants Who Died [ Time Frame: From randomization until the data cut-off date of 19 July 2016; median time on study was 17.6 and 17.3 months in each treatment group respectively. ]

Eligibility Criteria

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Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Documented evidence of multiple myeloma (per local assessment):
• Monoclonal plasma cells in the bone marrow greater than or equal to 10% and/or presence of a biopsy-proven plasmacytoma, and
• Monoclonal protein present in the serum and/or urine
• Radiographic (X-ray, or computer tomography [CT]) evidence of at least 1 lytic bone lesion (or at least 1 focal lesion per magnetic resonance imaging [MRI])
• Plan to receive or is receiving primary frontline anti-myeloma therapies
• Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
• Age ≥ 18 years

• Adequate organ function, as defined by the following criteria (per central or local laboratory values):

  • Serum aspartate aminotransferase (AST) ≤ 2.0 x upper limit of normal (ULN)
  • Serum alanine aminotransferase ≤ (ALT) 2.0 x ULN
  • Serum total bilirubin ≤ 2.0 x ULN
  • Creatinine clearance ≥ 30 mL/min
  • Serum calcium or albumin-adjusted serum calcium 2.0 mmol/L (8.0 mg/dL) and 2.9 mmol/L (11.5 mg/dL)
• Written informed consent before any study-specific procedure is performed

Exclusion Criteria:

• Nonsecretory multiple myeloma based upon standard M-component criteria (ie, measurable serum/urine M-component) unless the baseline serum free light chain level is elevated
• POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes)
• Plasma cell leukemia
• More than 30 days of previous treatment (before screening) with anti-myeloma therapy (does not include radiotherapy or a single short course of steroid [ie, less than or equal to the equivalent of dexamethasone 60 mg/day for 4 days]).
• Planned radiation therapy or surgery to the bone (does not include procedures performed before randomization)
• Prior administration of denosumab
• Use of oral bisphosphonates with a cumulative exposure of more than 1 year
• More than 1 previous dose of IV bisphosphonate administration
• Prior history or current evidence of osteonecrosis/osteomyelitis of the jaw
• Active dental or jaw condition which requires oral surgery, including tooth extraction
• Non-healed dental/oral surgery, including tooth extraction
• Planned invasive dental procedures

• Evidence of any of the following conditions per subject self-report or medical chart review:

  • Any prior invasive malignancy within 5 years before randomization
  • Any non-invasive malignancy not treated with curative intent or with knownactive disease within 5 years before randomization
  • Major surgery or significant traumatic injury occurring within 4 weeks before randomization
  • Active infection with Hepatitis B virus or Hepatitis C virus
  • Known infection with human immunodeficiency virus (HIV)
  • Active infection requiring IV anti-infective therapy
• Subject is pregnant or breast feeding, or planning to become pregnant within 5 months after end of treatment
• Female subject of child bearing potential is not willing to use highly effective contraception during treatment and for 5 months after the end of treatment (see section 6.3)
• Known sensitivity to any of the products to be administered during the study (eg, mammalian derived products, calcium or vitamin D)
• Subject is receiving or is less than 30 days since ending other experimental device or drug (no marketing authorization for any indication)
• Subject will not be available for follow-up assessment
• Any major medical or psychiatric disorder that in the opinion of the investigator, might prevent the subject from completing the study or interfere with the interpretation of the study results

Contacts and Locations

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  Show 309 Study Locations

Sponsors and Collaborators

Amgen

Daiichi Sankyo, Inc.

Investigators

Study Director:	MD	Amgen

More Information

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Additional Information:

AmgenTrials clinical trials website 

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Raje N, Terpos E, Willenbacher W, Shimizu K, García-Sanz R, Durie B, Legieć W, Krejčí M, Laribi K, Zhu L, Cheng P, Warner D, Roodman GD. Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomised, controlled, phase 3 study. Lancet Oncol. 2018 Mar;19(3):370-381. doi: 10.1016/S1470-2045(18)30072-X. Epub 2018 Feb 9.

Responsible Party:	Amgen
ClinicalTrials.gov Identifier:	NCT01345019 History of Changes
Other Study ID Numbers:	20090482; 2010-020454-34 ( EudraCT Number )
First Posted:	April 29, 2011
Results First Posted:	March 7, 2018
Last Update Posted:	March 7, 2018
Last Verified:	March 2018

Keywords provided by Amgen:

zoledronic acid; hematologic malignancies; SRE; skeletal-related event; blood cancer; lytic bone lesions; bone metastases; myeloma; fractures; spinal cord compression; radiation to bone; surgery to bone; bisphosphonates; Neoplasms, Plasma Cell	Paraproteinemias; Neoplasms; Neoplasm Metastasis; Bone Neoplasms; Bone Marrow Diseases; Blood Protein Disorders; Hematologic Diseases; multiple myeloma; denosumab; Neoplastic Processes; Bone Diseases; Diphosphonates; Bone Density Conservation Agents

Additional relevant MeSH terms:

Multiple Myeloma; Neoplasms, Plasma Cell; Neoplasm Metastasis; Neoplasms; Bone Diseases; Neoplasms by Histologic Type; Hemostatic Disorders; Vascular Diseases; Cardiovascular Diseases; Paraproteinemias; Blood Protein Disorders; Hematologic Diseases	Hemorrhagic Disorders; Lymphoproliferative Disorders; Immunoproliferative Disorders; Immune System Diseases; Neoplastic Processes; Pathologic Processes; Musculoskeletal Diseases; Zoledronic acid; Diphosphonates; Denosumab; Bone Density Conservation Agents; Physiological Effects of Drugs