Carfilzomib, Lenalidomide, and Dexamethasone for Smoldering Multiple Myeloma
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ClinicalTrials.gov Identifier: NCT01572480 |
Recruitment Status :
Active, not recruiting
First Posted : April 6, 2012
Results First Posted : September 13, 2022
Last Update Posted : September 13, 2022
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Background:
- Multiple myeloma is a blood cancer that affects the plasma cells. These cells help produce antibodies and fight infection. Smoldering multiple myeloma (SMM) is a related condition that may develop into multiple myeloma. The current standard of care for SMM is close follow-up without treatment until multiple myeloma develops. However, researchers are studying possible treatments for SMM itself. One possible treatment involves a combination of cancer treatment drugs.
- Lenalidomide is a drug that may help reduce or prevent the growth of cancer cells. Dexamethasone is a steroid that is often given with other anti-cancer drugs. These two drugs are an approved treatment for multiple myeloma that has not responded to at least one other treatment. Carfilzomib is an experimental drug that has been effective in treating multiple myeloma. Researchers want to combine these three drugs to see if they are a safe and effective treatment for SMM.
Objectives:
- To see if carfilzomib, lenalidomide, and dexamethasone are a safe and effective treatment for smoldering multiple myeloma.
Eligibility:
- Individuals at least 18 years of age who have SMM that is likely to progress to multiple myeloma.
Design:
- Participants will be screened with a physical exam and medical history. They will also have blood and urine tests, and baseline bone marrow scans. Bone marrow samples will also be collected.
- Participants will have eight 28-day cycles of treatment with the three study drugs. The drugs will be given as tablets or as infusions. Treatment will be monitored with frequent blood tests and study visits.
- After the first four cycles, participants who are eligible for a stem cell transplant will have their stem cells collected and stored for future use.
- At the end of eight cycles, participants whose disease has not progressed will have up to 12 more cycles of treatment with lenalidomide tablets alone.
Condition or disease | Intervention/treatment | Phase |
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Multiple Myeloma | Drug: Carfilzomib Drug: Revlimid Drug: Dexamethasone | Phase 2 |

Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 55 participants |
Allocation: | Non-Randomized |
Intervention Model: | Single Group Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Carfilzomib, Lenalidomide, and Dexamethasone in High-Risk Smoldering Multiple Myeloma: a Clinical and Correlative Pilot Study |
Actual Study Start Date : | May 29, 2012 |
Actual Primary Completion Date : | March 3, 2022 |
Estimated Study Completion Date : | June 1, 2025 |

Arm | Intervention/treatment |
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Experimental: Group A - (closed) - Carfilzomib with Revlimid and Dexamethasone
Carfilzomib (intravenous (IV), Days 1, 2, 8, 9, 15, and 16 of the 28-day cycle); Revlimid (by mouth (PO), Days 1-21 of the 28-day cycle; exception: not given on cycle 1 day 1); and Dexamethasone (PO or IV, Days 1, 2, 8, 9, 15, 16, 22, and 23 of the 28-day cycle; exception: not given on cycle 1 day 1)
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Drug: Carfilzomib
Carfilzomib intravenous (IV) 20-36 mg/m^2 per dose on days 1, 2, 8, 9, 15, and 16 of each cycle based on arm; until disease progression or unacceptable toxicity.
Other Name: Kyprolis Drug: Revlimid Revlimid by mouth (PO) 25 mg/day, days 1-21 every 28 days of each cycle based on arm; until disease progression or unacceptable toxicity.
Other Name: Lenalidomide Drug: Dexamethasone Dexamethasone by mouth (PO) 20 mg per dose on days 1, 2, 8, 9, 15, 16, 22, and 23 of each cycle based on arm; until disease progression or unacceptable toxicity.
Other Name: Ozurdex |
Experimental: Group B - Carfilzomib with Revlimid and Dexamethasone
Carfilzomib (intravenous (IV), Days 1, 2, 8, 9, 15, and 16 of the 28-day cycle); Revlimid (by mouth (PO), Days 1-21 of the 28-day cycle); and Dexamethasone (PO or IV, Days 1, 2, 8, 9, 15, 16, 22, and 23 of the 28-day cycle)
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Drug: Carfilzomib
Carfilzomib intravenous (IV) 20-36 mg/m^2 per dose on days 1, 2, 8, 9, 15, and 16 of each cycle based on arm; until disease progression or unacceptable toxicity.
Other Name: Kyprolis Drug: Revlimid Revlimid by mouth (PO) 25 mg/day, days 1-21 every 28 days of each cycle based on arm; until disease progression or unacceptable toxicity.
Other Name: Lenalidomide Drug: Dexamethasone Dexamethasone by mouth (PO) 20 mg per dose on days 1, 2, 8, 9, 15, 16, 22, and 23 of each cycle based on arm; until disease progression or unacceptable toxicity.
Other Name: Ozurdex |
- Percentage of Participants With Minimal Residual Disease (MRD)Negative Complete Response (CR) Per International Myeloma Working Group (IMWG) Criteria [ Time Frame: 8 months ]MRDnegative Complete Response (CR) per the IMWHG criteria is defined as absence of phenotypically aberrant clonal plasma cells by flow cytometry on bone marrow aspirates using the eight-color two tube approach with a minimum sensitivity of 1 in 10^5 nucleated cells or higher.
- Percentage of Participants That Have Minimal Residual Disease (MRD)-Negative Complete Response (CR) for a Minimum of 1 Year [ Time Frame: 1 year ]Percentage of participants that have Minimal Residual Disease (MRD)-negative Complete Response (CR) for a minimum of 1 year estimated along with a 95% two-sided confidence interval. MRDnegative Complete Response (CR) is defined as absence of phenotypically aberrant clonal plasma cells by flow cytometry on bone marrow aspirates using the eight-color two tube approach with a minimum sensitivity of 1 in 10^5 nucleated cells or higher.
- Number of Participants With Serious and/or Non-serious Adverse Events Assessed by the Common Terminology Criteria for Adverse Events (CTCAE v4.0) [ Time Frame: Date treatment consent signed to date off study, approximately 117 months and 1 day. ]Here is the number of participants with serious and/or non-serious adverse events assessed by the Common Terminology Criteria for Adverse Events (CTCAE v4.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life-threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned.
- Clinical Progression Free Survival [ Time Frame: time from enrollment in the study until development of overt clinical multiple myeloma (end organ damage or myeloma-defining event) or death. ]Clinical progression free survival is defined as the time from enrollment in the study until development of overt clinical multiple myeloma (end organ damage or myeloma-defining event) or death.
- Biochemical Progression Free Survival [ Time Frame: time from enrollment in the study until development of overt clinical multiple myeloma (end organ damage or myeloma-defining event) or death, and progressive disease by IMWG criteria. ]Biochemical progression free survival is defined as the time from enrollment in the study until development of overt clinical multiple myeloma (end organ damage or myeloma-defining event) or death, and progressive disease by International Myeloma Working Group (IMWG) criteria.
- Duration of Response [ Time Frame: time from partial response to disease progression. ]Duration of response is defined as the time from partial response to disease progression.
- Overall Response Rate (ORR) [ Time Frame: time measurement criteria are met for best response until the first date that recurrent or progressive disease ]ORR is measured from the time measurement criteria are met for best response until the first date that recurrent or progressive disease is objectively documented.

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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
- INCLUSION CRITERIA:
Patients must have histologically or cytologically confirmed Smoldering Multiple Myeloma confirmed by the Laboratory of Pathology, national Cancer Institute (NCI) or the Department of Laboratory Medicine, Clinical Center (CC) based on the International Myeloma Working Group Criteria:
- Serum M-protein greater than or equal to 3 g/dl and/or bone marrow plasma cells greater than or equal 10% and <60%
- Absence of anemia: Hemoglobin >10 g/dl
- Absence of renal failure: serum creatinine < 2.0 mg/dL
- Absence of hypercalcemia: Calcium (Ca) <10.5 mg/dl
- Absence of lytic bone lesion on X-ray, computed tomography (CT), or positron-emission tomography (PET)/CT and not more than 1 lesion on spinal magnetic resonance imaging (MRI). (NOTE: At the discretion of the investigator, PET/CT may replace MRI in patients who have a contraindication to MRI.)
- Involved-un-involved light chain ratio must be <100
Measurable disease within the past 4 weeks defined by any one of the following:
- Serum monoclonal protein greater than or equal to 1.0 g/dl
- Urine monoclonal protein >200 mg/24 hour
- Serum immunoglobulin free light chain >10 mg/dL AND abnormal kappa/lambda ratio
NOTE: As of Amendment L (version date 05/17/2018), the primary endpoint is minimal residual disease (MRD(-) Complete Response (CR) rate; therefore, per the discretion of the Principal Investigator, patients without measurable disease (e.g., M-spike <1) may also be enrolled. This is in line with the most recent International Myeloma Working Group (IMWG) multiple myeloma (MM) response criteria.
Age greater than or equal to 18 years. Because no dosing or adverse event data are currently available on the use of carfilzomib in combination with lenalidomide in patients <18 years of age, children are excluded from this study, but may be eligible for future pediatric trials.
Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 2 (Karnofsky greater than or equal to 60%).
Patients must have normal organ and marrow function as defined below:
- absolute neutrophil count (ANC) greater than or equal to1.0 K/uL
NOTE: At the discretion of the investigator, patients with an ANC of 0.5 K/uL <1.0 K/uL may also be enrolled if clinically appropriate (e.g., patients with a baseline neutropenia that is chronic and that does not cause complications)
- platelets greater than or equal to 75 K/uL
- hemoglobin greater than or equal to 8 g/dL(transfusions are permissible)
- total bilirubin less than or equal to 1.5 times institutional upper limit of normal
- aspartate aminotransferase (AST) serum glutamic-oxaloacetic transaminase (SGOT)/alanine aminotransferase (ALT) serum glutamic-pyruvic transaminase (SGPT) less than or equal to 3.0 times institutional upper limit of normal
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Serum creatinine less than or equal to 1.5 X institutional ULN. If serum creatinine is above 1.5 X ULN, Creatinine Clearance (CrCl) or estimated glomerular filtration rate (eGFR) (estimated glomerular filtration rate) must be greater than or equal to 50 ml/min.
- Creatinine clearance (CrCl) will be calculated by Cockcroft-Gault method. CrCl (calculated) = (140 - Age) x Mass (in kilograms) x [0.85 if Female] 72 x Serum Creatinine (in mg/dL).
- eGFR will be calculated by either of the following well established formulas: modification of diet in renal disease (MDRD) or the chronic kidney disease (CKD)-epidemiology collaboration (EPI) (institutional standard) equations
- CrCl may also be determined by measuring a 24 hour urine collection. The measured CrCl must be greater than or equal to 50 ml/min.
In addition to having Smoldering Multiple Myeloma (SMM), patients must also be classified as 'high-risk SMM' per Mayo Clinic or Spanish Programa de Estudio y Tratamiento de las Hemopatías Malignas (PETHEMA) criteria.
Criteria set forward by Rajkumar, Landgren, Mateos[14] may also be used to define high risk disease, namely clonal bone marrow plasma cells greater than or equal to 10% and any one or more of the following:
- Serum M protein greater than or equal to 30g/L
- Immunoglobulin A (IgA) SMM
- Immunoparesis with reduction of 2 uninvolved immunoglobulin isotypes
- Serum involved/uninvolved free light chain (FLC) ratio greater than or equal to 8 (but less than 100)
- Progressive increase in M protein level (evolving type of SMM; increase in serum M protein by greater than or equal to 25% on 2 successive evaluations within a 6-month period)
- Clonal bone marrow plasma cells (BMPCs) 50%-60%
- Abnormal plasma cells (PCs) immunophenotype (greater than or equal to 95% of BMPCs are clonal) and reduction of greater than or equal to 1 uninvolved immunoglobulin isotypes
- t(4;14) or del(17p) or 1q gain
- Increased circulating PCs
- MRI with diffuse abnormalities or 1 focal lesion
- PET-CT with focal lesion with increased uptake without underlying osteolytic bone destruction
All study participants must be registered into the mandatory RevAssist program and be willing and able to comply with the requirements of Risk Evaluation and Mitigation Strategy (REMS).
The effects of carfilzomib and lenalidomide on the developing human fetus are unknown. The immunomodulatory agents used in this trial (i.e., lenalidomide) are known to be teratogenic. Women of childbearing potential and men must agree to use adequate contraception. Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test within 10 - 14 days and again within 24 hours prior to prescribing lenalidomide for Cycle 1 (prescriptions must be filled within 7 days) and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure.
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. In regard to carfilzomib, FCBP and their male partners must agree to use at least one method of effective contraception for at least 30 days after the
last dose of carfilzomib and males must agree to use contraception and not to donate sperm for at least 90 days after the last dose of carfilzomib.
Ability of subject to understand and the willingness to sign a written informed consent document.
EXCLUSION CRITERIA:
Patients who are receiving any other investigational agents.
Concurrent systemic treatment or prior therapy within 4 weeks for SMM
- Treatment with corticosteroids for other indications is permitted
Patients with a diagnosis of MM as defined by the 2014 IMWH diagnostic criteria.
Contraindication to any concomitant medication, including antivirals, anticoagulation prophylaxis, tumor lysis prophylaxis, or hydration given prior to therapy
History of allergic reactions attributed to compounds of similar chemical or biologic composition to carfilzomib or lenalidomide agents used in study, such as bortezomib or thalidomide, in addition to patients with known allergy to sulfobutyl ether <=- cyclodextrin (Captisol).
Uncontrolled hypertension or diabetes
Pregnant or lactating females. Pregnant women are excluded from this study. The effects of carfilzomib on a developing human fetus are unknown. Lenalidomide is teratogenic with unknown potential for abortifacient effects. Breastfeeding women and women planning on breastfeeding may not participate. No studies of carfilzomib have been conducted on breast feeding women and it is not known if it is excreted in milk. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with Carfilzomib/Lenalidomide, breastfeeding should be discontinued if the mother is treated with Carfilzomib/Lenalidomide.
Significant cardiovascular disease with New York Heart Association (NYHA) Class II, III or IV symptoms, or hypertrophic cardiomegaly, or restrictive cardiomegaly, or myocardial infarction within 3 months prior to enrollment, or unstable angina, or unstable arrhythmia
Active hepatitis B or C infection
Has refractory gastrointestinal (GI) disease with refractory nausea/vomiting, inflammatory bowel disease, or bowel resection that would prevent absorption
Significant neuropathy >Grade 2 at the time of first dose or within 14 days of enrollment.
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations within 2 weeks that would limit compliance with study requirements.
History of other malignancy (apart from basal cell carcinoma of the skin, or in situ cervix carcinoma) except if the patient has been free of symptoms and without active therapy during at least 2 years or if, at the clinical discretion of the investigator, the risks of this study do not outweigh the potential benefits on a case to case basis.
Major surgery within 1 month prior to enrollment.

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01572480
United States, Maryland | |
National Institutes of Health Clinical Center, 9000 Rockville Pike | |
Bethesda, Maryland, United States, 20892 |
Principal Investigator: | Elizabeth Hill, M.D. | National Cancer Institute (NCI) |
Documents provided by Elizabeth Hill, National Cancer Institute (NCI):
Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: | Elizabeth Hill, Principal Investigator, National Cancer Institute (NCI) |
ClinicalTrials.gov Identifier: | NCT01572480 |
Other Study ID Numbers: |
120107 12-C-0107 |
First Posted: | April 6, 2012 Key Record Dates |
Results First Posted: | September 13, 2022 |
Last Update Posted: | September 13, 2022 |
Last Verified: | August 2022 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Yes |
Plan Description: | All individual participant data (IPD) recorded in the medical record will be shared with intramural investigators upon request. In addition, all large-scale genomic sequencing data will be shared with subscribers to the database of Genotypes and Phenotypes (dbGaP). |
Supporting Materials: |
Study Protocol Statistical Analysis Plan (SAP) Informed Consent Form (ICF) |
Time Frame: | Clinical data available during the study and indefinitely. Genomic data are available once genomic data are uploaded per protocol Genomic Data Sharing (GDS) plan for as long as database is active. |
Access Criteria: | Clinical data will be made available via subscription to Biomedical Translational Research Information System (BTRIS) and with the permission of the study principal investigator (PI). Genomic data are made available via the database of Genotypes and Phenotypes (dbGaP) through requests to the data custodians. |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Proteasome Inhibitor Immunomodulatory Agents Combination Therapy Anti-Myeloma Activity |
Multiple Myeloma Neoplasms, Plasma Cell Smoldering Multiple Myeloma Neoplasms by Histologic Type Neoplasms Hemostatic Disorders Vascular Diseases Cardiovascular Diseases Paraproteinemias Blood Protein Disorders Hematologic Diseases Hemorrhagic Disorders Lymphoproliferative Disorders Immunoproliferative Disorders Immune System Diseases |
Precancerous Conditions Hypergammaglobulinemia Dexamethasone Lenalidomide Anti-Inflammatory Agents Antiemetics Autonomic Agents Peripheral Nervous System Agents Physiological Effects of Drugs Gastrointestinal Agents Glucocorticoids Hormones Hormones, Hormone Substitutes, and Hormone Antagonists Antineoplastic Agents, Hormonal Antineoplastic Agents |