E-PRISM: Phase II Trial of Elotuzumab Lenalidomide and Dexamethasone in High-Risk Smoldering Multiple Myeloma

• ClinicalTrials.gov Identifier: NCT02279394
• Recruitment Status: Active, not recruiting
• First Posted: October 31, 2014
• Last Update Posted: April 7, 2020
• Sponsor: Dana-Farber Cancer Institute
• Collaborators: Bristol-Myers Squibb; Celgene; Blood Cancer Research Partnership; Multiple Myeloma Research Consortium; The Leukemia and Lymphoma Society
• Information provided by (Responsible Party): Irene Ghobrial, MD, Dana-Farber Cancer Institute

Study Description

Brief Summary:

This research study is aimed to determine the proportion of high risk smoldering multiple myeloma patients who are progression free at 2 years after receiving elotuzumab, lenalidomide and dexamethasone combination therapy.

Condition or disease	Intervention/treatment	Phase
Smoldering Myeloma; Smoldering Multiple Myeloma	Drug: Elotuzumab; Drug: Lenalidomide; Drug: Dexamethasone	Phase 2

Detailed Description:

This research study is a Phase II clinical trial, which tests the effectiveness of the investigational drugs elotuzumab, lenalidomide and dexamethasone in smoldering multiple myeloma. Recent research studies have shown that early treatment of smoldering multiple myeloma may delay or prevent the progression to active multiple myeloma. The purpose of this research study is to learn whether the combination of elotuzumab, lenalidomide and dexamethasone works in treating smoldering multiple myeloma.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 51 participants
• Allocation: Non-Randomized
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: E- PRISM: Precision Intervention Smoldering Myeloma: Phase II Trial of Combination of Elotuzumab, Lenalidomide and Dexamethasone in High-Risk Smoldering Multiple Myeloma
• Study Start Date: December 2014
• Estimated Primary Completion Date: January 2021
• Estimated Study Completion Date: October 2023

Arms and Interventions

Intervention Details:

• Drug: Elotuzumab
  10 mg/kg IV; Days 1, 8,15, 22 Cycles 1-2 10 mg/kg IV; Days 1 & 15 Cycles 3-8
  Other Name: HuLuc63
• Drug: Lenalidomide
  25 mg Oral; Days 1-21 days Cycles 1-24
  Other Name: REVLIMID
• Drug: Dexamethasone
  40 mg Oral; Days 1, 8, 15, 22 Cycles 1-2 40 mg Oral; Days 1, 8, 15 Cycles 3-8
  Other Name: Decadron

Outcome Measures

Primary Outcome Measures :

1. Proportion of patients who are progression free at 2 years [ Time Frame: 2 Years ]
   Time from protocol therapy initiation to progression to symptomatic myeloma

Secondary Outcome Measures :

1. Response rate [ Time Frame: 2 Years ]
   Response rate based on the IMWG criteria
2. Safety of the combination therapy [ Time Frame: 4 years ]
   safety of the combination of Elotuzumab, lenalidomide+/- dexamethasone
3. Time to progression [ Time Frame: 4 years ]
   Time from initiation of therapy to progression defined by the IMWG criteria.
4. Overall survival [ Time Frame: 2 Years ]
   Time from initiation of therapy to death

Eligibility Criteria

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

Criteria

Inclusion Criteria:

• Age ≥ 18 years
• Must have smoldering myeloma with high risk markers based on the Mayo OR the Spanish criteria as described below

• >10% plasma cells in the bone marrow and any one or more of the following:

  • Serum M protein of 3 g/dL or greater
  • IgA SMM
  • Immunoparesis with reduction of two uninvolved immunoglobulin isotypes
  • Serum involved/uninvolved free light chain ratio ≥8 (but less than 100)
  • Progressive increase in M protein level (Evolving type of SMM)†
  • Bone marrow clonal plasma cells 50-60%
  • Abnormal plasma cell immunophenotype (≥95% of bone marrow plasma cells are clonal) and reduction of one or more uninvolved immunoglobulin isotypes
  • t (4;14) or del 17p or 1q gain
  • Increased circulating plasma cells
  • MRI with diffuse abnormalities or 1 focal lesion
  • PET-CT with focal lesion with increased uptake without underlying osteolytic bone destruction † Increase in serum monoclonal protein by ≥25% on two successive evaluations within a 6 month period

• No evidence of CRAB (see below for details) criteria or new criteria of active multiple myeloma which including the following:

  • Increased calcium levels (corrected serum calcium >0.25 mmol/dL above the upper limit of normal or >.275 mmol/dL)
  • Renal insufficiency (attributable to myeloma)
  • Anemia (Hb 2g/dL below the lower limit of normal or <10g/dL)
  • Bone lesions (lytic lesions or generalized osteoporosis with compression fractures)

  • No evidence of the following new criteria for active MM including the following: Bone marrow plasma cells ≥ 60%, Serum involved/uninvolved FLC ratio ≥100, and MRI with more than one focal lesion

    • Participants with CRAB criteria that are attributable to conditions other than the disease under study may be eligible
• ECOG Performance Status (PS) 0, 1, or 2 (Appendix A)

• The following laboratory values obtained ≤ 14 days prior to registration:

  • ANC ≥1000/µL
  • PLT ≥ 50,000/µL
  • Total bilirubin ≤ 2.0 mg/dL (If total is elevated check direct and if normal patient is eligible.)
  • AST ≤ 3 x institutional upper limit of normal (ULN)
  • ALT ≤ 3 x institutional upper limit of normal (ULN)
  • Estimated creatinine clearance ≥ 60mL/min or a creatinine ≤ 2.2 mg/dL
• Voluntary written informed consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care
• Females of childbearing potential* must have a negative serum or urine pregnancy test
• Men must agree to use a latex condom during sexual contact with a female of childbearing potential even if they have had a successful vasectomy
• Ability to understand and the willingness to sign a written informed consent.
• Exclusion Criteria:
• Symptomatic Multiple Myeloma or any evidence of CRAB criteria including the new criteria for overt myeloma. Any prior therapy for active Myeloma should also be excluded. Prior therapy for smoldering myeloma is not an exclusion criteria. Bisphosphonates are not excluded
• Other concurrent chemotherapy, immunotherapy, radiotherapy, or any ancillary therapy considered investigational. Prior therapy with bisphosphonate is allowed. Prior radiation therapy to a solitary plasmacytoma is allowed. Prior clinical trials for smoldering MM or MGUS are allowed as long as the last therapy was at least 2 months prior and there was no improvement in M spike
• Serious medical or psychiatric illness likely to interfere with participation in this clinical study
• Diagnosed or treated for another malignancy within 2 years of enrollment, with the exception of complete resection of basal cell carcinoma or squamous cell carcinoma of the skin, an in situ malignancy, or low-risk prostate cancer after curative therapy
• Uncontrolled intercurrent illness
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to elotuzumab or lenalidomide
• Known seropositive for or active viral infection with human immunodeficiency virus, hepatitis B virus or hepatitis C virus. Patients who are seropositive because of hepatitis B virus vaccine are eligible

Contacts and Locations

Locations

United States, Colorado

Colorado Blood Cancer Institute

Denver, Colorado, United States, 80218

United States, Connecticut

St Francis Hospital and Medical Center

Hartford, Connecticut, United States, 06105

United States, Illinois

University of Chicago

Chicago, Illinois, United States, 60637

United States, Maine

Eastern Maine Medical Center

Brewer, Maine, United States, 04412

United States, Maryland

University of Maryland

Baltimore, Maryland, United States, 21201

United States, Massachusetts

Massachusetts General Hospital

Boston, Massachusetts, United States, 02114

Dana-Farber Cancer Institute

Boston, Massachusetts, United States, 02215

United States, Michigan

Barbara Ann Karmanos Cancer Institute

Detroit, Michigan, United States, 48201

United States, North Carolina

Levine Cancer Institute

Charlotte, North Carolina, United States, 28204

Sponsors and Collaborators

Dana-Farber Cancer Institute

Bristol-Myers Squibb

Celgene

Blood Cancer Research Partnership

Multiple Myeloma Research Consortium

The Leukemia and Lymphoma Society

Investigators

• Principal Investigator: Irene Ghobrial, MD; Dana-Farber Cancer Institute

More Information

• Responsible Party: Irene Ghobrial, MD, Principal Investigator, Dana-Farber Cancer Institute
• ClinicalTrials.gov Identifier: NCT02279394
• Other Study ID Numbers: 14-338
• First Posted: October 31, 2014
• Last Update Posted: April 7, 2020
• Last Verified: April 2020

Keywords provided by Irene Ghobrial, MD, Dana-Farber Cancer Institute:

Smoldering myeloma; Smoldering Multiple Myeloma

Additional relevant MeSH terms:

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; Elotuzumab; 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