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Safety and Efficacy of ABI-009 (Nab-rapamycin) in Combination With Pomalidomide and Dexamethasone for Relapsed and Refractory Multiple Myeloma

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ClinicalTrials.gov Identifier: NCT03657420
Recruitment Status : Withdrawn (Funding withdrawn by sponsor)
First Posted : September 5, 2018
Last Update Posted : August 14, 2019
Sponsor:
Collaborator:
Aadi, LLC
Information provided by (Responsible Party):
Andrew Yee, MD, Massachusetts General Hospital

Brief Summary:

This research study is studying a combination of drugs as a possible treatment for multiple myeloma.

The drugs that will be administered are:

  • ABI-009 (nab-rapamycin)
  • Pomalidomide
  • Dexamethasone

Condition or disease Intervention/treatment Phase
Multiple Myeloma Drug: ABI-009 Drug: Pomalidomide Drug: Dexamethasone Phase 1

Detailed Description:

This research study is a Phase I clinical trial, which tests the safety of an investigational drug and also tries to define the appropriate dose of the investigational drug to use for further studies. "Investigational" means that the drug is being studied.

The FDA (the U.S. Food and Drug Administration) has not approved ABI-009 as a treatment for any disease.

The FDA has approved pomalidomide and dexamethasone as treatment options for multiple myeloma.

The purpose of this study is to determine whether ABI-009 (study drug) will be safe and slow the progress of the disease when used in combination with pomalidomide and dexamethasone, depending on what type of cancer.

ABI-009 is an inhibitor of an overactive biological pathway in the cancer cells. Pomalidomide is an immunomodulatory agent and believed to work by affecting the growth signals that keep cancer cells alive. Dexamethasone is a steroid which is believed to kill cancer cells. The investigators hope that the combination of ABI-009 with pomalidomide and dexamethasone will help stop the growth of the cancer.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase Ib Investigation of the Safety and Efficacy of ABI-009 (Nab-rapamycin) in Combination With Pomalidomide and Dexamethasone for Relapsed and Refractory Multiple Myeloma
Estimated Study Start Date : May 30, 2019
Estimated Primary Completion Date : September 30, 2021
Estimated Study Completion Date : September 30, 2024


Arm Intervention/treatment
Experimental: ABI-009 + Pomalidomide + Dexamethasone
  • Pomalidomide is given orally daily on days 1-21, 7 days off
  • ABI-009 is given intravenously on days 1, 8, and 15
  • Dexamethasone is given orally weekly on days 1, 8, 15, 22
Drug: ABI-009
ABI-009 is an mTOR inhibitor. This pathway is believed to be overactive in multiple myeloma.
Other Name: nab-rapamycin

Drug: Pomalidomide
Pomalidomide is an immunomodulatory agent and believed to work by affecting the growth signals that keep cancer cells alive.
Other Name: Pomalyst

Drug: Dexamethasone
Dexamethasone is a steroid which is believed to kill cancer cells
Other Name: Decadron




Primary Outcome Measures :
  1. Maximum tolerated dose. [ Time Frame: 1 Cycle (28-Days) ]
    The maximum Tolerated Dose (MTD) is the highest dose of ABI-009 (nab-rapamycin) when administered in combination with pomalidomide and dexamethasone that dose not cause unacceptable side effects. The maximum tolerated dose is determined in clinical trials by testing increasing doses on different groups of people until the highest dose with acceptable side effects is found. A standard 3+3 dose escalation design will be used to assess the MTD.


Secondary Outcome Measures :
  1. Overall response rate. [ Time Frame: 2 years ]
    The number of participants that achieve a partial response or better. This is assessed using International Myeloma Working Group criteria.

  2. Progression free survival. [ Time Frame: 2 years ]
    Progression free survival is defined as the time to disease progression or death from any cause, censored at date last known progression free for those who have not progressed or died. Progression is assessed using International Myeloma Working Group Criteria.

  3. Treatment-emergent adverse events. [ Time Frame: 2 years ]
    Adverse events will be assessed using CTCAE criteria.



Information from the National Library of Medicine

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

Inclusion Criteria:

  • Previously treated relapsed and refractory multiple myeloma. Relapsed and refractory is defined per International Myeloma Working Group Criteria (Rajkumar et al., 2011).
  • Patients must have received at least two prior therapies with at least 2 cycles of lenalidomide and at least 2 cycles of a proteasome inhibitor (either in separate regimens or within the same regimen)
  • Disease progression on or within 60 days of completion of last therapy.
  • All laboratory assessments should be performed within 21 days of initiation of protocol therapy unless otherwise specified.
  • Participant has given voluntary signed written informed consent before performance of any study-related procedure that is not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to their future medical care.
  • Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (see Appendix A).
  • Age ≥ 18 years
  • Measurable disease of multiple myeloma as defined by at least one of the following:

    • Serum monoclonal protein ≥ 0.5 g/dL
    • ≥ 200 mg of monoclonal protein in the urine on 24-hour electrophoresis
    • Serum free light chain ≥ 100 mg/L (10 mg/dL) and abnormal serum free kappa to serum free kappa light chain ratio
  • ANC ≥ 1000/μL. G-CSF is not permitted within 14 days of screening.
  • Platelet count ≥ 75,000/µL. Platelet transfusions are not permitted within 7 days of screening.
  • Hemoglobin ≥ 8 g/dL. Red blood cell transfusions are permitted to meet eligibility criteria.
  • Calculated creatinine clearance of ≥ 30 mL/min according to Cockroft-Gault equation
  • Patient has adequate hepatic function, as evidenced by the following:

    • Serum bilirubin values < 2 mg/dL, and serum alanine transaminase (ALT), and serum aspartate transaminase (AST) values < 3 × the institutional upper limit of normal (ULN).

Patients with elevated bilirubin due to Gilbert's syndrome may be permitted with PI approval

  • Must be able to take acetylsalicylic acid (ASA) daily as prophylactic anticoagulation. Patients intolerant to ASA may use low molecular weight heparin or equivalent. Warfarin will be allowed provided patient is fully anticoagulated, with an INR of 2-3.
  • All study participants must be registered into the mandatory POMALYST REMS program and be willing and able to comply with the requirements of the POMALYST REMS program.
  • Females of reproductive potential must adhere to the scheduled pregnancy testing as required in the POMALYST REMS program.
  • Able to swallow capsules whole (pomalidomide capsules cannot be crushed, dissolved or broken).

Exclusion Criteria:

  • Prior therapy with mTOR inhibitor (e.g. everolimus, sirolimus). Note, prior pomalidomide therapy is permitted.
  • Patients who have had chemotherapy or radiotherapy within 2 weeks (6 weeks for nitrosoureas or mitomycin C) prior to the first dose or those who have not recovered from adverse events due to agents administered more than 2 weeks earlier. Patients may have received dexamethasone within 2 weeks prior to entering study.
  • Patients who are receiving any other investigational agents.
  • Concomitant high dose corticosteroids except participants may be on chronic steroids (maximum dose 10 mg/day prednisone equivalent) if they are being given for disorders other than myeloma, e.g. adrenal insufficiency, rheumatoid arthritis, etc.
  • Pregnant or lactating females
  • Prior history of malignancies, other than MM, unless the patient has been free of the disease for ≥ 3 years. Exceptions include the following:

    • Basal or squamous cell carcinoma of the skin
    • Carcinoma in situ of the cervix
    • Ductal carcinoma in situ of the breast
    • Incidental histologic finding of prostate cancer (T1a or T1b)
  • Patients undergoing active treatment for another malignancy with the exception of non-melanoma skin cancer or in situ cervical cancer.
  • Patients with plasma cell leukemia, POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome, or amyloidosis are excluded from this trial.
  • HIV infection
  • Active hepatitis B infection or active hepatitis C infection, per treating investigator. Patients who have prior hepatitis C infection but who have received an antiviral treatment and show no detectable viral RNA for 6 months are eligible
  • Peripheral neuropathy ≥ grade 2 despite supportive therapy
  • Hypersensitivity to thalidomide, lenalidomide, pomalidomide, bortezomib, or dexamethasone (such as Stevens-Johnson syndrome). Rash to immunomodulatory drug that can be medically managed is allowed
  • Patients who had allogeneic stem cell transplant fewer than 12 months prior to initiation of study treatment and who have not discontinued immunosuppressive treatment for at least four weeks prior to initiation of study treatment and are currently dependent on such treatment.
  • Patients with active graft v. host disease.
  • History of significant cardiovascular, neurological, endocrine, gastrointestinal, respiratory, or inflammatory illness that could preclude study participation, pose an undue medical hazard, or interfere with the interpretation of the study results, including, but not limited to, patients with congestive heart failure (New York Heart Association [NYHA] Class 3 or 4); unstable angina; cardiac arrhythmia; recent (within the preceding 6 months) myocardial infarction or stroke; hypertension requiring > 2 medications for adequate control; diabetes mellitus with > 2 episodes of ketoacidosis in the preceding 12 months; or chronic obstructive pulmonary disease (COPD) requiring > 2 hospitalizations in the preceding 12 months.
  • Patient has any other medical, psychiatric, or social condition that would preclude participation in the study, pose an undue medical hazard, interfere with the conduct of the study, or interfere with interpretation of the study results.
  • History of interstitial lung disease and/or pneumonitis, or pulmonary hypertension.
  • Use of strong inhibitors and inducers of CYP3A4 within the 14 days prior to receiving the first dose of ABI-009. Additionally, use of any known CYP3A4 substrates with narrow therapeutic window (such as fentanyl, alfentanil, astemizole, cisapride, dihydroergotamine, pimozide, quinidine, terfanidine) within the 14 days prior to receiving the first dose of ABI-009.

Information from the National Library of Medicine

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): NCT03657420


Locations
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United States, Massachusetts
Massachusetts General Hospital Cancer Center
Boston, Massachusetts, United States, 02114
Sponsors and Collaborators
Massachusetts General Hospital
Aadi, LLC
Investigators
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Principal Investigator: Andrew J. Yee, MD Massachusetts General Hospital

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Responsible Party: Andrew Yee, MD, Principal Investigator, Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT03657420     History of Changes
Other Study ID Numbers: 18-252
First Posted: September 5, 2018    Key Record Dates
Last Update Posted: August 14, 2019
Last Verified: August 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Andrew Yee, MD, Massachusetts General Hospital:
Multiple Myeloma
Additional relevant MeSH terms:
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Multiple Myeloma
Neoplasms, Plasma Cell
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
Sirolimus
Thalidomide
Dexamethasone
Dexamethasone acetate
Everolimus
Pomalidomide
BB 1101
Anti-Inflammatory Agents
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists