Response Adapted Therapy With Bortezomib/Dexamethasone Followed by Addition of Lenalidomide in Non Responders as Initial Treatment for Patients With Multiple Myeloma

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2015 by Memorial Sloan Kettering Cancer Center.
Sponsor:
Collaborator:
Millennium Pharmaceuticals, Inc.
Information provided by (Responsible Party):
Memorial Sloan Kettering Cancer Center.
ClinicalTrials.gov Identifier:
NCT01919086
First received: August 7, 2013
Last updated: March 11, 2015
Last verified: March 2015
  Purpose

The purpose of this study is to see if researchers could get the same good results with less toxicity by using this new approach.

We already know that the three drugs bortezomib, lenalidomide, and dexamethasone given together at the same time are effective. Most physicians therefore treat patients with multiple myeloma with the 3 drug combination. However, the researchers also know that the three drugs given together result in more side effects than when only 2 drugs (bortezomib and dexamethasone or lenalidomide and dexamethasone) are given. The researchers believe that all patients may not necessarily need the three drugs to have good results. In this study, the researchers will first treat your disease with bortezomib and dexamethasone. If the disease is not well controlled with these 2 drugs, only then the third drug, lenalidomide, will be added. By using this sequential approach we may reach the same good results with fewer side effects.


Condition Intervention Phase
Multiple Myeloma (MM)
Drug: Bortezomib
Drug: Dexamethasone
Drug: Lenalidomide
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Response Adapted Therapy With Bortezomib/Dexamethasone Followed by Addition of Lenalidomide in Non Responders as Initial Treatment for Patients With Multiple Myeloma

Resource links provided by NLM:


Further study details as provided by Memorial Sloan Kettering Cancer Center.:

Primary Outcome Measures:
  • overall response rate [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    (defined as > or = to PR) after 4 cycles of response-adapted sequential therapy, using bortezomib and dexamethasone (BD) followed by the addition of lenalidomide in suboptimal responders


Secondary Outcome Measures:
  • overall response rate [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    for the entire population after up to 8 cycles of response-adapted sequential therapy

  • response [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    will be tabulated after the completion of cycle four and cycle eight (for those who would have completed 8 cycles), and the overall response rate for the entire population after up to eight cycles will be estimated and compared to the responses reported in the phase II study by Richardson et al. using the 3-drug-combination.

  • toxicity [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
    Before each drug dose, the patient will be evaluated for possible toxicities that may have occurred after the previous dose(s). Toxicities are to be assessed according to the NCI Common Toxicity Criteria for Adverse Events (CTCAE), Version 4.0.

  • quality of life (QOL) [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    QoL will be assessed in this study using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30) and its corresponding multiple myeloma module (EORTC QLQ-MY20).

  • progression-free survival (PFS) [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    will be estimated for all patients using Kaplan-Meier methodology. This analysis will include all patients regardless of their transplantation status.

  • Characterization of genomic mutations of targetable genes [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  • Characterization of immunomodulatory checkpoint pathways in multiple myeloma [ Time Frame: 2 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 28
Study Start Date: August 2013
Estimated Primary Completion Date: August 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Patients with Multiple Myeloma
This is a phase II, single center clinical trial designed to evaluate the response rate and toxicity of a response-adapted, sequential therapy, using bortezomib and dexamethasone, followed by the addition of lenalidomide in non-responders, in patients with untreated MM.
Drug: Bortezomib
Bortezomib SC (or IV if SC not tolerated) 1.3 mg/m2, days 1, 4, 8, and 11
Drug: Dexamethasone
Dexamethasone 40 mg PO or IV days 1, 4, 8, and 11 or on a split-dose regimen.
Drug: Lenalidomide
Lenalidomide may be added to the patient's regimen at any time if there is evidence of hematologic disease progression

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age 18 or greater at the time of signing the informed consent document.

    • Patients diagnosed with symptomatic multiple myeloma based on IMWG Diagnostic Criteria. According to these criteria, patient must have

    • Monoclonal plasma cells in the bone marrow ≥ 10% and/or presence of a biopsy-proven bony or extramedullary plasmacytoma and any one or more of the following myeloma defining events:
    • Clonal bone marrow plasma cell percentage ≥ 60% (Note: clonality should be established by showing kappa/lambda-light-chain restriction on flow cytometry, immunohistochemistry, or immunofluorescence. Bone marrow plasma cell percentage should preferably be estimated from a core biopsy specimen; in case of a disparity between the aspirate, the highest value should be used)
    • Involved:Uninvolved serum free light chain ratio ≥ 100 (values are based on the serum Freelite assay) The involved free light chain must be ≥ 10 mg/dL >1 focal lesions on MRI studies (each focal lesion must be 5 mm or more in size)
    • [C] Calcium elevation in the blood, defined as serum calcium >11 mg/dl or > 1 mg/dL higher than the upper limit of normal
    • [R] Renal insufficiency, defined as serum creatinine > 2 mg/dl or creatinine clearance < 40 mL/min
    • [A] Anemia, defined as hemoglobin <10 g/dl or > 2 g/dl below the lower limit of normal
    • [B] Lytic bone lesions or osteoporosis. one or more osteolytic lesions on skeletal radiography, CT, or PET-CT (if bone marrow has less than 10% clonal plasma cells, more than one bone lesion is required to distinguish from solitary plasmacytoma with minimal marrow involvement)
  • Patients must have symptomatic multiple myeloma without advanced organ damage (such as multiple fractures or advanced bone disease causing immobilization, renal failure, spinal cord compression, or organ compromise due to soft tissue plasmacytoma). If immediate therapy with radiation and high-dose steroids (eg, for spinal cord compression) or if triple therapy is clearly advisable from the start, the patient is not eligible for this trial.
  • Patients with measurable disease defined as one or more of the following: serum M protein ≥ 1.0 g/dl, urine M-protein ≥ 200 mg/24h, and/or serum FLC assay: involved FLC level ≥ 10 mg/dl with abnormal serum FLC ratio.
  • Only non transplant candidates or those who opt to forgo ASCT during first line therapy are eligible
  • ECOG performance status ≤ 2
  • Female patients must:

    • be postmenopausal for at least 1 year before the Screening visit, OR
    • be surgically sterile, OR
    • If they are of childbearing potential, agree to practice 2 effective methods of contraception, at the same time, from the time of signing the informed consent through 30 days after the last dose of study treatment, OR agree to completely abstain from heterosexual intercourse
  • Male patients, even if surgically sterilized (ie, status post-vasectomy), must:

    • Agree to practice effective barrier contraception during the entire study treatment period and through 30 days after the last dose of study treatment, OR
    • Agree to completely abstain from heterosexual intercourse
  • Patients must be able to provide 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.

Exclusion Criteria:

  • Participant treated with any prior systemic therapy with the exception of the following:

    • Treatment by localized radiotherapy for a specific indication within 2 weeks of initiation of treatment.
    • Treatment with corticosteroids, not to exceed the equivalent of 160 mg of dexamethasone over a four-week period before initiation of protocol therapy.
  • Presence of Primary or associated amyloidosis (AL)
  • Participants who plan to proceed with ASCT as part of first line therapy
  • Poor tolerability or known allergy to lenalidomide, bortezomib and/or dexamethasone or compounds that have similar chemical or biologic composition to these study drugs.
  • Platelet count < 50,000/mm3 within 21 days of initiation of protocol therapy for patients in whom <50% of bone marrow nucleated cells are plasma cells; or platelet count <30,000/mm3 for patients in whom ≥ 50% of bone marrow nucleated cells are plasma cells. Transfusion is not allowed to meet platelet eligibility criteria.
  • ANC < 1,000 cells/mm3 within 21 days of initiation of protocol therapy. Growth factor administration is not allowed to meet ANC eligibility criteria.
  • Hemoglobin < 8 g/dL within 21 days of initiation of protocol therapy. Transfusion may be used to meet hemoglobin eligibility criteria.
  • Hepatic impairment, defined as bilirubin > 1.5 x institutional upper limit of normal (ULN) Patients with benign hyperbilirubinemia (e.g., Gilbert's syndrome) are eligible or AST (SGOT), or ALT (SGPT), or alkaline phosphatase ≥ to 2 x ULN, within 21 days of initiation of protocol therapy.
  • Renal insufficiency, defined as creatinine clearance < 30 ml/min within 21 days of initiation of protocol therapy. Creatinine clearance will be the primary eligibility criteria in determining renal insufficiency. The Cockcroft-Gault formula.
  • Active hepatitis B or C infection
  • HIV 1 or 2 positivity
  • Female participant who is pregnant or breast-feeding.
  • Inability to comply with an anti-thrombotic treatment regimen (e.g., administration of aspirin, enoxaparin, or low molecular weight heparin administration).
  • Peripheral neuropathy ≥ Grade 2 on clinical examination, within 21 days of initiation of protocol therapy.
  • Participant who had myocardial infarction within 6 months prior to enrollment or has New York Heart Association (NYHA) Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities.
  • Participant who has hypersensitivity to bortezomib, boron, or mannitol.
  • Serious medical or psychiatric illness likely to interfere with participation in this clinical study.
  • Participant 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. Patients who have had prior malignancies within the past 2 years but are considered to be "cured" with a low likelihood of recurrence may be eligible at the discretion of the Principal Investigator.
  • Any other medical condition or laboratory evaluation that, in the treating physician's or principle investigator's opinion, makes the patient unsuitable to participate in this clinical trial.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01919086

Contacts
Contact: Hani Hassoun, MD 212-639-3228
Contact: Heather Landau, MD 212-639-8808

Locations
United States, New Jersey
Memoral Sloan Kettering Cancer Center Recruiting
Basking Ridge, New Jersey, United States
Contact: Hani Hassoun, MD    212-639-3228      
United States, New York
Memorial Sloan Kettering Cancer Center @ Suffolk Recruiting
Commack, New York, United States, 11725
Contact: Hani Hassoun, MD    212-639-3228      
Memorial Sloan Kettering Cancer Center Recruiting
New York, New York, United States, 10065
Contact: Hani Hassoun, MD    212-639-3228      
Contact: Heather Landau, MD    212-639-8808      
Principal Investigator: Hani Hassoun, MD         
Memorial Sloan Kettering at Mercy Medical Center Recruiting
Rockville Centre, New York, United States
Contact: Hani Hassoun, MD    212-639-3228      
Memoral Sloan Kettering Cancer Center at Phelps Recruiting
Sleepy Hollow, New York, United States, 10591
Contact: Hani Hassoun, MD    212-639-3228      
Memorial Sloan Kettering West Harrison Recruiting
West Harrison, New York, United States, 10604
Contact: Hani Hassoun, MD    212-639-3228      
Principal Investigator: Hani Hassoun, MD         
Sponsors and Collaborators
Memorial Sloan Kettering Cancer Center.
Millennium Pharmaceuticals, Inc.
Investigators
Principal Investigator: Hani Hassoun, MD Memorial Sloan Kettering Cancer Center.
  More Information

Additional Information:
No publications provided

Responsible Party: Memorial Sloan Kettering Cancer Center.
ClinicalTrials.gov Identifier: NCT01919086     History of Changes
Other Study ID Numbers: 13-064
Study First Received: August 7, 2013
Last Updated: March 11, 2015
Health Authority: United States: Institutional Review Board

Keywords provided by Memorial Sloan Kettering Cancer Center.:
Bortezomib
Dexamethasone
Lenalidomide
13-064

Additional relevant MeSH terms:
Multiple Myeloma
Neoplasms, Plasma Cell
Blood Protein Disorders
Cardiovascular Diseases
Hematologic Diseases
Hemorrhagic Disorders
Hemostatic Disorders
Immune System Diseases
Immunoproliferative Disorders
Lymphoproliferative Disorders
Neoplasms
Neoplasms by Histologic Type
Paraproteinemias
Vascular Diseases
BB 1101
Bortezomib
Dexamethasone
Dexamethasone 21-phosphate
Dexamethasone acetate
Lenalidomide
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Anti-Inflammatory Agents
Antiemetics
Antineoplastic Agents
Antineoplastic Agents, Hormonal
Autonomic Agents
Central Nervous System Agents
Enzyme Inhibitors
Gastrointestinal Agents

ClinicalTrials.gov processed this record on March 26, 2015