Filgrastim in Treating Patients With Bortezomib-, Carfilzomib-, or IMID-Refractory Multiple Myeloma

Multiple Myeloma Clinical Trial

Official title:

A Pilot Study of G-CSF to Disrupt the Bone Marrow Microenvironment in Bortezomib-, Carfilzomib-, or IMID-Refractory Multiple Myeloma

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT01537861
• Other study ID #: 201204086
• Status: Terminated
• Phase: Phase 0
• First received: February 15, 2012
• Last updated: January 21, 2015
• Start date: June 2012
• Est. completion date: December 2014

Study information

• Verified date: January 2015
• Source: Washington University School of Medicine
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review BoardUnited States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

Based on the pre-clinical data the investigators hypothesize that G-CSF treatment in patients with multiple myeloma will generate a 'hostile' bone marrow microenvironment for myeloma cells, depriving them of key support signals and rendering them more sensitive to chemotherapy. The investigators therefore propose to do an initial pilot study 1) to explore the safety of the combination of G-CSF and bortezomib-, carfilzomib-, or IMID-based treatment regimens in patients with bortezomib-, carfilzomib-, or IMID-refractory myeloma and 2) to generate correlative data for a subsequent larger study looking at the combination.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 7
• Est. completion date: December 2014
• Est. primary completion date: February 2014
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patient must have a confirmed diagnosis of multiple myeloma. The patient may be any stage of multiple myeloma. The patient may have received one or more lines of prior therapy (there is no limit to number of prior lines of therapy permissible).

• Patient must be =18 years of age

• Patient must be in active treatment with one of the following:

• twice-weekly bortezomib (on Days 1, 4, 8, and 11 of a 21-day cycle) with or without dexamethasone

• carfilzomib (on Days 1, 2, 8, 9, 15, and 16 of a 28-day cycle) with or without dexamethasone

• an IMID with or without dexamethasone daily on Days 1 to 21.

• Patients being treated with bortezomib or carfilzomb may also be receiving an IMID or PO cyclophosphamide with the regimen.

• Patient must have shown stable or progressive disease on the current bortezomib-, carfilzomib-, or IMID-containing regimen with a measurable monoclonal protein component in the serum (at least 0.5 g/dl on electrophoresis or 0.05 g/dl [50mg/dl] on serum-free-light-chain). Patients who had an initial response on the current bortezomib-, carfilzomib-, or IMID-containing regimen but now have stable (plateaued) disease are eligible.

• Patient must have an ECOG performance status of 0 - 2

• Patient must be receiving concurrent treatment with bisphosphonates, with one dose occurring within 30 days prior to first day (Day -3) of protocol treatment

• Patient must have acceptable hematologic parameters, defined as:

• Absolute neutrophil count > 1000 cells/mm3

• Platelets = 50,000 cells/mm3

• Hemoglobin = 8 g/dl

• Patient must have adequate liver function, defined as:

• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) < 3 x upper limit of normal

• Total bilirubin < 2 x upper limit of normal

• Patient must be able to understand and willing to sign a written informed consent document

Exclusion Criteria:

• Patient must not be receiving any agents with known or suspected anti-myeloma activity (other than bortezomib, carfilzomib, dexamethasone, an IMID or PO cyclophosphamide, and bisphosphonates with the current regimen)

• Patient must not be actively using myeloid growth factors

• Patient must not have had any prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, in-situ cervical cancer, or other cancer from which the subject has been disease-free for at least 2 years

• Patient must not have any uncontrolled medical problems such as diabetes mellitus, coronary artery disease, hypertension, unstable angina, arrhythmias, pulmonary disease, and symptomatic heart failure

• Patient must not have neuropathy = grade 3 or painful neuropathy = grade 2 (NCI CTCAE v 4.0)

• Patient must not have any known active infections requiring IV antibiotic, antiviral, or antifungal therapy

• Patient must not be pregnant or breastfeeding

Study Design

Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Multiple Myeloma
• Neoplasms, Plasma Cell

Intervention

Drug:
• Filgrastim

• Bortezomib

• Carfilzomib

• Dexamethasone

• Cyclophosphamide

• Thalidomide

• Lenalidomide

• Pomalidomide

Locations

Country	Name	City	State
United States	Washington University School of Medicine	St. Louis	Missouri

Sponsors (1)

Lead Sponsor	Collaborator
Washington University School of Medicine

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safety of the combination of G-CSF and bortezomib-, carfilzomib-, or IMID-based treatment regimens in patients with refractory multiple myeloma.	Number and grade of adverse events based on NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.	Up to 30 days after last treatment	Yes
Secondary	Effects of G-CSF on bone marrow and bone marrow cytokine and chemokine levels. Including: Quantification of marrow osteoblasts and CAR cells, measurement of SDF-1 (CXCL12), IL-6, BAFF, assessment of myeloma cell proliferation and survival in bone marrow		14 days after last drug treatment	No
Secondary	Response rate as defined by the International Myeloma Working Group (IMWG) criteria		14 days after last drug treatment	No
Secondary	Overall survival duration of patients treated on study	Defined as the date of first dose of study drug to the date of death from any cause.	1 year	No
Secondary	Progression-free survival of patients treated on study	Defined as the interval from the date of first treatment to date of first documentation of disease progression.	1 year	No
Secondary	Duration of response of patients treated on study	Defined as the interval from the date of first documentation of response to the first documentation of disease progression.	1 year	No

External Links

•   Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine