Myelodysplastic Syndrome Clinical Trial
Official title:
Phase I Trial of Systemic Administration of Vesicular Stomatitis Virus Genetically Engineered to Express NIS and Human Interferon, in Patients With Relapsed or Refractory Multiple Myeloma, Acute Myeloid Leukemia, Lymphomas, or Histiocytic/Dendritic Cell Neoplasms
Verified date | April 2024 |
Source | Mayo Clinic |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This phase I trial studies the best dose and side effects of recombinant vesicular stomatitis virus carrying the human NIS and IFN beta genes (VSV-hIFNbeta-sodium iodide symporter [NIS]) with or without cyclophosphamide or ipilimumab and nivolumab or cemiplimab in treating patients with multiple myeloma, acute myeloid leukemia (AML) or lymphoma that has come back or does not respond to treatment. A virus, called VSV-hIFNbeta-NIS, which has been changed in a certain way, may be able to kill cancer cells without damaging normal cells. Cyclophosphamide is in a class of medications called alkylating agents. It works by damaging the cell's DNA and may kill cancer cells. It may also lower the body's immune response. Immunotherapy with ipilmumab and nivolumab or cemiplimab may induce changes in body's immune system and may interfere with the ability of tumor cells to grow and spread. Giving VSV-hIFNbeta-NIS and ruxolitinib phosphate may work better at treating multiple myeloma, acute myeloid leukemia and T-cell lymphoma.
Status | Recruiting |
Enrollment | 120 |
Est. completion date | April 1, 2032 |
Est. primary completion date | December 31, 2028 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Age >= 18 years - Relapsed or refractory: - Groups A, B, C or D: Multiple myeloma (MM) previously treated with an immunomodulatory imide drug (IMID), a proteosome inhibitor, and an alkylating agent - Groups A, B, C only: Relapsed peripheral T-cell lymphoma (PTCL) of the following histologies: peripheral T-cell lymphoma-NOS (PTCL-NOS); angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell (ALCL), and mycosis fungoides (MF). Patients should have failed standard therapy and in the case of PTCL-NOS, AITL, and ALCL either have failed or be ineligible for high-dose therapy with autologous stem cell transplant - Group B and C only: B-cell lymphoma (other than Burkitt's lymphoma), or histiocytic/dendritic cell neoplasms (HCN) at any stage - Group E only: Relapsed peripheral T-cell lymphoma (PTCL) of the following histologies: peripheral T-cell lymphoma-NOS (PTCL-NOS); anaplastic large cell (ALCL), and mycosis fungoides (MF) - Group F only: Expansion Cohort for B-cell lymphoma (other than Burkitt's lymphoma) with low tumor burden - Group G only: Expansion Cohort for peripheral T cell lymphoma (PTCL) with low tumor burden - Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2 times upper limit of normal (ULN) (obtained =< 15 days prior to registration) - Creatinine =< 2.0 mg/dL (obtained =< 15 days prior to registration) - Direct bilirubin =< 1.5 x ULN (obtained =< 15 days prior to registration) - International normalized ratio (INR)/prothrombin time (PT) and activated partial thromboplastin time (aPTT) =< 1.5 x ULN (obtained =< 15 days prior to registration) - If baseline liver disease, Child Pugh score not exceeding class A (obtained =< 15 days prior to registration) - Negative pregnancy test for persons of child-bearing potential (obtained =< 15 days prior to registration) - FOR MULTIPLE MYELOMA ONLY: Measurable disease of multiple myeloma as defined by at least ONE of the following: - Serum monoclonal protein >= 1.0 g/dL by protein electrophoresis - >= 200 mg of monoclonal protein in the urine on 24-hour electrophoresis - Serum immunoglobulin free light chain >= 10 mg/dL AND abnormal serum immunoglobulin kappa to lambda free light chain ratio - FOR MULTIPLE MYELOMA ONLY: Absolute neutrophil count (ANC) >= 1000/uL (obtained =< 14 days prior to registration) - FOR MULTIPLE MYELOMA ONLY: Platelet (PLT) >= 100,000/uL (obtained =< 14 days prior to registration) - FOR MULTIPLE MYELOMA ONLY: Hemoglobin >= 8.5 g/dl (obtained =< 14 days prior to registration) - FOR AML ONLY: No ANC restriction (obtained =< 14 days prior to registration) - FOR AML ONLY: PLT >= 10,000/uL (transfusion to get platelets >= 10,000 is allowed) (obtained =< 14 days prior to registration) - FOR AML ONLY: Hemoglobin >= 7.5 g/dl (obtained =< 14 days prior to registration) - FOR AML ONLY: Absence of uncompensated disseminated intravascular coagulation (DIC- as diagnosed by standard International Society on Thrombosis and Hemostasis [ISTH] criteria) - FOR TCL/BCL ONLY: ANC >= 1,000/uL (obtained =< 14 days prior to registration) - FOR TCL/BCL ONLY: PLT >= 100,000/uL (obtained =< 14 days prior to registration) - FOR TCL/BCL ONLY: Hemoglobin >= 8.5 g/dl (obtained =< 14 days prior to registration) - FOR TCL/BCL ONLY: Measurable disease by CT or magnetic resonance imaging (MRI): must have at least one lesion that has a single diameter of > 2 cm or tumor cells in the blood > 5 x 10^9/L; NOTE: skin lesions can be used if the area is > 2 cm in at least one diameter and photographed with a ruler and the images are available in the medical record - FOR HCN ONLY: ANC >= 1,000/uL obtained =< 15 days prior to registration - FOR HCN ONLY: PLT >= 100,000/uL obtained =< 15 days prior to registration - FOR HCN ONLY: Hemoglobin >= 8.0 g/dl obtained =< 15 days prior to registration - FOR HCN ONLY: Measurable disease by CT or MRI: Must have at least one lesion that has a single diameter of >= 1.5 cm or tumor cells in the blood >5 x10^9/L. NOTE: Skin lesions can be used if the area is >= 1.5 cm in at least one diameter and photographed with a ruler and the images are available in the medical record - Absence of active central nervous system (CNS) involvement; NOTE: pre-enrollment lumbar puncture not mandatory - Ability to provide written informed consent - Willingness to return to Mayo Clinic for follow-up - Life expectancy >= 12 weeks - Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1, or 2 - Willing to provide mandatory biological specimens for research purposes Exclusion Criteria: - Availability of and patient acceptance of curative therapy - Uncontrolled infection - Active tuberculosis or hepatitis, or chronic hepatitis - Any of the following prior therapies: - Chemotherapy (IMIDs, alkylating agents, proteosome inhibitors) =< 2 weeks prior to registration - Immunotherapy (monoclonal antibodies) =< 4 weeks prior to registration - Experimental agent in case of AML or TCL within 4 half-lives of the last dose of the agent - New York Heart Association classification III or IV, known symptomatic coronary artery disease, or symptoms of coronary artery disease on systems review, or known cardiac arrhythmias (atrial fibrillation or supraventricular tachycardia [SVT]) - Active CNS disorder or seizure disorder or known CNS disease or neurologic symptomatology; in case of AML active CNS involvement as detected by lumbar puncture or neuro-imaging (only to be done if clinically indicated) - Human immunodeficiency virus (HIV) positive test result or other immunodeficiency or immunosuppression - Other concurrent chemotherapy, immunotherapy, radiotherapy, or any ancillary therapy considered investigational (used for a non-Food and Drug Administration [FDA] approved indication and in the context of a research investigation); - NOTE: in AML, the concurrent use of hydroxyurea to help control proliferative counts is allowed throughout the treatment protocol; - NOTE: in TCL, patients may use topical emollients or corticosteroids, acetic acid soaks, etc. to control pruritis and prevent infection; no topical chemotherapy is allowed (no topical nitrogen mustard) - Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown: - Pregnant women or women of reproductive ability who are unwilling to use effective contraception - Nursing women - Men who are unwilling to use a condom (even if they have undergone a prior vasectomy) while having intercourse with any woman, while taking the drug and for 4 weeks after stopping treatment - AML ONLY: Current disseminated intravascular coagulopathy (DIC) - ADDITIONAL EXCLUSION CRITERIA FOR GROUP A (LOW TUMOR BURDEN) ONLY: - Diagnosis of AML - Multiple myeloma only: > 25% plasma cells or plasmacytoma > 5cm in largest diameter - Lymphoma or HCN only: Any mass >5cm - Diagnosis of Burkitt's lymphoma - ADDITIONAL EXCLUSION CRITERIA FOR GROUP B (HIGH TUMOR BURDEN) ONLY: - Diagnosis of AML - Diagnosis of Burkitt's lymphoma - ADDITIONAL EXCLUSION CRITERIA FOR GROUP C (COMBINATION WITH CYCLOPHOSPHAMIDE) ONLY: - Diagnosis of AML - Diagnosis of Burkitt's lymphoma - ADDITIONAL EXCLUSION CRITERIA FOR GROUP D AND E (COMBINATION WITH IPILIMUMAB AND NIVOLUMAB OR CEMIPLIMAB) ONLY: - Diagnosis of AML - Diagnosis of AITL - Hypersensitivity to ipilimumab or its excipients - ADDITIONAL EXCLUSION CRITERIA FOR GROUP F (BCL EXPANSION COHORT) ONLY: - Diagnosis of Burkitt's lymphoma - ADDITIONAL EXCLUSION CRITERIA FOR GROUP G (PTCL EXPANSION COHORT) ONLY: - Diagnosis of cutaneous TCL |
Country | Name | City | State |
---|---|---|---|
United States | Mayo Clinic in Rochester | Rochester | Minnesota |
United States | Mayo Clinic in Arizona | Scottsdale | Arizona |
Lead Sponsor | Collaborator |
---|---|
Mayo Clinic | National Cancer Institute (NCI) |
United States,
Cook J, Peng KW, Witzig TE, Broski SM, Villasboas JC, Paludo J, Patnaik M, Rajkumar V, Dispenzieri A, Leung N, Buadi F, Bennani N, Ansell SM, Zhang L, Packiriswamy N, Balakrishnan B, Brunton B, Giers M, Ginos B, Dueck AC, Geyer S, Gertz MA, Warsame R, Go — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Biodistribution and kinetics of virus spread | Assessed by single photon emission computed tomography (SPECT)/computed tomography (CT) imaging. Descriptive statistics and scatterplots will form the basis of presentation of these variables. Correlations between the laboratory values and other outcome measures will be carried out by standard parametric and non-parametric tests (e.g., Pearson's and Spearman's rho). Will be correlated with tumor distribution. | Up to 2 years | |
Other | NIS gene expression in tumor samples | Assessed by single photon emission computed tomography (SPECT)/computed tomography (CT) imaging. Descriptive statistics and scatterplots will form the basis of presentation of these variables. Correlations between the laboratory values and other outcome measures will be carried out by standard parametric and non-parametric tests (e.g., Pearson's and Spearman's rho). Will be correlated with tumor distribution. | Up to 2 years | |
Primary | Incidence of adverse events of grade 3 or higher | Assessed by the Common Terminology Criteria for Adverse Events version 4.0. The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed to determine patterns (by cohort and overall). Additionally, the relationship of the adverse event(s) to the study treatment will be taken into consideration. The rate of grade 3 or higher non-hematologic adverse events, and the rate of grade 4 or higher adverse event (hematologic and non-hematologic) will be computed each with a 95% exact binomial confidence. | Up to 2 years | |
Secondary | Clinical response | The number of responses (complete response [CR], very good partial response, partial response [PR], or minimal response for multiple myeloma; CR, CR with incomplete recovery, cytogenetic complete response, PR for acute myeloid leukemia [AML]; CR or PR for T-cell lymphoma [TCL]) will be summarized by simple descriptive summary statistics. | Up to 2 years | |
Secondary | Progression-free survival | The distribution of survival time will be estimated using the method of Kaplan-Meier (overall, by dose level, and by disease type). | From registration to disease progression or death due to any cause, assessed up to 2 years | |
Secondary | Overall survival | The distribution of survival time will be estimated using the method of Kaplan-Meier (overall, by dose level, and by disease type). | From registration to death due to any cause, assessed up to 2 years |
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