Recurrent Plasma Cell Myeloma Clinical Trial
Official title:
A Phase I Dose Escalation Study of Hydroxychloroquine With Infusional Cyclophosphamide, Pulse Dexamethasone and Rapamycin in Patients With Relapsed or Refractory Multiple Myeloma
This phase I trial studies the side effects and best dose of hydroxychloroquine when given together with cyclophosphamide, dexamethasone, and sirolimus in treating patients with multiple myeloma that has come back after a period of improvement or does not respond to treatment. Biological therapies, such as hydroxychloroquine, may stimulate the immune system in different ways and stop cancer cells from growing. Sirolimus may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cyclophosphamide and dexamethasone, work in different ways to stop the growth of cancer cells, either by killing the cells, stopping them from dividing, or by stopping them from spreading. Giving hydroxychloroquine together with sirolimus, cyclophosphamide, and dexamethasone may be a better treatment for multiple myeloma.
PRIMARY OBJECTIVES:
I. To determine the maximum tolerated dose (MTD) of hydroxychloroquine (HCQ) in combination
with rapamycin (sirolimus) and infusional cyclophosphamide and pulse dexamethasone (cy/dex)
for patients with relapsed/ refractory multiple myeloma.
SECONDARY OBJECTIVES:
I. To evaluate biological activity and efficacy of the combination of cyclophosphamide,
dexamethasone, rapamycin and hydroxychloroquine in patients with relapsed/refractory multiple
myeloma.
II. To determine whether this treatment regimen results in mammalian target of rapamycin
(mTOR) and autophagy inhibition in primary myeloma cells during therapy and if this
corresponds with treatment responses.
OUTLINE: This is a dose-escalation study of hydroxychloroquine.
Patients receive hydroxychloroquine orally (PO) daily on days 1-28 (days 5-28 of course 1),
sirolimus PO on days -2 to 4, and cyclophosphamide intravenously (IV) continuously and
dexamethasone PO on days 1-4. Treatment repeats every 28 days for up to 12 courses in the
absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for 12 months.
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