A Clinical Study of Melphalan Flufenamide (Melflufen) and Dexamethasone for Patients With Immunoglobulin Light Chain (AL) Amyloidosis

AL Amyloidosis Clinical Trial

Official title:

An Open-Label, Phase 1/2 Study of Melflufen and Dexamethasone for Patients With AL Amyloidosis Following at Least One Prior Line of Therapy

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT04115956
• Other study ID #: OP201
• Status: Terminated
• Phase: Phase 1
• Start date: August 6, 2020
• Est. completion date: January 5, 2022

Study information

• Verified date: February 2022
• Source: Oncopeptides AB
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a phase 1/2 open label study of melphalan flufenamide (melflufen) in combination with dexamethasone for participants with Al amyloidosis following at least one prior line of therapy. Melflufen will be administered on Day 1 of each 28-day cycle in combination with dexamethasone on days 1 and 2. In both phases, treatment of each individual participant will continue for up to 8 cycles or until any stopping events occur. Approximately 46 participants will be enrolled. The study was intended to be a Phase 1/2 trial but was early terminated and never moved forward to Phase 2.

Description:

This is a clinical trial of melphalan flufenamide (melflufen), a peptide-conjugated alkylator which belongs to an novel class of drugs called peptidase-enhanced compounds, and targets the transformation process of tumor cells with a unique mechanism of action, as potential treatment option of AL amyloidosis. AL amyloidosis is a rare progressive disease caused by proteotoxic light chain protein produced by small plasma cell clone. This plasma cell dyscrasia is characterized by monoclonal plasma cell's excessive production of monoclonal immunoglobulin light-chains that tends to misfold and subsequently deposit as amyloid fibrils in visceral organs. The plasma cell dyscrasia in AL amyloidosis is similar to that in multiple myeloma (MM) and therapies that are effective in MM are often used to treat AL amyloidosis. Melphalan flufenamide is currently been evaluated in several ongoing clinical trials in patients with multiple myeloma, with observed efficacy. There are currently no therapies approved for treatment of AL amyloidosis and based on the efficacy of melphalan flufenamide and the demonstrated efficacy of melphalan (and other alkylators), it is anticipated that patients with AL amyloidosis may receive benefit from treatment with melphalan flufenamide. This study consist of a screening period (up to 28 days), a treatment period (up to 8 cycles) and a follow-up period (up to 24 months). Phase 1: Approximately 8-30 participants will be screened to achieve 7-23 enrolled participants. Phase 2: Approximately 30 participants will be screened to achieve 23 enrolled participants. The study was intended to be a Phase 1/2 trial but was early terminated and study never moved forward to Phase 2.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 6
• Est. completion date: January 5, 2022
• Est. primary completion date: January 5, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria: (For full list of inclusion criteria, see study protocol)

• Male or female, age 18 years or older at the time of signing the informed consent
• Proven histochemical diagnosis of AL amyloidosis based on tissue specimens with Congo red staining
• At least one prior line of therapy, defined as either one non-transplant regimen, one ASCT (autologous stem cell transplantation), or one regimen of induction therapy followed by a single ASCT. No more that 4 cycles of melphalan containing chemotherapy is allowed.
• Measurable hematologic disease
• Objectively measurable organ amyloid involvement
• ECOG performance status = 2 (ECOG = Eastern cooperative oncology group)
• Women of child bearing potential must have a negative serum or urine pregnancy test
• Less than 30% plasma cells in bone marrow aspirate or biopsy
• Acceptable laboratory results met (absolute neutrophil count (ANC), platelet count, hemoglobin, total bilirubin,alkaline phosphatase, AST (aspartate aminotransferase) and ALT (alanine aminotransferase), renal function)
• Male participant agrees to use contraception during treatment and 90 days after last dose of melflufen Exclusion Criteria: (For full list of exclusion criteria, see study protocol)
• Amyloidosis due to known mutations of the transthyretin gene or presence of another non-AL amyloidosis
• Evidence of gastro-intestinal bleeding
• Cardiac risk stage 3
• Low platelets value with evidence of mucosal or internal bleeding
• Medical documented cardiac syncope, NYHA Class 3 or 4 congestive heart failure, myocardial infarction, unstable angina pectoris, clinically significant ventricular arrhythmias (NYHA=New York Heart Association Functional Classification)
• Clinically significant finding on 24 h Holter recording
• Severe orthostatic hypotension
• Clinically significant factor X deficiency
• Clinically significant autonomic disease
• Any medical condition that would impose excessive risk to the patient
• Serious psychiatric illness, active alcoholism or drug addiction that may hinder or confuse compliance
• Known HIV or active hepatitis B or C viral infections
• Previous cytotoxic therapies, including cytotoxic investigational agents within 3 weeks prior to start of study treatment. Monoclonal antibodies within 4 weeks. Concomitant immunotherapy, investigational therapy and anticoagulation therapy are not permitted
• Prior autologous or allogenic stem cell transplant within 12 weeks of initiation of therapy
• Prior allogeneic stem cell transplant with active graft-host-disease
• Prior major surgical procedure or radiation therapy within 4 weeks of the first dose of study treatment

Related Conditions & MeSH terms

• AL Amyloidosis
• Amyloidosis
• Immunoglobulin Light-chain Amyloidosis

Intervention

Drug:
• Melphalan-Flufenamide (Melflufen)
Treatment consist of i.v. melflufen on Day 1 of each 28-day cycle.
• Dexamethasone
Dexamethasone 40 mg (20 mg at investigator's discretion) administered on Days 1 and 2 of each 28-day cycle.

Locations

Country	Name	City	State
Czechia	Fakultní Nemocnice Ostrava	Ostrava - Poruba
France	Centre Hospitalier Universitaire de Limoges	Limoges
Germany	Universitätsklinikum Heidelberg	Heidelberg
Greece	Alexandra General Hospital of Athens	Athen
Israel	Hadassah University Hospital Ein Kerem	Jerusalem
Norway	Oslo University Hospital - Rikshospitalet	Oslo
Spain	Hospital Clinic de Barcelona	Barcelona
United Kingdom	University College London Hospitals NHS Foundation Trust	London
United States	Boston University Medical Center	Boston	Massachusetts

Sponsors (2)

Lead Sponsor	Collaborator
Oncopeptides AB	PRA Health Sciences

Countries where clinical trial is conducted

United States,  Czechia,  France,  Germany,  Greece,  Israel,  Norway,  Spain,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The primary objective in Phase 1 is to explore safety and tolerability of melflufen	Endpoints: Frequency and grade of Adverse Events. The maximum grade for each type of AE will be recorded for each participant and frequency tables will be presented and reviewed to determine patterns; Laboratory values (laboratory abnormalities) for hematology, coagulation, blood chemistry, urinalysis	During phase 1 for up to 8 cycles of treatment of 28 days each (approx. up to 8 months)
Primary	The primary objective in Phase 1 is to identify recommended Phase 2 dose (RP2D)	Endpoint: Dose-Limiting Toxicity (DLT) during Cycle 1 up to maximum dose of melflufen of 40 mg. A DLT event is defined as thrombocytopenia, neutropenia, non-hematologic toxicity and/or inability to receive Cycle 2 Day 1 dose within 14 days from planned Cycle 2 Day 2 due to continued melflufen-related toxicity from Cycle 1.	During phase 1 for up to 8 cycles of 28 days each (approx. up to 8 months)
Primary	The primary endpoint in Phase 2 is to evaluate the hematologic overall response rate (ORR) after 4 cycles at the RP2D determined in Phase 1	The proportion of participants who achieve a hematologic Complete Response (CR), Very Good Partial Response (VGPR) or Partial Response (PR)	During phase 2 after 4 cycles of treatment ( approx. 4 months)
Secondary	To assess pharmacokinetic profile of melflufen in this patient population	Melphalan plasma concentration post melflufen administration at 3 time points	At Cycle 1 Day 1 and Cycle 2 Day 1 at time points 5-10 minutes, 1-2 hours and 3-8 hours after end of infusion. Each cycle length is 28 days.
Secondary	To assess best hematologic response	Proportion of patients with each outcome (Complete Response (CR), Very Good Partial Response (VGPR), Partial Response (PR), No Response (NR) or Progressive Disease (PD))	Throughout the study treatment of up to 8 cycles of 28 days each (approx. 8 months) per patient
Secondary	To assess the duration of hematologic response	Median time (Complete Response (CR), Very Good Partial Response (VGPR), Partial Response (PR), No Response (NR) or Progressive Disease (PD))	Throughout the study treatment period of up to 8 cycles of 28 days each (approx 8 months) per patient
Secondary	To assess the proportion of organ system responses	Proportion of participants with kidney, cardiac or liver response, respectively	Throughout the study treatment period of up to 8 cycles of 28 days each (approx 8 months) per patient
Secondary	To assess duration of organ system responses	Duration of organ responses separately for each organ	Throughout the study treatment period of up to 8 cycles (approx 8 months) per patient
Secondary	To assess hematologic ORR (overall response rate)	Proportion of participants who achieve a hematologic CR, VGPR or PR	During phase 1 for up to 8 cycles of treatment of 28 days each (approx. up to 8 months)
Secondary	To assess time to next AL amyloidosis treatment	Time to next AL amyloidosis treatment	Throughout the study, covering up to 8 cycles (approx. 8 months) of treatment and 24 months of follow up
Secondary	To assess Overall Survival (OS)	Overall survival	Throughout the study, covering up to 8 cycles (approx. 8 months) of treatment and up to 24 months of follow up