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Clinical Trial Summary

This phase 2 study ain to evaluate the efficacy of Isatuximab plus Pomalidomide and Dexamethasone (IPd), in patients with AL amyloidosis not in VGPR or better after any previous therapy. It will enrolled 46 patients (34 in France and 12 in Australia) through 15 sites (11 in France and 4 in Australia).

Clinical Trial Description

Systemic AL amyloidosis is a rare disease caused by the deposition of misfolded monoclonal immunoglobulin free light chains (FLC) in various tissues and organs. It is usually associated with a clonal plasma cell dyscrasia with a low tumor burden. Treatment of AL amyloidosis relies mainly on chemotherapy aimed at suppressing the underlying plasma cell clone secreting monoclonal FLC. The organ responses and the survival are greatly influenced by the degree of hematological response evaluated by the decrease in serum FLC that has been the principal endpoint in recent trials in AL amyloidosis. The goal of treatment is to reach at least a very good partial response (VGPR) defined as a difference between the involved FLC and the normal one below 40 mg/L. Over the last 5 years, monoclonal antibodies (mAb) as daratumumab and Isatuximab (anti CD38 mAb) has emerged as a breakthrough targeted therapies for patients with multiple myeloma (MM). CD38, is a type II transmembrane glycoprotein that functions both as a signal-transducing receptor and a multifunctional ectoenzyme. The expression of CD38 is increased in MM and AL amyloidosis plasma cells. Daratumumab (DARA) is an IgG 1k human mAb that received initial approval as monotherapy in patients with heavily pretreated RRMM and who were refractory to proteasome inhibitors (PIs) and immunomodulatory drugs (IMiD®). DARA has since been approved in combination with Lenalidomide/Dexamethasone1,2 and Bortezomib/Dexamethasone3,4 for the treatment of frontline and relapsed/refractory (RR) MM patients. IFM and other groups previously demonstrated that DARA in monotherapy is safe and effective in relapsed AL amyloidosis patients5. Our prospective phase II study showed that about 70 to 80% of patients have a response but only around 50% reached a VGPR. DARA activity could be increased with IMiD® as treating plasma cells with IMiD®, such as pomalidomide or lenalidomide, has been shown to increase the expression of CD38 levels on the surface of these cells. In AL amyloidosis, the Italian and the British groups demonstrated that pomalidomide is very effective and better tolerated than lenalidomide especially in patients with renal insufficiency6,7. The dose of pomalidomide (4 mg) was like the dose used in MM. Combining an anti CD38 mAb to pomalidomide could therefore be an attractive regimen for relapsed AL amyloidosis patients. Isatuximab (ISA) is another IgG1 κ mAb that binds selectively to a unique epitope on the human CD38 receptor and has anti plasma cells activity via multiple mechanisms of action. In a previous phase 1b study, around 65% of patients with relapsed and refractory multiple myeloma achieved an overall response with a combination of Isatuximab with Pomalidomide and low-dose Dexamethasone. The addition of Isatuximab to Pomalidomide-Dexamethasone was used in a large phase III study in RRMM8. Safety profile was also favorable, and these results granted an approval of the combination of ISA plus Pomalidomide (4 mg) and Dexamethasone in these patients. ;

Study Design

Related Conditions & MeSH terms

NCT number NCT05066607
Study type Interventional
Source Intergroupe Francophone du Myelome
Contact Cécile DEAL
Phone 01 40 21 24 01
Email [email protected]
Status Not yet recruiting
Phase Phase 2
Start date December 2021
Completion date August 2024

See also
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Completed NCT02632786 - The PRONTO Study, a Global Phase 2b Study of NEOD001 in Previously Treated Subjects With Light Chain (AL) Amyloidosis Phase 2
Completed NCT02841033 - Daratumumab for the Treatment of Patients With AL Amyloidosis Phase 1/Phase 2
Active, not recruiting NCT04304144 - A Study to Evaluate the Safety and Tolerability of CAEL-101 in Patients With AL Amyloidosis Phase 2
Recruiting NCT01408225 - Ohio State University Multiple Myeloma and Amyloidosis Data Registry and Sample Resource
Recruiting NCT04895917 - Daratumumab and Pomalidomide in Previously Treated Patients With AL Amyloidosis Phase 2
Terminated NCT02489500 - Trial of High Dose Melphalan/Stem Cell Transplant With or Without Bortezomib Phase 3
Completed NCT01570387 - A Phase I/II Trial of Pomalidomide and Dexamethasone in Subjects With Previously-Treated AL Amyloidosis Phase 1/Phase 2
Terminated NCT03154047 - Study in Subjects With Light Chain (AL) Amyloidosis Phase 2
Recruiting NCT03236792 - Ixazomib In Combination With Cyclophosphamide And Dexamethasone for Newly Diagnosed AL Amyloidosis Phase 1/Phase 2
Recruiting NCT04392960 - Novel Imaging Tools in Newly-diagnosed Patients With Cardiac AL Amyloidosis N/A
Enrolling by invitation NCT04210791 - Autologous Stem Cell Transplantation for Patients With AL Amyloidosis
Terminated NCT03000660 - Trial of Venetoclax (ABT-199) and Dexamethasone for Relapsed or Refractory Systemic AL Amyloidosis Phase 1
Completed NCT01222260 - Bendamustine and Dexamethasone in Patients With Relapsed AL Amyloidosis Phase 2
Completed NCT01277016 - A Trial for Systemic Light-chain (AL) Amyloidosis Phase 3
Recruiting NCT04839003 - A Registry of AL Amyloidosis (ReAL)
Recruiting NCT04617925 - A Study of Belantamab Mafodotin in Patients With Relapsed or Refractory AL Amyloidosis Phase 2