Bortezomib and Pegylated Liposomal Doxorubicin Hydrochloride in Treating Patients With Previously Untreated Symptomatic Multiple Myeloma

DS Stage II Plasma Cell Myeloma Clinical Trial

Official title:

Phase II Study of Bortezomib (PS-341) and Pegylated Liposomal Doxorubicin as Initial Therapy for Adult Patients With Symptomatic Multiple Myeloma

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00088855
• Other study ID #: NCI-2014-01607
• Secondary ID: NCI-2014-01607NC
• Status: Completed
• Phase: Phase 2
• Start date: June 15, 2004
• Est. completion date: January 8, 2008

Study information

• Verified date: September 2019
• Source: National Cancer Institute (NCI)
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This phase II trial studies the side effects and how well bortezomib and pegylated liposomal doxorubicin hydrochloride work in treating patients multiple myeloma that are experiencing symptoms and have not received prior treatment. Bortezomib and pegylated liposomal doxorubicin hydrochloride may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.

Description:

PRIMARY OBJECTIVE:

I. To evaluate the complete response (CR) + near-complete response (nCR) rate of the bortezomib/pegylated liposomal doxorubicin (pegylated liposomal doxorubicin hydrochloride) regimen in patients with previously untreated, symptomatic multiple myeloma.

II. To evaluate the toxicity of the bortezomib/pegylated liposomal doxorubicin regimen in patients with previously untreated, symptomatic multiple myeloma.

SECONDARY OBJECTIVES:

I. To evaluate the overall response rate, including patients with CR, nCR, and partial response (PR), of the bortezomib/pegylated liposomal doxorubicin regimen in patients with previously untreated, symptomatic multiple myeloma.

II. To evaluate the impact of therapy with the bortezomib/pegylated liposomal doxorubicin regimen on the ability to collect peripheral blood stem cells in those patients going on to subsequent autologous stem cell transplantation.

III. To evaluate the time to progression (TTP) in all patients receiving bortezomib/pegylated liposomal doxorubicin therapy, both those who go on to autologous stem cell transplantation and those who do not go on to transplantation.

IV. To evaluate the value of early changes in levels of serum interleukin 6 (IL-6) and macrophage inflammatory protein 1 alpha (MIP-1α) as predictors of response to bortezomib/pegylated liposomal doxorubicin.

V. To correlate pre-treatment clinical and biological characteristics with response to therapy and toxicity.

OUTLINE:

Patients receive bortezomib intravenously (IV) over 3-5 seconds on days 1, 4, 8, and 11 and pegylated liposomal doxorubicin hydrochloride IV over 1 hour on day 4. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 6 weeks for 2 years and then every 6 months for 3 years.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 55
• Est. completion date: January 8, 2008
• Est. primary completion date: October 31, 2006
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patients must have a histologically confirmed diagnosis of symptomatic multiple myeloma with evaluable disease parameters

• A diagnosis of symptomatic multiple myeloma requires:

• A monoclonal serum and/or urine protein

• Clonal bone marrow plasmacytosis, or a histologically confirmed plasmacytoma

• Related organ or tissue impairment, consisting of:

• Hypercalcemia (serum calcium > 0.25 mmol/l above the upper limit of normal, or > 2.75 mmol/l [i.e. > 11.5 mg/dl]) AND/OR

• Renal insufficiency (serum creatinine > 173 mmol/l [i.e., > 2 mg/dL]); (please note that serum creatinine may not be >= 2.5 mg/dL) AND/OR

• Anemia (hemoglobin 2 g/dl below the lower limit of normal, or hemoglobin < 10 g/dl) AND/OR

• Bony lesions (lytic bony lesions, or osteoporosis with compression fractures) AND/OR

• Other findings, such as symptomatic hyperviscosity, amyloidosis, or recurring bacterial infections (> 2 episodes in 12 months)

• Patients may not have undergone any prior therapy, with the following exceptions:

• Prior plasmapheresis with plasma exchange (PLEX) for a hyperviscosity syndrome is allowed, providing the patient has no current evidence of hyperviscosity and has not required PLEX for at least one week prior to initiation of therapy

• Prior radiation therapy to areas of spinal cord compression by plasmacytomas, painful lesions due to bony involvement, or other myeloma-related indications, is allowed provided that radiation will have been completed 3 weeks before initiation of therapy

• Prior surgical intervention, such as for bony fractures or other myeloma-related complications, is allowed provided that this will have been completed 3 weeks before the initiation of therapy, and patients have recovered from surgery

• Prior therapy with corticosteroids for indications other than multiple myeloma is allowed, provided such therapy has been discontinued at least two weeks prior to study entry, and at least two weeks before their baseline disease evaluation

• Prior supportive therapy with bisphosphonates or erythropoietin is allowed

• Inclusion of females of childbearing potential requires a negative pregnancy test

• Eastern Cooperative Oncology Group (ECOG) performance status =< 2

• Patients may not have a prior history of a hypersensitivity reaction to pegylated liposomal doxorubicin or doxorubicin, bortezomib or other boronic acid-based compounds

• Patients with a history of reactions to liposomal drug formulations other than pegylated liposomal doxorubicin will be evaluated individually, and if their reactions were felt to have been due to the liposomal component itself, as opposed to the encapsulated agent, they will be excluded at the discretion of the investigators

• Patients who are known to be human immunodeficiency virus (HIV)-seropositive and are taking anti-retrovirals may not participate in this study; patients who are HIV-seropositive and not on anti-retroviral therapy, and who otherwise meet the organ function criteria, will be eligible for the study

• Patients who are known to have active hepatitis A, B, or C viral infection may not participate in this study

• No electrocardiogram (EKG) evidence of acute ischemia

• No EKG evidence of medically significant conduction system abnormalities

• No history of myocardial infarction within the last 6 months

• Left ventricular ejection fraction (LVEF) must be >= 45% by either echocardiography or radionuclide-based multiple gated acquisition (radionuclide ventriculography [RNV] or multiple gate acquisition scan [MUGA])

• No class 3 or class 4 New York Heart Association congestive heart failure

• Creatinine < 2.5 mg/dL

• Alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) and aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) =< 2.5 times the upper limit of the institutional normal value

• Total bilirubin =< 1.2 times the upper limit of the institutional normal value

• Absolute neutrophil count (ANC) >= 1,000/ul

• Platelets >= 100,000/ul

• Hemoglobin >= 8 g/dl (transfusion- and/or growth factor-dependent patients are not excluded if the above parameters can be achieved with such support)

• For those patients receiving warfarin (Coumadin), unfractionated heparin, or low-molecular weight heparin therapy, the applicable coagulation parameter that is being monitored must be within the accepted therapeutic ranges for those indications

Related Conditions & MeSH terms

• DS Stage I Plasma Cell Myeloma
• DS Stage II Plasma Cell Myeloma
• DS Stage III Plasma Cell Myeloma
• Multiple Myeloma
• Neoplasms, Plasma Cell

Intervention

Drug:
• Bortezomib
Given IV

Other:
• Laboratory Biomarker Analysis
Correlative studies

Drug:
• Pegylated Liposomal Doxorubicin Hydrochloride
Given IV

Locations

Country	Name	City	State
United States	Central Vermont Medical Center/National Life Cancer Treatment	Berlin	Vermont
United States	Walter Reed National Military Medical Center	Bethesda	Maryland
United States	Roswell Park Cancer Institute	Buffalo	New York
United States	University of Vermont and State Agricultural College	Burlington	Vermont
United States	UNC Lineberger Comprehensive Cancer Center	Chapel Hill	North Carolina
United States	Novant Health Presbyterian Medical Center	Charlotte	North Carolina
United States	University of Chicago Comprehensive Cancer Center	Chicago	Illinois
United States	Danville Regional Medical Center	Danville	Virginia
United States	Holy Cross Hospital	Fort Lauderdale	Florida
United States	Greenville Health System Cancer Institute-Eastside	Greenville	South Carolina
United States	Jupiter Medical Center	Jupiter	Florida
United States	Lenoir Memorial Hospital	Kinston	North Carolina
United States	Mount Sinai Medical Center	Miami Beach	Florida
United States	Minneapolis VA Medical Center	Minneapolis	Minnesota
United States	Palo Alto Medical Foundation-Camino Division	Mountain View	California
United States	Christiana Care Health System-Christiana Hospital	Newark	Delaware
United States	AdventHealth Orlando	Orlando	Florida
United States	Kansas City NCI Community Oncology Research Program	Prairie Village	Kansas
United States	Frisbie Hospital	Rochester	New Hampshire
United States	Center for Cancer Care and Research	Saint Louis	Missouri
United States	Missouri Baptist Medical Center	Saint Louis	Missouri
United States	Washington University School of Medicine	Saint Louis	Missouri
United States	MedStar Georgetown University Hospital	Washington	District of Columbia
United States	MedStar Washington Hospital Center	Washington	District of Columbia
United States	Wake Forest University Health Sciences	Winston-Salem	North Carolina

Sponsors (1)

Lead Sponsor	Collaborator
National Cancer Institute (NCI)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	CR+nCR rate	Will be estimated with an exact 90% confidence interval.	After 18 weeks (6 courses of treatment)
Secondary	CR+nCR+PR rate	Will be estimated with an exact 90% confidence interval.	After 18 weeks (6 courses of treatment)
Secondary	Maximal response rate		After 18 weeks (6 courses of treatment)
Secondary	Incidence of adverse events, graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0	Toxicities will be tabulated by type and grade.	Up to 5 years
Secondary	Progression-free survival	Will be estimated using the Kaplan-Meier method.	From on-study date to the date of progression or death, whichever comes first, assessed up to 5 years
Secondary	Overall survival	Will be estimated using the Kaplan-Meier method.	From on-study date to the date of death, assessed up to 5 years
Secondary	Changes in IL-6 and MIP-1	The association of response with pre-treatment characteristics such as cytogenetics and fluorescence in situ hybridization and with early changes in IL-6 and MIP-1 will be described by reporting response rates (and their confidence intervals) according to subgroup (e.g., response rates by age group; response rates by large/small change in IL-6 level).	Baseline to up to day 2 of course 1