Study Evaluating ABT-199 in Participants With Relapsed or Refractory Multiple Myeloma

Relapsed/Refractory Multiple Myeloma Clinical Trial

Official title:

A Phase 1/2 Study Evaluating the Safety and Pharmacokinetics of ABT-199 in Subjects With Relapsed or Refractory Multiple Myeloma

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01794520
• Other study ID #: M13-367
• Secondary ID: 2012-000589-38
• Status: Completed
• Phase: Phase 1/Phase 2
• Start date: October 10, 2012
• Est. completion date: November 29, 2021

Study information

• Verified date: March 2023
• Source: AbbVie
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The Phase 1 primary objectives of this study were to assess the safety profile, characterize pharmacokinetics (PK) and determine the dosing schedule, maximum tolerated dose (MTD), and recommended Phase 2 dose (RPTD) of ABT-199 (venetoclax) when administered in participants with relapsed or refractory multiple myeloma. This study also assessed the safety profile and PK of venetoclax in combination with dexamethasone in participants with t(11;14)-positive multiple myeloma.

The Phase 2 primary objective was to further evaluate the objective response rate (ORR) and very good partial response or better rate (VGPR+) in participants with t(11;14)-positive multiple myeloma.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 117
• Est. completion date: November 29, 2021
• Est. primary completion date: November 29, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• ECOG (Eastern Cooperative Oncology Group) performance score of 1 or 0. Participants in the Phase 2 portion: ECOG performance score of 2, 1, or 0.

• Diagnosis of multiple myeloma (MM) previously treated with at least one prior line of therapy.

• Induction therapy followed by stem cell transplant and maintenance therapy will be considered a single line of therapy.

• For Safety Expansion, participants must have been previously treated with a proteasome inhibitor (e.g., bortezomib) and an immunomodulatory agent (e.g., thalidomide, lenalidomide).

• For Venetoclax-Dexamethasone Combination, participants must have been previously treated with a proteasome inhibitor (e.g., bortezomib) and an immunomodulatory agent (e.g., thalidomide, lenalidomide) AND have t(11;14)-positive multiple myeloma per the central lab testing.

• For Phase 2, participants must have MM positive for the t(11;14) translocation, as determined by an analytically validated fluorescence in situ hybridization (FISH) assay per the central laboratory testing (enrollment with local t(11;14)-positive FISH results only will be considered at the discretion of the Therapeutic Area MD). Participants must have evidence of disease progression on or within 60 days of last dose of most recent previous treatment based on International Myeloma Working Group (IMWG) criteria AND must have previously received at least 2 lines of therapy, including an immunomodulatory drug (lenalidomide or pomalidomide), a proteasome inhibitor (bortezomib, carfilzomib or ixazomib), daratumumab, and glucocorticoids.

• For US participants: Daratumumab combination regimen must be one of the prior lines of therapy (for this study, daratumumab plus corticosteroids will not be considered a combination regimen).

• For Non-US participants: Either daratumumab monotherapy or combination therapy is acceptable. Daratumumab monotherapy will be limited to approximately 20 percent of the total number of Phase 2 participants.

• Measurable disease at Screening:

• Serum monoclonal protein of at least 1.0 g/dL (10g/L) by protein electrophoresis.

• At least 200 mg of monoclonal protein in the urine on 24-hr electrophoresis.

• Serum immunoglobulin free light chain of at least 10 mg/dL and abnormal serum immunoglobulin kappa to lambda free light chain ratio.

• Participants with a history of autologous or allogenic stem cell transplantation must have adequate peripheral blood counts independent of any growth factor support, and have recovered from any transplant related toxicity(s) and be:

• At least 100 days post-autologous transplant prior to first dose of study drug or

• At least 6 months post-allogenic transplant prior to first dose of study drug and not have active graft-versus-host disease (GVHD), i.e., requiring treatment.

• Meet the following laboratory parameters, per the reference range, at least once during the screening period:

• Absolute Neutrophil Count (ANC) of at least 1000/µL (Participants may use growth factor support to achieve ANC eligibility criteria).

• Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) not higher than 3 x Upper Limit of Normal Range (ULN).

• Calculated creatinine clearance of at least 30 mL/min using a modified Cockcroft-Gault calculation.

• Platelet count of at least 30,000 mm³ (independent of transfusion for 2 weeks).

• Hemoglobin of at least 8.0 g/dL (participants may receive blood transfusion to achieve hemoglobin eligibility criteria).

• Total bilirubin not higher than 1.5 x ULN (Participants with Gilbert's Syndrome may have bilirubin higher than 1.5 x ULN).

Exclusion Criteria:

• Exhibits evidence of other clinically significant uncontrolled condition(s), including, but not limited to:

• Acute infection within 14 days prior to first dose of study drug requiring antibiotic, antifungal, or antiviral therapy.

• Diagnosis of fever and neutropenia within 1 week prior to first dose of study drug.

• Cardiovascular disability status of New York Heart Association Class = 3.

• Significant history of renal, neurologic, psychiatric, endocrinologic, metabolic, immunologic, cardiovascular or hepatic disease, within the last 6 months that, in the opinion of the investigator, would adversely affect his/her participation in the study.

• History of other active malignancies other than multiple myeloma within the past 3 years prior to study entry, with the following exceptions:

• Adequately treated in situ carcinoma of the cervix uteri;

• Basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin;

• Localized prostate cancer Gleason grade 6 or lower AND with stable prostate specific antigen (PSA) levels off treatment

• Previous malignancy confined and surgically resected (or treated with other modalities) with curative intent.

• Known Human Immunodeficiency Viral (HIV) infection.

• Active hepatitis B or C infection.

Related Conditions & MeSH terms

• Multiple Myeloma
• Neoplasms, Plasma Cell
• Relapsed/Refractory Multiple Myeloma

Intervention

Drug:
• Venetoclax
Each dose of venetoclax was to be taken with approximately 240 mL of water. On days that pre-dose pharmacokinetic (PK) sampling was required, dosing was to occur in the morning at the clinic at approximately 0900 (± 1 hour) to facilitate PK sampling. Dose Escalation cohort participants were to take venetoclax within 30 minutes after the completion of a standard low-fat breakfast with approximately 240 mL of water on Cycle 2 Day 1. On all other dosing days, participants were instructed to take venetoclax orally QD within 30 minutes after the completion of a low-fat breakfast. Tablets were to be swallowed whole and must not have been broken, chewed, or crushed.
• Dexamethasone
Tablets were administered by mouth per the dexamethasone prescribing information.

Locations

Country	Name	City	State
Belgium	ZNA Stuivenberg /ID# 170067	Antwerp
Belgium	UZ Brussel /ID# 170711	Jette	Bruxelles-Capitale
Belgium	Duplicate_University Hospital Leuven /ID# 170715	Leuven
France	Duplicate_CHU Grenoble - Hopital Michallon /ID# 126658	Grenoble
France	CHRU Lille - Hopital Claude Huriez /ID# 74995	Lille	Hauts-de-France
France	CHU de Nantes, Hotel Dieu -HME /ID# 75033	Nantes	Pays-de-la-Loire
France	CHRU Tours - Hopital Bretonneau /ID# 126639	Tours CEDEX 9	Indre-et-Loire
Norway	Ulleval, OUS /ID# 170707	Oslo
United States	University of Michigan Comprehensive Cancer Center Michigan Medicine /ID# 170007	Ann Arbor	Michigan
United States	Emory University, Winship Cancer Institute /ID# 74993	Atlanta	Georgia
United States	Tufts Medical Center /ID# 203814	Boston	Massachusetts
United States	University Hospitals - Seidman Cancer Center /ID# 204502	Cleveland	Ohio
United States	Ohio State Cancer Center /ID# 200249	Columbus	Ohio
United States	Baylor University Medical Ctr. /ID# 170056	Dallas	Texas
United States	Duke Cancer Center /ID# 129356	Durham	North Carolina
United States	The John Theurer Cancer /ID# 200248	Hackensack	New Jersey
United States	Ingalls Memorial Hosp /ID# 205346	Harvey	Illinois
United States	Hattiesburg Clinic /ID# 201187	Hattiesburg	Mississippi
United States	University of Arkansas for Medical Sciences /ID# 170002	Little Rock	Arkansas
United States	Univ of Wisconsin Hosp/Clinics /ID# 200246	Madison	Wisconsin
United States	Medical College of Wisconsin /ID# 205229	Milwaukee	Wisconsin
United States	Yale University /ID# 203704	New Haven	Connecticut
United States	Tulane Cancer Center Clinic /ID# 204123	New Orleans	Louisiana
United States	University of Nebraska Medical Center /ID# 169158	Omaha	Nebraska
United States	Mayo Clinic - Rochester /ID# 74994	Rochester	Minnesota
United States	Washington University-School of Medicine /ID# 76094	Saint Louis	Missouri
United States	Mayo Clinic - Scottsdale /ID# 75808	Scottsdale	Arizona
United States	Swedish Cancer Institute - Edmonds /ID# 170006	Seattle	Washington
United States	Avera Cancer Institute /ID# 204178	Sioux Falls	South Dakota

Sponsors (2)

Lead Sponsor	Collaborator
AbbVie	Genentech, Inc.

Countries where clinical trial is conducted

United States,  Belgium,  France,  Norway, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Participants With Adverse Events	An adverse event (AE) is defined as any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product which does not necessarily have a causal relationship with this treatment. The investigator assesses the relationship of each event to the use of study drug. A serious adverse event (SAE) is an event that results in death, is life-threatening, requires or prolongs hospitalization, results in a congenital anomaly, persistent or significant disability/incapacity or is an important medical event that, based on medical judgment, may jeopardize the participant and may require medical or surgical intervention to prevent any of the outcomes listed above. Treatment-emergent adverse events/treatment-emergent serious adverse events (TEAEs/TESAEs) are defined as any event that began or worsened in severity on or after the first dose of study drug.	From first dose of study drug until 30 days following last dose of study drug (up to 2482 days)
Primary	Phase 1: Maximum Observed Plasma Concentration (Cmax) of Venetoclax	Cmax is the highest concentration that a drug achieves in the blood after administration in a dosing interval.	Cycle 2, Day 1 at predose, 2, 4, 6, 8, and 24 hours postdose
Primary	Phase 1: Time to Maximum Observed Plasma Concentration (Tmax) of Venetoclax	Tmax is the the time at which the maximum plasma concentration (Cmax) is observed.	Cycle 2, Day 1 at predose, 2, 4, 6, 8, and 24 hours postdose
Primary	Phase 1: Area Under the Plasma Concentration-Time Curve Over Time From 0 to 24 Hours (AUC0-24) of Venetoclax	AUC is a measure of how long and how much drug is present in the body after dosing.	Cycle 2, Day 1 at predose, 2, 4, 6, 8, and 24 hours postdose (dose escalation cohort); (1200 mg dose): Cycle 2, Day 1 at predose (safety expansion cohort, 1200 mg dose)
Primary	Phase 2: Overall Response Rate	Overall response rate is defined as the percentage of participants with documented best overall response of Partial Response (PR) or better (PR, Very good partial response [VGPR], Complete response [CR], or Stringent complete response [sCR]) per 2016 standard International Myeloma Working Group (IMWG) criteria.	Response was assessed at Cycle 2, Day 1, and on Day 1 of every cycle thereafter; estimated median time on follow-up was 31.7 months
Primary	Phase 2: Very Good Partial Response Rate or Better	The percentage of participants with documented best overall response of Very Good Partial Response (VGPR) or better (VGPR, Complete response [CR], or Stringent complete response [sCR]) per 2016 standard International Myeloma Working Group (IMWG) criteria was computed.	Response was assessed at Cycle 2, Day 1, and on Day 1 of every cycle thereafter; estimated median time on follow-up was 31.7 months
Secondary	Phase 1: Overall Response Rate	Overall response rate is defined as the percentage of participants with documented best overall response of Partial Response (PR) or better (PR, Very good partial response [VGPR], Complete response [CR], or Stringent complete response [sCR]) per 2011 International Myeloma Working Group (IMWG) criteria.	Response was assessed at Cycle 2, Day 1, and on Day 1 of every cycle thereafter; estimated median time on follow-up was 8.1 months
Secondary	Time to Response (TTR)	TTR is defined as the number of days from the date of first dose of study drug until the date of their first favorable response of Partial Response (PR) or better (PR, Very good partial response [VGPR], Complete response [CR], or Stringent complete response [sCR]) per 2011 International Myeloma Working Group (IMWG) criteria (Phase 1) or 2016 IMWG criteria (Phase 2). If a participant did not experience a favorable response, they were to be censored at the date of last adequate assessment. TTR was analyzed by Kaplan- Meier (K-M)\ methodology.	Response was assessed at Cycle 2, Day 1, and on Day 1 of every cycle thereafter; Estimated median time on follow-up was 8.1 months for Phase 1 and 31.7 months for Phase 2
Secondary	Time to Progression (TTP)	TTP is defined as the number of days from the date of first dose of study drug to the date of first documented disease progression or death due to multiple myeloma, whichever occurs first. TTP was analyzed by Kaplan- Meier (K-M) methodology.	Estimated median duration of follow-up was 8.1 months for Phase 1 and 31.7 months for Phase 2
Secondary	Duration of Response	DOR is defined as the number of days from the date of first response of Partial Response (PR) or better to the date of first documented disease progression or death due to multiple myeloma, whichever occurs first. DOR was analyzed by Kaplan- Meier (K-M) methodology.	Assessed at Cycle 2, Day 1, and on Day 1 of every cycle thereafter; estimated median duration of follow-up was 8.1 months for Phase 1 and 31.7 months for Phase 2
Secondary	Phase 2: Progression-Free Survival (PFS)	PFS is defined as the number of days from the date of the first dose of study treatment to the date of first documented disease progression or death due to any cause, whichever occurs first. PFS was analyzed by Kaplan-Meier methodology.	Estimated median duration of follow-up was 31.7 months
Secondary	Phase 2: Overall Survival (OS)	OS is defined as the number of days from the date of the first dose of study drug to the date of death due to any cause. If a participant was not known to have died, OS was censored at the last known alive date. The distribution of OS was estimated using Kaplan-Meier methodology.	Estimated median duration of follow-up was 31.7 months
Secondary	Phase 2: Mean Change From Baseline in Brief Pain Inventory - Short Form (BPI-SF) Worst Pain	The BPI-SF is a pain-specific measure developed to assess patient-reported severity (or intensity) of pain (4 items) and the impact of pain on daily functioning (7 items) in patients with cancer pain. The four pain severity items assess pain at its "worst in last 24 hours," "least in last 24 hours," "average," and "now" (current pain). For these items, participants are asked to rate their pain on an 11-point numeric rating scale with anchors of 0 (no pain) and 10 (pain as bad as you can imagine). The Worst Pain scores range from 0 to 10, with higher scores indicating severe pain. Negative changes from baseline indicate improvement.	Baseline; Cycle 3, Day 1; Cycle 5, Day 1; Cycle 7, Day 1; Cycle 9, Day 1; Cycle 11, Day 1; Cycle 13, Day 1; Cycle 15, Day 1; Cycle 17, Day 1; Cycle 19, Day 1; Cycle 21, Day 1; Cycle 23, Day 1; Cycle 25, Day 1; Final visit
Secondary	Phase 2: Mean Change From Baseline in Physical Functioning Scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)	The QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including five functional scales (physical, role, emotional, social, and cognitive), three symptom scales (fatigue, nausea and vomiting, and pain), a global health status/quality of life scale, and six single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). For the Physical Functioning scale, participants rate five items on a four-point scale, with 1 as "not at all" and 4 as "very much." The Physical Functioning Scale scores range from 0 to 100 and were calculated per the EORTC QLQ-C30 Scoring Manual (3rd edition), version 3.0. A high scale score represents high/healthy level of functioning. Positive changes from baseline indicate improvement.	Baseline; Cycle 3, Day 1; Cycle 5, Day 1; Cycle 7, Day 1; Cycle 9, Day 1; Cycle 11, Day 1; Cycle 13, Day 1; Cycle 15, Day 1; Cycle 17, Day 1; Cycle 19, Day 1; Cycle 21, Day 1; Cycle 23, Day 1; Cycle 25, Day 1; Final visit
Secondary	Phase 2: Mean Change From Baseline in Global Health Status/Quality of Life Scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)	The QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including five functional scales (physical, role, emotional, social, and cognitive), three symptom scales (fatigue, nausea and vomiting, and pain), a global health status/quality of life scale, and six single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). For the Global Health Status/Quality of Life scale, participants rate two items on a seven point scale, with 1 as "very poor" and 7 as "excellent." The Global Health Status/Quality of Life scale ranges from 0 to 100 and was calculated per the EORTC QLQ-C30 Scoring Manual (3rd edition), version 3.0. A high score for the global health status/QoL represents a high QoL. Positive changes from baseline indicate improvement.	Baseline; Cycle 3, Day 1; Cycle 5, Day 1; Cycle 7, Day 1; Cycle 9, Day 1; Cycle 11, Day 1; Cycle 13, Day 1; Cycle 15, Day 1; Cycle 17, Day 1; Cycle 19, Day 1; Cycle 21, Day 1; Cycle 23, Day 1; Cycle 25, Day 1; Final visit
Secondary	Phase 2: Mean Change From Baseline in Patient Reported Outcomes Measurement Information System [PROMIS] Cancer Fatigue Short Form [SF] Score	PROMIS Cancer Fatigue SF is a seven item questionnaire that assesses the impact and experience of fatigue over the past 7 days. All questions employ the following five response options: 1 = Not at all, 2 = A little bit, 3 = Somewhat, 4 = Quite a bit, and 5 = Very much. The total raw score is the sum of the responses to each question and is converted to a T-score. The T-score re-scales the total raw score to a standardized score with a mean of 50 and a standard deviation of 10. The [PROMIS] Cancer Fatigue Short Form [SF] 7a T-Scores range from 29.4 to 83.2, with higher scores indicating more fatigue. Negative changes from baseline indicate improvement.	Baseline; Cycle 3, Day 1; Cycle 5, Day 1; Cycle 7, Day 1; Cycle 9, Day 1; Cycle 11, Day 1; Cycle 13, Day 1; Cycle 15, Day 1; Cycle 17, Day 1; Cycle 19, Day 1; Cycle 21, Day 1; Cycle 23, Day 1; Cycle 25, Day 1; Final visit

External Links

•   This clinical study may be evaluating a usage that is not currently FDA approved. Please see US Prescribing Information for approved uses.