Recurrent Plasma Cell Myeloma Clinical Trial
Official title:
Phase I/II Trial of Systemic Administration of Edmonston Strain of Measles Virus, Genetically Engineered to Express NIS, With or Without Cyclophosphamide, in Patients With Recurrent or Refractory Multiple Myeloma
Verified date | January 2019 |
Source | Mayo Clinic |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This phase I/II trial studies the side effects and best dose of vaccine therapy when given with or without cyclophosphamide and to see how well they work in treating patients with multiple myeloma that has come back (recurrent) or has not responded to previous treatment (refractory). Vaccines made from a gene-modified virus may help the body build an effective immune response to kill cancer cells. Drugs used in chemotherapy, such as cyclophosphamide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving vaccine therapy together with cyclophosphamide may be a better treatment for multiple myeloma.
Status | Completed |
Enrollment | 48 |
Est. completion date | November 20, 2019 |
Est. primary completion date | July 10, 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Myeloma relapsing from partial response or better - Patients relapsing > 18 months from transplant if not on maintenance, or - If off maintenance, discontinued at least 6 months ago, or - If relapsing on maintenance, at least 3 years from transplant, or - Off prior myeloma therapy at least 6 months ago - Sufficient tumor burden that is assessable for response - Serum M-spike >= 0.5 g/dL, or - If immunoglobulin A (IgA) myeloma, IgA > 1000 mg/dL, or - Difference between involved and uninvolved free light chain (dFLC) > 10 mg/dL, or - Urine M-spike >= 200 mg/24 hours, or - Bone marrow plasmacytosis >= 10%, or - Plasmacytoma >= 2 cm in diameter - Absolute neutrophil count (ANC) >= 1000/uL - Platelets (PLT) >= 50,000/uL - Hemoglobin >= 8.5 g/dl - Aspartate aminotransferase (AST) =< 2 times upper limit of normal - Creatinine < 2 times upper limit of normal - Total bilirubin =< 1.5 x upper limit of normal - International normalized ratio (INR) =< 1.4 x ULN at the time of registration - Ability to provide informed consent - Willingness to return to Mayo Clinic Rochester for follow-up - Life expectancy >= 12 weeks - Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1, or 2 - Willingness to provide all biological specimens as required by the protocol - Negative serum pregnancy test done =< 7 days prior to registration for women of childbearing potential only - Measles antibody titer on the BioRad Multiplex assay less than or equal to 1.0 Exclusion Criteria: - Uncontrolled infection - Active tuberculosis - Any myeloma directed therapy within 12 weeks of registration including plasmapheresis or transfusion - New York Heart Association classification III or IV, known symptomatic coronary artery disease, or symptoms of coronary artery disease on systems review - Active central nervous system (CNS) disorder or seizure disorder - Human immunodeficiency virus (HIV) positive test result - Other concurrent chemotherapy, immunotherapy, radiotherapy, or any ancillary therapy considered investigational (used for a non-Food and Drug Administration [FDA] approved indication and in the context of a research investigation) - Previous exposure to heat inactivated measles virus vaccine (this vaccine was given to some individuals between the years of 1963-1967) - Any of the following: - Pregnant women or women of reproductive ability who are unwilling to use effective contraception - Nursing women - Men who are unwilling to use a condom (even if they have undergone a prior vasectomy) while having intercourse with any woman, while taking the drug and for 4 weeks after stopping treatment - Evidence of chronic or acute graft versus host disease or on-going treatment for graft versus host disease from prior allogeneic stem cell transplantation - Exposure to household contacts =< 15 months old or household contact with known immunodeficiency |
Country | Name | City | State |
---|---|---|---|
United States | Mayo Clinic | Rochester | Minnesota |
Lead Sponsor | Collaborator |
---|---|
Mayo Clinic | National Cancer Institute (NCI) |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Time Until Any Treatment Related Toxicity (Phase I) | Tolerability will be explored in an ancillary manner through time-related variables, including time until any treatment related toxicity. Simple summary statistics will be supplemented with Kaplan-Meier survival estimates and related confidence intervals. The effect of dose and ancillary dichotomized covariates such as age will be explored using log-rank testing involving one covariate at a time. | Up to 1 year | |
Other | Time Until Hematologic Nadirs (White Blood Cells, ANC, Platelets) (Phase I) | Tolerability will be explored in an ancillary manner through time-related variables, including time until hematologic nadirs. Simple summary statistics will be supplemented with Kaplan-Meier survival estimates and related confidence intervals. The effect of dose and ancillary dichotomized covariates such as age will be explored using log-rank testing involving one covariate at a time. | Up to 1 year | |
Other | Time Until Treatment Related Grade 3+ Toxicity (Phase I) | Tolerability will be explored in an ancillary manner through time-related variables, including time until treatment related grade 3+ toxicity. Simple summary statistics will be supplemented with Kaplan-Meier survival estimates and related confidence intervals. The effect of dose and ancillary dichotomized covariates such as age will be explored using log-rank testing involving one covariate at a time. | Up to 1 year | |
Other | Biodistribution and Kinetics of Virus Spread | Will be correlated with tumor distribution. Descriptive statistics and scatterplots will form the basis of presentation of these variables. Correlations between the laboratory values and other outcome measures will be carried out by standard parametric and non-parametric tests (e.g. Pearson's and Spearman's rho). | Up to 6 weeks | |
Other | NIS Gene Expression in Vivo | Will be correlated with tumor distribution. Descriptive statistics and scatterplots will form the basis of presentation of these variables. Correlations between the laboratory values and other outcome measures will be carried out by standard parametric and non-parametric tests (e.g. Pearson's and Spearman's rho). | Up to 6 weeks | |
Other | Radiation Dose | The radiation dose that could be delivered to the bone marrow as well as critical organs such as the liver, lungs and kidneys if iodine-131 were to be administered using MIRDOSE 3 program will be estimated. Where patterns of correlation are indicated, ordinary and partial correlation coefficients (controlling for dose levels) will be calculated. Inferential testing for significant shifts in the correlative laboratory data results across dose levels will be carried out only as a hypothesis generating exercise. | Up to 6 weeks | |
Other | Viral Replication | Descriptive statistics and scatterplots will form the basis of presentation of these variables. Correlations between the laboratory values and other outcome measures will be carried out by standard parametric and non-parametric tests (e.g. Pearson's and Spearman's rho). | Up to 6 weeks | |
Other | Viral Shedding | Descriptive statistics and scatterplots will form the basis of presentation of these variables. Correlations between the laboratory values and other outcome measures will be carried out by standard parametric and non-parametric tests (e.g. Pearson's and Spearman's rho). | Up to 6 weeks | |
Primary | Number of Phase I Participants With Dose-Limiting Toxicity Events (Phase I) | The Maximum Tolerated Dose (MTD) is defined as the dose level below the lowest dose that induces dose-limiting toxicity (DLT) in at least one-third of patients graded according to NCI Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Dose-limiting toxicities include non-hematologic events graded 3 or higher and deemed at least possibly related to treatment. A total of 6 patients treated at the MTD will be sufficient to identify common toxicities at the MTD. The number of patients reporting a dose-limiting event are reported. | 6 weeks | |
Primary | Maximum Tolerated Dose (MTD) (Phase I) | The Maximum Tolerated Dose (MTD) is defined as the dose level below the lowest dose that induces dose-limiting toxicity (DLT) in at least one-third of patients graded according to NCI Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Dose-limiting toxicities include non-hematologic events graded 3 or higher and deemed at least possibly related to treatment. A total of 6 patients treated at the MTD will be sufficient to identify common toxicities at the MTD. The MTD is reported below. | 6 weeks | |
Primary | Proportion of Confirmed Response, Defined as a Partial Response (PR) or Better (Phase II) | Confirmed response will be evaluated using all cycles. The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR | Up to 1 year | |
Secondary | Overall Toxicity Rate, Assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events Version 3.0 (NCI CTCAE v3.0) (Phase I) | The overall toxicity rates (percentages) for grade 3 or higher adverse events considered at least possibly related to treatment are reported below by stage for Phase I patients. | Up to 1 year | |
Secondary | Number of Patients With Clinical Responses (Phase I) | The number of patients with clinical responses (CR, VGPR, PR, or minimal response [MR]) will be summarized by stage. | Up to 1 year | |
Secondary | Overall Survival (Phase II) | Time from registration to death due to any cause, assessed up to 1 year. The distribution of survival time will be estimated using the method of Kaplan-Meier. | Time from registration to death due to any cause, assessed up to 1 year | |
Secondary | Time to Progression (TTP) (Phase II) | Time from registration to the earliest date with documentation of disease progression, assessed up to 1 year. The distribution of time to progression will be estimated using the method of Kaplan-Meier. | Time from registration to the earliest date with documentation of disease progression, assessed up to 1 year | |
Secondary | Progression-free Survival (Phase II) | 1-year progression-free survival (PFS1). Evidence of local recurrence, distant metastasis, or death from any cause within 1 year counted as events in the time-to-event Kaplan-Meier analysis of progression-free survival. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions | At 1 year | |
Secondary | Progression-free Survival (Phase II) | 2-year progression-free survival (PFS2). Evidence of local recurrence, distant metastasis, or death from any cause within 2 years counted as events in the time-to-event Kaplan-Meier analysis of progression-free survival. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions | At 2 years | |
Secondary | Progression-free Survival (Phase II) | Progression free survival (PFS) is defined as the time from the date of randomization to the date of disease progression or death resulting from any cause, whichever comes first. Progression is defined according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. The median and 95% confidence intervals are estimated using the Kaplan-Meier estimator. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions | Up to 5 years | |
Secondary | Failure-free Survival (Phase II) | Time from registration to the earliest of progressive disease, alternative treatment for myeloma, or death due to any cause, assessed up to 1 year. The distribution of failure-free survival will be estimated using the method of Kaplan-Meier. | Time from registration to the earliest of progressive disease, alternative treatment for myeloma, or death due to any cause, assessed up to 1 year | |
Secondary | Overall Toxicity Rate, Assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events Version 3.0 (NCI CTCAE v3.0) (Phase II) | The overall toxicity rates (percentages) for grade 3 or higher adverse events considered at least possibly related to treatment are reported below for Phase II patients. | Up to 1 year |
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT02948283 -
Metformin Hydrochloride and Ritonavir in Treating Patients With Relapsed or Refractory Multiple Myeloma or Chronic Lymphocytic Leukemia
|
Phase 1 | |
Terminated |
NCT04956302 -
Panobinostat in Combination With Daratumumab, Bortezomib and Dexamethasone for the Treatment of Relapsed/Refractory Multiple Myeloma
|
Phase 1 | |
Completed |
NCT01527045 -
Donor Atorvastatin Treatment in Preventing Severe Acute GVHD After Nonmyeloablative Peripheral Blood Stem Cell Transplant in Patients With Hematological Malignancies
|
Phase 2 | |
Completed |
NCT01689987 -
Hydroxychloroquine, Cyclophosphamide, Dexamethasone, and Sirolimus in Treating Patients With Relapsed or Refractory Multiple Myeloma
|
Phase 1 | |
Completed |
NCT02506959 -
Panobinostat, Gemcitabine Hydrochloride, Busulfan, and Melphalan Before Stem Cell Transplant in Treating Patients With Refractory or Relapsed Multiple Myeloma
|
Phase 2 | |
Active, not recruiting |
NCT03457142 -
Abatacept, Ixazomib Citrate, and Dexamethasone in Treating Patients With Multiple Myeloma Resistant to Chemotherapy
|
Phase 2 | |
Recruiting |
NCT03246906 -
Comparison of Triple GVHD Prophylaxis Regimens for Nonmyeloablative or Reduced Intensity Conditioning Unrelated Mobilized Blood Cell Transplantation
|
Phase 2 | |
Withdrawn |
NCT03328936 -
Study of Personalized Melphalan Dosing in the Setting of Autologous Transplant
|
Phase 2 | |
Active, not recruiting |
NCT02765854 -
Ixazomib and Dexamethasone Versus Ixazomib, Dexamethasone and Lenalidomide, Randomized With NFKB2 Rearrangement
|
Phase 2 | |
Recruiting |
NCT05514990 -
Bortezomib and Pembrolizumab With or Without Pelareorep for the Treatment of Relapsed or Refractory Multiple Myeloma, AMBUSH Trial
|
Phase 1/Phase 2 | |
Completed |
NCT01989598 -
Trametinib and Akt Inhibitor GSK2141795 in Treating Patients With Relapsed or Refractory Multiple Myeloma
|
Phase 2 | |
Completed |
NCT03605719 -
Dexamethasone, Carfilzomib, & Nivolumab With Pelareorep for Relapsed/Refractory Multiple Myeloma
|
Phase 1 | |
Completed |
NCT01903811 -
S1304, Carfilzomib and Dexamethasone for Treating Patients With Relapsed or Refractory Myeloma
|
Phase 2 | |
Recruiting |
NCT05391750 -
Venetoclax and Tocilizumab for the Treatment of Patients With Relapsed or Refractory t(11;14) Multiple Myeloma
|
Phase 1 | |
Completed |
NCT00789776 -
Fludarabine Phosphate, Cyclophosphamide, Total-Body Irradiation, and Donor Bone Marrow Transplant Followed by Donor Natural Killer Cell Therapy, Mycophenolate Mofetil, and Tacrolimus in Treating Patients With Hematologic Cancer
|
Phase 1/Phase 2 | |
Completed |
NCT02593123 -
Adoptive Immunotherapy in Relapsed Hematological Malignancy: Early GVHD Prophylaxis
|
Phase 2 | |
Terminated |
NCT04407442 -
Daratumumab, Azacitidine, and Dexamethasone for Treatment of Patients With Recurrent or Refractory Multiple Myeloma Previously Treated With Daratumumab
|
Phase 2 | |
Completed |
NCT03338972 -
Immunotherapy With BCMA CAR-T Cells in Treating Patients With BCMA Positive Relapsed or Refractory Multiple Myeloma
|
Phase 1 | |
Recruiting |
NCT04508790 -
Leflunomide, Pomalidomide, and Dexamethasone for the Treatment of Relapsed or Refractory Multiple Myeloma
|
Phase 2 | |
Recruiting |
NCT05363111 -
Radioimmunotherapy (111Indium/225Actinium-DOTA-daratumumab) for the Treatment of Relapsed/Refractory Multiple Myeloma
|
Phase 1 |