Phase 1b Multicenter Study of Carfilzomib With Lenalidomide and Dexamethasone in Relapsed Multiple Myeloma

Relapsed Multiple Myeloma Clinical Trial

Official title:

Phase 1b Multicenter Dose Escalation Study of Carfilzomib With Lenalidomide and Dexamethasone for Safety and Activity in Relapsed Multiple Myeloma

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT00603447
• Other study ID #: PX-171-006
• Status: Active, not recruiting
• Phase: Phase 1
• First received: January 16, 2008
• Last updated: October 21, 2015
• Start date: May 2008
• Est. completion date: March 2016

Study information

• Verified date: October 2015
• Source: Onyx Pharmaceuticals
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

To evaluate the safety and maximum tolerated dose (MTD) of carfilzomib in combination with lenalidomide and dexamethasone in patients with relapsed multiple myeloma

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 84
• Est. completion date: March 2016
• Est. primary completion date: May 2013
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

Disease related:

1. Symptomatic multiple myeloma

2. Relapsed or progressive disease after at least one but no more than three prior therapeutic treatments or regimens for multiple myeloma

3. Prior therapeutic treatment regimens may have included bortezomib, lenalidomide, and/or thalidomide, among other agents.

4. If previously treated with lenalidomide or bortezomib, the subject must not have progressed during the first 3 months of treatment with the drug and must not have discontinued treatment due to lenalidomide intolerance (bortezomib intolerant subjects may enroll).

5. Measurable disease, as indicated by one or more of the following:

• Serum M-protein = 0.5 g/dL

• Urine Bence-Jones protein = 200 mg/24 h

• If Serum Protein Electrophoresis is felt to be unreliable for routine M-protein measurement (particularly for patients with Immunoglobulin (Ig)A multiple myeloma), then quantitative immunoglobulin levels can be accepted.

6. Prior to enrollment, sites must provide evidence of myeloma progression/relapse, with start and stop dates of the most recent treatment regimen, as well as best tumor response to all prior treatment regimens.

Demographic

7. Males and females = 18 years of age

8. Life expectancy of more than three months

9. Eastern Cooperative Oncology Group (ECOG) Performance Status 0-2

Laboratory

10. Adequate hepatic function, with bilirubin < 2 times the upper limit of normal (ULN) and alanine aminotransferase (ALT) < 3 times ULN

11. Absolute neutrophil count (ANC) = 1,000/mm³, hemoglobin = 8 gm/dL, platelet count = 50,000/ mm³ (= 30 × 10^9/L if myeloma involvement in the bone marrow is > 50%)

• Screening ANC should be independent of granulocyte- and granulocyte/macrophage colony stimulating factor (G-CSF and GM-CSF) support for at least 1 week and of pegylated G-CSF for at least 2 weeks.

• Subjects may receive red blood cell (RBC) or platelet transfusions, if clinically indicated, in accordance with institutional guidelines

• Screening platelet count should be independent of platelet transfusions for at least 2 weeks

12. Calculated or measured creatinine clearance of = 50 mL/minute, calculated using the formula of Cockcroft and Gault [(140 - Age) x Mass (kg) / (72 x creatinine mg/dL)]; multiply result by 0.85 (if female). Other generally accepted calculation methods can be substituted.

Ethical/Other

13. Written informed consent in accordance with federal, local, and institutional guidelines

14. Females of childbearing potential (FCBP) must agree to ongoing pregnancy testing

15. FCBP* must have a negative serum or urine pregnancy test, with a sensitivity of at least 50 mIU/mL within 10-14 days (US/RevAssist®) or 25 mIU/mL within 7-14 days (Canada/RevAidSM), prior to and again within 24 hours of starting lenalidomide and must either commit to continued abstinence from heterosexual intercourse or to use two methods of reliable birth control, including at least one highly effective method AND one additional effective method of birth control (contraception) AT THE SAME TIME, beginning 4 weeks prior to initiating treatment with lenalidomide, during therapy, during therapy delay, and continuing for 4 weeks following discontinuation of lenalidomide therapy. If a hormonal method (birth control pills, injections, patch or implants) or intrauterine device (IUD) is not medically possible for the subject, the subject may use another highly effective method or two barrier methods AT THE SAME TIME.

16. Male subjects must agree to NEVER have unprotected sexual contact with a female who can become pregnant and must agree to either completely abstain from sexual contact with females who are pregnant or are able to become pregnant, or he must use a latex condom EVERY TIME he engages in any sexual contact with females who are pregnant or may become pregnant while he is taking lenalidomide and for 4 weeks after he stops taking the drug, even if he has had a successful vasectomy. The subject must agree to inform his physician if he has had unprotected sexual contact with a female who can become pregnant or if he thinks FOR ANY REASON, that his sexual partner may be pregnant.

17. Male subjects cannot donate semen or sperm while taking lenalidomide.

18. All study participants must be registered into the mandatory RevAssist (US) or RevAid (Canada) programs and be willing and able to comply with the requirements of Rev Assist/RevAid

19. Subjects must adhere to the study visit schedule and other protocol requirements and receive outpatient treatment and laboratory monitoring at the institute that administers the drug

20. Subjects must agree to take enteric-coated aspirin 81-325 mg orally daily, or if history of prior thrombotic disease or allergy to aspirin, must be fully anticoagulated with warfarin (INR 2-3) or be treated with full-dose, low molecular weight heparin, as if to treat deep venous thrombosis (DVT)/pulmonary embolism.

Exclusion Criteria:

Disease related

1. Subjects with non-secretory or hyposecretory multiple myeloma, defined as < 0.5 g/dL M-protein in serum, < 200 mg/24 hr Bence Jones protein in urine, or disease only measured by serum free light chain (FLC)

2. Subjects who never achieved at least a durable minimal response (MR, = 25% reduction in M-protein for at least 6 weeks) on any prior therapy

3. Corticosteroid therapy in a dose equivalent to dexamethasone = 4 mg/day or prednisone = 20 mg/day within 3 weeks prior to first dose

4. Use of any other experimental drug or therapy within 28 days of baseline

5. POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes)

6. Plasma cell leukemia

7. Waldenström's macroglobulinemia

8. Chemotherapy with approved or investigative anticancer therapeutics, including steroid therapy dose as defined above, within 3 weeks prior to first dose

9. Radiation therapy or immunotherapy within 4 weeks prior to first dose; localized radiation therapy within 1 week prior to first dose

10. Planned radiation therapy that occurs after the start of treatment

11. Participation in an investigational therapeutic study within 3 weeks or within 5 drug half-lives (t1/2) prior to first dose, whichever time is greater.

Concurrent conditions

12. Pregnant or lactating females

13. History of allergy to boron or mannitol

14. Major surgery within 3 weeks prior to first dose

15. Congestive heart failure (New York Heart Association class III to IV), symptomatic ischemia, conduction abnormalities uncontrolled by conventional intervention or myocardial infarction in the previous six months

16. Uncontrolled hypertension

17. Acute active infection requiring systemic antibiotics, antivirals, or antifungals within two weeks prior to first dose

18. Known or suspected human immunodeficiency virus (HIV) infection, known HIV seropositivity, or active hepatitis A, B, or C infection

19. Non-hematologic malignancy within the past three years except

1. adequately treated basal cell or squamous cell skin cancer,

2. carcinoma in situ of the cervix, or

3. prostate cancer < Gleason Grade 6 with stable prostate specific antigen (PSA) levels

20. Serious psychiatric or medical conditions that could interfere with treatment

21. Significant neuropathy (Grade 3, Grade 4, or Grade 2 with pain) at the time of the first dose and/or within 14 days before enrollment

22. Contraindication to any of the required concomitant drugs, including proton-pump inhibitor (e.g., lansoprazole), enteric-coated aspirin or other anticoagulant, or if a history of prior thrombotic disease, warfarin or low molecular weight heparin

23. Subjects in whom the required program of oral and intravenous fluid hydration is contraindicated, e.g., due to pre-existing pulmonary, cardiac, or renal impairment

24. Subjects with known or suspected amyloidosis

25. Subjects with pleural effusions requiring thoracentesis or ascites requiring paracentesis

26. Prior carfilzomib treatment

Study Design

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

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

Intervention

Drug:
• Carfilzomib
Carfilzomib for Injection was administered intravenously over 10 minutes on Days 1, 2, 8, 9, 15, and 16 of a 28-day cycle for the first 12 cycles. Each dose of Carfilzomib for Injection was normalized to body surface area.
• Lenalidomide
Lenalidomide was administered orally on Days 1 to 21 of each 28-day cycle.
• Dexamethasone
Dexamethasone 40 mg orally or intravenous equivalent was administered 30 minutes to 4 hours before carfilzomib on Days 1, 8, and 15, as well as on Day 22 of each 28-day cycle.

Locations

Country	Name	City	State
Canada	Jewish General Hospital	Montreal	Quebec
United States	Gabrail Cancer Center	Canton	Ohio
United States	Northwestern University	Chicago	Illinois
United States	Hackensack University Medical Center	Hackensack	New Jersey
United States	MD Anderson Cancer Center	Houston	Texas
United States	Pacific Shores Medical Group	Long Beach	California
United States	Cedars Sinai Medical Center	Los Angeles	California
United States	Medical College of Wisconsin	Milwaukee	Wisconsin
United States	Cornell University	New York	New York
United States	University of California San Francisco	San Francisco	California
United States	Fred Hutch Cancer Research Center	Seattle	Washington
United States	H. Lee Moffitt Cancer Center & Research Institute	Tampa	Florida

Sponsors (1)

Lead Sponsor	Collaborator
Onyx Therapeutics, Inc.

Countries where clinical trial is conducted

United States,  Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Participants With Adverse Events (AEs)	Treatment-related are those AEs with possible or probable relationship to carfilzomib, lenalidomide or dexamethasone as assessed by the Investigator. The severity of each adverse event was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 3.0, per the following: Grade 1 = Mild, Grade 2 = Moderate, Grade 3 = Severe, Grade 4 = Life-threatening and Grade 5 = Death.; Serious adverse events were defined as AEs meeting one of the following: death, life-threatening, required or prolonged in-patient hospitalization, resulted in persistent or significant disability/incapacity, a congenital anomaly/birth defect in the offspring of an exposed participant, important medical events that may jeopardize the participant and may require medical or surgical intervention to prevent one of the outcomes listed above, or pregnancy or suspected pregnancy.	From the first dose of study drug until 30 days after the last dose; 1 to 52 months, with an average of 12 months.	Yes
Primary	Number of Participants With Dose-limiting Toxicities	Dose-limiting toxicity was defined as any of the following events assessed as related to carfilzomib, lenalidomide, or dexamethasone: Nonhematologic; = Grade 2 neuropathy with pain; = Grade 3 nonhematologic toxicity (excluding nausea, vomiting, diarrhea, hyperglycemia due to dexamethasone, and rash due to lenalidomide); = Grade 3 nausea, vomiting, or diarrhea uncontrolled by maximal supportive therapy; = Grade 4 fatigue persisting > 7 days; Treatment delay for toxicity > 21 days; Hematologic; Grade 4 neutropenia (absolute neutrophil count [ANC] < 500/mm³) > 7 days; Febrile neutropenia (ANC < 1,000/mm³ with fever = 38.3ºC); Grade 4 thrombocytopenia (platelets < 25,000/mm³) for > 7 days despite holding treatment, or Grade 3 or 4 thrombocytopenia associated with bleeding; Treatment delay for toxicity > 21 days.; The maximum-tolerated dose was defined as the dose level below which a drug-related DLT was observed in = 33% of participants in a cohort.	Cycle 1, 28 days	Yes