Clinical Trials /

Phase Ib Study of SAR650984 in Combination With Carfilzomib for Treatment of Relapsed or Refractory Multiple Myeloma

NCT02332850

Description:

This phase Ib trial studies the side effects and best dose of isatuximab when given together with carfilzomib with or without dexamethasone and lenalidomide in treating patients with multiple myeloma that has returned after a period of improvement (relapsed) or has not respond to previous treatment (refractory). Immunotherapy with monoclonal antibodies, such as isatuximab, may induce changes in the body's immune system and may interfere with the ability of tumor cells to grow and spread. Carfilzomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as dexamethasone and lenalidomide, 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 isatuximab and carfilzomib with or without dexamethasone and lenalidomide may be a better treatment for patients with multiple myeloma.

Related Conditions:
  • Multiple Myeloma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Phase Ib Study of SAR650984 in Combination With Carfilzomib for Treatment of Relapsed or Refractory Multiple Myeloma
  • Official Title: A Multi-ARM Phase Ib Study of SAR650984 (Isatuximab, an Anti-CD38 mAb) in Combination With Standard Carfilzomib, and High-dose Weekly Carfilzomib and Dexamethasone for the Treatment of Relapsed or Refractory Multiple Myeloma

Clinical Trial IDs

  • ORG STUDY ID: 139511
  • SECONDARY ID: NCI-2015-00712
  • NCT ID: NCT02332850

Conditions

  • Multiple Myeloma

Interventions

DrugSynonymsArms
IsatuximabSAR 650984Arm I (20 mg dexamethasone, isatuximab, carfilzomib)
CarfilzomibKyprolis, PR-171Arm I (20 mg dexamethasone, isatuximab, carfilzomib)
DexamethasoneOrgadrone, Spersadex, VisumetazoneArm I (20 mg dexamethasone, isatuximab, carfilzomib)

Purpose

This phase Ib trial studies the side effects and best dose of isatuximab when given together with carfilzomib with or without dexamethasone and lenalidomide in treating patients with multiple myeloma that has returned after a period of improvement (relapsed) or has not respond to previous treatment (refractory). Immunotherapy with monoclonal antibodies, such as isatuximab, may induce changes in the body's immune system and may interfere with the ability of tumor cells to grow and spread. Carfilzomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as dexamethasone and lenalidomide, 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 isatuximab and carfilzomib with or without dexamethasone and lenalidomide may be a better treatment for patients with multiple myeloma.

Detailed Description

      PRIMARY OBJECTIVES:

      ARM 1: To determine the maximum tolerated dose (MTD) of SAR650984 in combination with
      standard carfilzomib (Arm 1 is complete).

      ARM 2: To determine the safety AND efficacy (objective response rate (ORR)) of adding
      SAR650984 10mg/kg weekly x 4 doses then every other week in combination with weekly
      carfilzomib (70 mg/m2) and dexamethasone, in patients with relapsed or refractory myeloma.
      ORR will be defined using the International Myeloma Working Group (IMWG) uniform response
      criteria.

      SECONDARY OBJECTIVES:

      ARM 1:

        1. To evaluate the safety, including immunogenicity (ARM 1), of SAR650984 in combination
           with carfilzomib, in patients with relapsed or refractory myeloma after receiving 1+
           prior lines of therapy. The severity, frequency and incidence of all toxicities will be
           assessed.

        2. To evaluate the pharmacokinetics (PK) of SAR650984 and carfilzomib when administered in
           ARM 1 (completed).

        3. To assess the relationship between clinical (adverse event and/or tumor response)
           effects and pharmacologic parameters (PK/PD), and/or biologic (correlative laboratory)
           results.

        4. To estimate the activity (ORR) using the International Myeloma Working Group (IMWG)
           defined response criteria of SAR650984 plus carfilzomib (ARM 1)

        5. To describe progression free survival (PFS), time to disease progression (TTP) and
           1-year overall survival (OS) in patients treated with SAR650984 plus standard
           carfilzomib, and SAR650984 with weekly carfilzomib and dexamethasone.

      EXPANSION COHORTS:

      ARM 1:

      1. To further evaluate safety, PK, PD and to estimate the anti-tumor activity (response
      rates) using IMWG defined response criteria of study therapy (SAR650984 plus carfilzomib).

      ARM 1 and 2:

      1. To describe progression-free survival, 1-year OS, and TTP in patients with relapsed or
      refractory myeloma treated with these combinations.

      OUTLINE: This is a dose-escalation study of isatuximab. Patients are randomized to 1 of 2
      arms.

      ARM I: Patients receive dexamethasone intravenously (IV) on days 1, 8, 15, and 22 of cycle 1,
      and orally (PO) or IV on days 1 and 15 of subsequent cycles. Patients receive isatuximab IV
      over 4-6 hours on days 1, 8, 15, and 22 of cycle 1 and days 1 and 15 of subsequent cycles,
      and carfilzomib IV over 10 minutes on days 1, 2, 8, 9, 15, and 16. Treatment repeats every 28
      days for up to 8 cycles in the absence of disease progression or unacceptable toxicity.
      Patients may continue treatment after 8 cycles if clinical benefit is present at the
      investigator's discretion (carfilzomib may be switched to days 1, 2, 15, and 16 per
      investigator discretion).

      ARM II: Patients receive dexamethasone IV or PO on days 1, 8, 15, and 22, isatuximab IV over
      4-6 hours on 1, 8, 15, and 22 of cycle 1 and days 1 and 15 of subsequent cycles, and
      carfilzomib IV over 30 minutes on days 1, 8, and 15. Cycles repeat every 28 days in the
      absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up at 30 and 60 days and then
      every 3 months for up to 3 years.
    

Trial Arms

NameTypeDescriptionInterventions
Arm I (20 mg dexamethasone, isatuximab, carfilzomib)Experimental20 mg dexamethasone IV given on days 1, 8, 15, 22 (pre- SAR650984 and carfilzomib), then dexamethasone 4 IV or PO mg Day 2, 9, 16. All patients will receive a fixed dose of Isatuximab (SAR650984) according to their assigned dose cohort. Patients receive isatuximab IV over 4-6 hours on days 1 and 15 of every cycle for the starting cohort, and days 1, 8, 15, and 22 of cycle 1 and days 1 and 15 of subsequent cycles. Carfilzomib IV will be administered over 10 minutes on days 1, 2, 8, 9, 15, and 16 . Treatment repeats every 28 days for 8 courses in the absence of disease progression or unacceptable toxicity. Patients may continue treatment after 8 courses if clinical benefit is present at the investigator's discretion (carfilzomib may be switched to days 1, 2, 15, and 16 after 8 cycles per investigator discretion).
  • Isatuximab
  • Carfilzomib
  • Dexamethasone
Arm II (40 mg dexamethasone, isatuximab, carfilzomib)Experimental40 mg dexamethasone IV given on Days 1, 8, 15 and 22 (use as premed to isatuximab). All patients will receive a fixed dose of Isatuximab (SAR650984) according to the assigned dose. Patients receive isatuximab IV over 4-6 hours on day 1, 3-4 hours on Day 8, 15, and 22 of cycle 1 and then on days 1 and 15 of subsequent cycle (patients may be eligible for rapid siatuximab given over 75 minutes), and carfilzomib IV over 30 minutes on days 1, 8, and 15. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
  • Isatuximab
  • Carfilzomib
  • Dexamethasone

Eligibility Criteria

        Inclusion Criteria:

          1. Males or females, age 18 years or older

          2. Diagnosis of multiple myeloma (MM) and documentation of treatment

               -  ARM 1: Must have prior exposure to an immunomodulatory drug (IMiD) and proteasome
                  inhibitor (PI) and have had 2 prior regimens/lines of therapy; but there is no
                  maximum number of prior regimens, and prior autologous bone marrow transplant is
                  acceptable if > 12 weeks from transplantation; patients may have received prior
                  carfilzomib (sensitive, relapsed and refractory [having progressed while
                  receiving carfilzomib or within 60 days of stopping carfilzomib] are all
                  eligible), but must be > 4 weeks from last dosing of carfilzomib

               -  ARM 2: Must have had at least 1 but no more than 3 prior lines of anti-myeloma
                  therapy; may be refractory to lenalidomide but sensitive to carfilzomib; prior
                  exposure to carfilzomib is allowed but may not be refractory to carfilzomib;
                  subjects must be >= 8 weeks from last carfilzomib therapy

               -  A line of therapy is defined as a course of therapy that is not interrupted by
                  progressive disease; for example, induction therapy, autologous stem cell
                  transplantation, and maintenance therapy without intervening progressive disease
                  is one line of therapy

          3. Confirmed evidence of relapse/disease progression from immediately prior MM therapy or
             relapsed and refractory to the immediately prior treatment; relapsed and refractory
             disease is defined as those who are non-responsive (< minimal response) on salvage
             therapy or experience disease progression within 60 days of last therapy in patients
             who have achieved an MR or better to previous therapy; relapsed disease is defined as
             previously treated myeloma that progresses and requires the initiation of salvage
             therapy but does not meet IMWG criteria for relapsed and refractory

          4. Patients may have received prior carfilzomib (sensitive, relapsed and refractory all
             eligible); response and duration of prior carfilzomib therapy must be known

          5. Patients must have measurable disease defined as at least one of the following:

               -  Serum M-protein >= 0.5 g/dl (>= 5 g/l)

               -  Urine M-protein >= 200 mg/24 hours (h)

               -  Serum free light chain (FLC) assay: involved FLC level >= 10 mg/dl (>= 100 mg/l)
                  and an abnormal serum free light chain ratio (< 0.26 or > 1.65)

               -  Quantitative immunoglobulin > 500 mg/dL, only for immunoglobulin (Ig)A and (Ig)D
                  myeloma when the protein electrophoresis under-represents disease burden

               -  Biopsy proven plasmacytoma > 1x1 cm (should be measured within 28 days prior to
                  initial investigational agent dosing)

          6. Subject has an Eastern Cooperative Oncology Group (ECOG) =< 2 performance status OR
             Karnofsky >= 60% performance status

          7. Females of childbearing potential (FCBP)

               -  A female of childbearing potential is a sexually mature woman who: 1) has not
                  undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally
                  postmenopausal for at least 24 consecutive months

               -  Females of childbearing potential must have a negative serum beta-human chorionic
                  gonadotropin (beta-hCG) pregnancy test with a sensitivity of at least 50
                  milli-international units per milliliter(mIU/mL), within 10-14 days of study
                  start (during screening)

               -  FCBP must also agree to ongoing pregnancy testing. Pregnancy testing is not
                  required for post-menopausal or surgically sterilized women

               -  Females must agree to avoid pregnancy during the study and must agree to use a
                  medically acceptable method of birth control as determined by the study doctor
                  while participating in the study and for at least 5 months after the last dose of
                  study medication

          8. Men must agree to use contraception (i.e. a latex condom) during sexual contact with a
             FCBP even if they have had a successful vasectomy and agree to not donate sperm for 5
             months after last study therapy (SAR650984, lenalidomide and carfilzomib).

          9. Voluntary written informed consent before performance of any study-related procedure
             not part of routine medical care with the understanding that consent may be withdrawn
             by the subject at any time without prejudice to future medical care

         10. Ability to understand the purpose and risks of the study and provide signed and dated
             informed consent and authorization to use protected health information (in accordance
             with national and local subject privacy regulations)

         11. For patients with platelets > 100,000 cells/ul (100x10^9/L) able to take aspirin daily
             as prophylactic anticoagulation therapy for ARM 2 (patients intolerant to aspirin may
             use warfarin, low-molecular-weight heparin or equivalent anti-platelet therapy)

         12. Inclusion Clinical Laboratories Criteria. The following laboratory results must be
             met:

               -  Absolute neutrophil count (ANC) > 1,000 cells/dL (1.0 x 10e9/L) (growth factor
                  cannot be used within the previous 7 days)

               -  Hemoglobin >= 8.0 g/dl (without transfusion within the previous 7 days)

               -  Platelet count > 75,000 cells/dL (75 x 10e9/L)

               -  Creatinine clearance >= 30 mL/min (Cockcroft-Gault equation)

               -  Serum glutamic oxaloacetic transaminase (SGOT)/aspartate aminotransferase (AST)
                  or serum glutamate pyruvate transaminase (SGPT)/alanine aminotransferase (ALT) <
                  2.5 x upper limit of normal (ULN)

               -  Total bilirubin =< 1.5 x ULN

               -  Serum calcium (corrected for albumin) level at or below the ULN range (treatment
                  of hypercalcemia is allowed and subject may enroll if hypercalcemia returns to
                  normal with standard treatment) prior to study therapy initiation

               -  Left ventricular ejection fraction (LVEF) >= 40% (by echocardiogram or multigated
                  acquisition scan (MUGA) testing)

               -  Fasting glucose under control (< 150 mg/dL [8.3 mmol/L])

        Exclusion Criteria:

        Patients who have met all the inclusion criteria listed above will be screened for the
        following exclusion criteria:

          1. Diagnosed or treated for another malignancy within 3 years of enrollment, with the
             exception of complete resection of basal cell carcinoma or squamous cell carcinoma of
             the skin, an in situ malignancy, low-risk prostate cancer after curative therapy or
             complete resection of other advanced malignancy with the expectation that the patient
             has received curative therapy

          2. Patient has received other investigational drugs with 21 days before enrollment (or
             must be > than four half-lives of the experimental agent); no prior SAR650984
             anti-CD38 antibody therapy allowed

          3. History of significant cardiovascular disease unless the disease is well-controlled or
             history of myocardial infarction in the past 6 months; significant cardiac diseases
             includes second/third degree heart block; significant conduction abnormalities,
             significant ischemic heart disease; poorly controlled hypertension; congestive heart
             failure of New York Heart Association (NYHA) class II or worse (slight limitation of
             physical activity; comfortable at rest, but ordinary physical activity results in
             fatigue, palpitation, or dyspnea) and inability to tolerate intravenous hydration
             necessary for study therapy administration

          4. Prior autologous or allogeneic peripheral stem cell transplant within 12 weeks of the
             first dose of study treatment

          5. Daily requirement for corticosteroids (> 10 mg prednisone once daily (QD) or
             equivalent)

          6. Patients with evidence of significant mucosal or internal bleeding

          7. Prior radiation therapy or chemotherapy within 2 weeks or major surgical procedure
             within 4 weeks of the first dose of study treatment

          8. Known active infection requiring parenteral or oral anti-infective treatment, once a
             patient has completed antibiotics and symptoms of infection have resolved to < grade
             2, they are then considered eligible from an infection standpoint

          9. Serious psychiatric illness, active alcoholism, or drug addiction that may hinder or
             confuse follow-up evaluation

         10. Any medical conditions that, in the Investigator's opinion, would impose excessive
             risk to the patient; examples of such conditions include any pre-existing kidney
             disease (acute or chronic, unless renal insufficiency is felt to be secondary to MM),
             hypertension, active seizure disorder or pulmonary diseases that would impose
             excessive risk to the patient

         11. Patient has hypersensitivity to boron, mannitol sucrose, histidine (as base and
             hydrochloride salt) and polysorbate 80 or any of the components of study therapy
             including required prophylactic medications

         12. Known human immunodeficiency virus (HIV) seropositivity or active hepatitis B or C
             viral infection

         13. Neuropathy >= grade 3 or painful neuropathy >= grade 2 (National Cancer Institute
             Common Terminology Criteria for Adverse Events [NCI CTCAE] version [v]4.03)

         14. Gastro-intestinal abnormalities, including bowel obstruction, inability to take oral
             medication, requirement for intravenous (IV) alimentation, active peptic ulcer or
             prior surgical procedures or bowel resection affecting absorption
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:ARM I: Incidence of Dose-Limiting Toxicities (DLT)
Time Frame:Up to 60 days of the last dose of study drug
Safety Issue:
Description:Treatment-related Adverse events resulting in a DLT will be summarized by maximum toxicity grade for each dose level of isatuximab.

Secondary Outcome Measures

Measure:ARM I: Pharmacokinetic (PK) profile of isatuximab
Time Frame:Baseline, 2 hours mid-infusion, 4, 7, and 11 hours after end of infusion on day 1, days 2, 3, 8, and 15 of course 1, and 0 and 4 hours after end of infusion on day 1 of courses 2-8 (and 0 hours on day 15 of course 2 only)
Safety Issue:
Description:Individual plasma concentrations and PK parameters of SAR650984 will be tabulated with standard descriptive statistics. Pharmacokinetic analyses will be carried out in the Pharmacokinetics, Dynamics and Metabolism Department at Sanofi for SAR650984 and carfilzomib.
Measure:ARM I: Overall Response Rate (ORR)
Time Frame:Up to 60 days of the last dose of study drug
Safety Issue:
Description:Overall response rate; defined as sCR+CR+VGPR + PR utilizing IMWG Uniform Response Criteria
Measure:ARM I: Clinical benefit response (CBR)
Time Frame:Up to 60 days of the last dose of study drug
Safety Issue:
Description:defined as CR + VGPR + PR + minor response (MR), utilizing International Myeloma Working Group (IMWG) Uniform Response Criteria
Measure:ARM I: Incidence of isatuximab-specific antidrug antibodies (ADA)
Time Frame:Up to 1 year
Safety Issue:
Description:Analysis to be performed by Sanofi-Oncology
Measure:ARM I: Percentage of bone marrow cells expressing cell surface determinant, CD38 and receptor density
Time Frame:Up to 30 days of the last dose of study drug
Safety Issue:
Description:
Measure:Overall survival (OS)
Time Frame:assessed at 1, 2, and 3 years from start of treatment
Safety Issue:
Description:Duration of time from start of treatment to death on study from any cause,
Measure:Progression Free Survival (PFS)
Time Frame:from start of treatment up to 1 year
Safety Issue:
Description:Duration of time from start of treatment to the first occurrence of disease progression or death on study from any cause, whichever occurs earlier,
Measure:Time To Progression (TTP)
Time Frame:from start of treatment up to 1 year
Safety Issue:
Description:Defined as the duration from start of treatment until the first occurrence of disease progression with deaths from causes other than disease progression, censored
Measure:Duration of Response (DOR)
Time Frame:up to 60 days of the last dose of study drug
Safety Issue:
Description:The duration of overall response is defined as the time period when criteria are met for MR or better (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented. The duration of CR is defined as the time when criteria are first met for CR until the first date that IMWG relapse is objectively documented
Measure:Changes in pharmacodynamics variables as they relate to dose, response, and toxicity of carfilzomib in combination with isatuximab
Time Frame:Baseline to up to 30 days of the last dose of study drug
Safety Issue:
Description:Changes from baseline in pharmacodynamic markers and proliferation markers, will be evaluated and summarized for each dose cohort.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Thomas Martin, MD

Trial Keywords

  • Relapsed
  • Refractory

Last Updated

July 21, 2021