Clinical Trials /

Ixazomib With Pomalidomide, Clarithromycin and Dexamethasone in Treating Patients With Multiple Myeloma

NCT02542657

Description:

This phase I/II trial studies the side effects and best dose of clarithromycin when given together with ixazomib citrate, pomalidomide, and dexamethasone and to see how well it works in treating patients with multiple myeloma that has not responded to previous treatment. Biological therapies, such as clarithromycin, pomalidomide, and dexamethasone, use substances made from living organisms that may stimulate the immune system in different ways and stop cancer cells from growing. Ixazomib citrate may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving clarithromycin with ixazomib citrate, pomalidomide and dexamethasone may be a better treatment for patients with multiple myeloma.

Related Conditions:
  • Multiple Myeloma
Recruiting Status:

Active, not recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Ixazomib With Pomalidomide, Clarithromycin and Dexamethasone in Treating Patients With Multiple Myeloma
  • Official Title: Phase I/II Study of Ixazomib in Combination With Pomalidomide, Clarithromycin and Dexamethasone (PiC-D) in Patients With Double Refractory Multiple Myeloma

Clinical Trial IDs

  • ORG STUDY ID: 728937
  • SECONDARY ID: UCDCC#253
  • SECONDARY ID: X16043
  • SECONDARY ID: UCDCC#253
  • SECONDARY ID: PO-TR-MM-PI-004614
  • NCT ID: NCT02542657

Conditions

  • Myeloma

Interventions

DrugSynonymsArms
ClarithromycinBiaxinTreatment (PiC-D therapy)
DexamethasoneDecadronTreatment (PiC-D therapy)
Ixazomib CitrateMLN9708Treatment (PiC-D therapy)
PomalidomidePomalystTreatment (PiC-D therapy)

Purpose

This phase I/II trial studies the side effects and best dose of clarithromycin when given together with ixazomib citrate, pomalidomide, and dexamethasone and to see how well it works in treating patients with multiple myeloma that has not responded to previous treatment. Biological therapies, such as clarithromycin, pomalidomide, and dexamethasone, use substances made from living organisms that may stimulate the immune system in different ways and stop cancer cells from growing. Ixazomib citrate may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving clarithromycin with ixazomib citrate, pomalidomide and dexamethasone may be a better treatment for patients with multiple myeloma.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To establish the maximum tolerated dose (MTD) and the recommended phase 2 dose (RP2D) for
      PiC-D therapy (pomalidomide, ixazomib [ixazomib citrate], clarithromycin, and dexamethasone)
      in patients with multiple myeloma who are bortezomib and lenalidomide refractory. (Phase I)
      II. To determine the complete response (CR) and stringent CR (sCR) rate for PiC-D therapy in
      patients with multiple myeloma who are bortezomib and lenalidomide refractory. (Phase II)

      SECONDARY OBJECTIVES:

      I. To evaluate the safety and tolerability of PiC-D therapy. (Phase I) II. To characterize
      the pharmacokinetics (PK) in plasma of oral ixazomib in combination with pomalidomide,
      clarithromycin and dexamethasone. (Phase I) III. To assess preliminary evidence of clinical
      activity. (Phase I) IV. To assess the effects of PiC-D therapy on quality of life (QOL).
      (Phase I) V. To assess the effects of PiC-D therapy on immune status (phenotypic analysis and
      cytokine profiling).

      VI. To evaluate the safety of PiC-D therapy. (Phase II) VII. To determine the overall
      response rate (ORR) (ORR; CR, sCR, partial response, and very good partial response. (Phase
      II) VIII. To determine the clinical benefit rate (CBR) (CBR; minimal response + ORR). (Phase
      II) IX. To determine the disease control rate (DCR) (DCR; stable disease + CBR). (Phase II)
      X. To determine the duration of response (DOR) in patients achieving a partial response or
      better. (Phase II) XI. To determine the time to next treatment (TNT). (Phase II) XII. To
      determine progression free survival (PFS) and overall survival (OS). (Phase II) XIII. To
      assess the effects of PiC-D therapy on quality of life (QOL). (Phase II)

      TERTIARY OBJECTIVES:

      I. To assess the effects of PiC-D therapy on immune status (phenotypic analysis and cytokine
      profiling). (Phase II)

      OUTLINE: This is a phase I, dose-escalation study of clarithromycin followed by a phase II
      study.

      Patients receive pomalidomide orally (PO) once daily (QD) on days 1-21; ixazomib citrate PO
      on days 1, 8, and 15; clarithromycin PO twice daily (BID) on days 15-21 of course 1 and days
      1-21 and courses 2-6; and dexamethasone PO on days 1, 8, 15, and 22. Treatment repeats every
      28 days for 6 courses in the absence of disease progression or unacceptable toxicity.

      MAINTENANCE THERAPY:

      Patients receive pomalidomide, ixazomib citrate, and dexamethasone as above and receive
      clarithromycin PO BID or QD. Courses repeat every 28 days in the absence of disease
      progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up every 2-3 months for up to 3
      years.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (PiC-D therapy)ExperimentalPatients receive pomalidomide PO QD on days 1-21; ixazomib citrate PO on days 1, 8, and 15; clarithromycin PO BID on days 15-21 of course 1 and days 1-21 of courses 2-6; and dexamethasone PO on days 1, 8, 15, and 22. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive pomalidomide, ixazomib citrate, and dexamethasone as above and receive clarithromycin PO BID or QD. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Clarithromycin
  • Dexamethasone
  • Ixazomib Citrate
  • Pomalidomide

Eligibility Criteria

        Inclusion Criteria:

          -  Voluntary written consent

          -  Patients must have a confirmed biopsy diagnosis of a multiple myeloma

          -  Submission of original biopsy for review and verification by hematopathologist at
             local institution

          -  Patients must have measurable disease according to International Myeloma Working Group
             (IMWG) criteria; measurable disease includes at least one of the following criteria:

               -  Serum M-protein >= 1.0 g/dL, and/or

               -  Urine M-protein >= 200 mg/24 hours, and/or

               -  Involved serum free light chain >= 10 mg/dL (>= 100 mg/L) AND an abnormal serum
                  free light chain ratio, and/or

               -  Baseline marrow burden or myeloma of at least 30%

          -  Disease that has progressed during or within 6 months of coming off therapy with
             bortezomib and lenalidomide (either sequentially or concurrent); progressive disease
             is defined as any of the following:

               -  An increase of >= 25% from lowest response value in any of the following:

                    -  Serum M-protein (absolute increase must be >= 0.5 g/dL) AND/OR

                    -  Urine M-protein (absolute increase must be >= 200 mg/24 hours) AND/OR

                    -  For patients without a measurable serum or urine M-protein but measurable
                       disease by serum free light chain testing: Difference between the involved
                       and uninvolved serum free light chain level (absolute increase must be >= 10
                       mg/dL) AND/OR

                    -  For patients without a measurable serum or urine M-component or serum free
                       light chain level: % marrow involvement with myeloma (absolute increase must
                       be >= 10%) AND/OR

               -  Definite development of new bone lesions or extramedullary plasmacytomas or
                  definite increase in the size of existing bone lesions or extramedullary
                  plasmacytomas AND/OR

               -  Hypercalcemia (corrected serum calcium > 11.5 mg/dL) attributable to myeloma
                  (e.g. not due to omitted doses of bisphosphonate)

          -  Life expectancy of greater than 3 months

          -  Eastern Cooperative Oncology Group (ECOG) performance status and/or other performance
             status 0, 1, or 2

          -  Disease free of prior malignancies for > 5 years with exception of patients with
             nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have
             undergone complete resection

          -  Absolute neutrophil count (ANC) >= 1,000/mm^3 and

          -  Platelet count >= 50,000/mm^3; note: platelet transfusions to help patients meet
             eligibility criteria are not allowed within 3 days before study enrollment

          -  Total bilirubin =< 2.0 × the upper limit of the normal range (ULN)

          -  Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 × ULN

          -  Calculated creatinine clearance >= 30 mL/min

          -  Female patients who:

               -  Are postmenopausal for at least 1 year before the screening visit, OR

               -  Are surgically sterile, OR

               -  If they are of childbearing potential, agree to practice two effective methods of
                  contraception, at the same time, from the time of signing the informed consent
                  form through 90 days after the last dose of study drug, OR

               -  Agree to practice true abstinence when this is in line with the preferred and
                  usual lifestyle of the subject (periodic abstinence [e.g., calendar, ovulation,
                  symptothermal, post-ovulation methods] and withdrawal are not acceptable methods
                  of contraception)

          -  Male patients, even if surgically sterilized (i.e., status post-vasectomy), must agree
             to one of the following:

               -  Agree to practice effective barrier contraception during the entire study
                  treatment period and through 90 days after the last dose of study drug, OR

               -  Agree to practice true abstinence when this is in line with the preferred and
                  usual lifestyle of the subject; (periodic abstinence [e.g., calendar, ovulation,
                  symptothermal, post-ovulation methods] and withdrawal are not acceptable methods
                  of contraception)

        Exclusion Criteria:

          -  Female patients who are lactating or have a positive serum pregnancy test during the
             screening period

          -  Treatment with clarithromycin, anti-myeloma therapy including investigational agents
             or plasmapheresis within 30 days prior to treatment in this study

          -  Failure to have fully recovered (i.e., =< grade 1 toxicity or to patient's clinical
             baseline) from the reversible effects of prior chemotherapy

          -  Major surgery within 14 days before enrollment

          -  Radiotherapy within 14 days before enrollment

          -  Central nervous system involvement

          -  Infection requiring systemic antibiotic therapy or other serious infection within 14
             days before study enrollment

          -  Evidence of current uncontrolled cardiovascular conditions, including uncontrolled
             hypertension, uncontrolled cardiac arrhythmias, symptomatic congestive heart failure,
             unstable angina, or myocardial infarction within the past 6 months

          -  Systemic treatment within 14 days before the first dose of study drugs, or concurrent
             use, with any of the following:

               -  Strong inhibitors of cytochrome P450, family 1, subfamily A, polypeptide 2
                  (CYP1A2)

               -  Strong inhibitors of family cytochrome P450 family 3, subfamily A (3A)

               -  Strong cytochrome 3A polypeptide 4 inducers

          -  Known ongoing or active systemic infection, active hepatitis B or C virus infection

          -  Patients with human immunodeficiency virus (HIV) infection may be eligible provided
             they meet the following:

               -  No history of acquired immunodeficiency syndrome (AIDS)-defining conditions or
                  other HIV related illness

               -  Cluster of differentiation (CD)4+ cells nadirs > 350/mm^3

               -  Treatment sensitive HIV and, if on anti-HIV therapy, HIV viral load < 50
                  copies/mm^3; please note: HIV+ patients who enroll on this study may need to
                  modify their anti-retroviral therapy prior to receiving protocol therapy if they
                  are on strong inducers or potent inhibitors of cytochrome P450; adverse events in
                  HIV+ patients will be reported separately

          -  Any serious medical or psychiatric illness that could, in the investigator's opinion,
             potentially interfere with the completion of treatment according to this protocol

          -  Known allergy to any of the study medications, their analogues, or excipients in the
             various formulations of any agent

          -  Previous allergic reaction to an immunomodulatory drug (IMiD)

          -  Known gastrointestinal (GI) disease or GI procedure that could interfere with the oral
             absorption or tolerance of study drugs including difficulty swallowing

          -  Patient has >= grade 3 peripheral neuropathy, or grade 2 with pain on clinical
             examination during the screening period

          -  Previous treatment with ixazomib or pomalidomide
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:MTD of clarithromycin when given in combination with ixazomib citrate, pomalidomide, and dexamethasone assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (Phase I)
Time Frame:28 days
Safety Issue:
Description:The MTD is defined as the highest dose tested in which fewer than 33% of patients experience a dose limiting toxicity and at least 6 patients have been treated at that dose. The MTD will be the recommended Phase 2 dose, provided that other safety considerations are acceptable.

Secondary Outcome Measures

Measure:Clinical best response
Time Frame:Up to 3 years
Safety Issue:
Description:Will be listed for each patient and summarized using standard descriptive methods.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Joseph Tuscano

Last Updated

October 29, 2019