Description:
Myeloma patients who relapse after prior treatment with bortezomib and lenalidomide have
survival of less than 1 year. A number of new drugs have been approved for the treatment of
relapse myeloma in the last couple of years, including, Elotuzumab, Panobinostat, Ixazomib,
carfilzomib and Pomalidomide. However, most of these drugs either do not have good single
agent activity or still belongs to the category of immunomodulatory drugs or proteasome
inhibitors. Daratumumab is a monoclonal antibody against CD38 that is highly expressed on
myeloma plasma cells. In phase ½ studies, it has impressive single agent activity in relapse
and refractory myeloma with a very acceptable toxicity profile. This set the stage for
combinations with daratumumab to increase efficacy and improve outcome of patients with
myeloma. The use of immunomodulatory drugs, such as thalidomide and lenalidomide, has been
shown to augment NK cell activity. NK cells are important mediator of antibody dependent
cellular cytotoxicity. We therefore hypothesize that the combination of Daratumumab with
thalidomide may therefore improve the efficacy of the treatment.
In this study, we will plan to perform a phase II trial using the Daratumumab, Thalidomide,
Dexamethasone combination in 100 myeloma patients with relapse myeloma in Asia.
Title
- Brief Title: Daratumumab, Thalidomide and Dexamethasone in Relapse and/or Refractory Myeloma
- Official Title: Phase 2 Study of Daratumumab in Combination With Thalidomide and Dexamethasone in Relapse and / or Refractory Myeloma
Clinical Trial IDs
- ORG STUDY ID:
AMN004
- NCT ID:
NCT03143036
Conditions
- Relapse and / or Refractory Myeloma
Interventions
Drug | Synonyms | Arms |
---|
Daratumumab, thalidomide and dexamethasone | | Daratumumab, thalidomide and dexamethasone |
Purpose
Myeloma patients who relapse after prior treatment with bortezomib and lenalidomide have
survival of less than 1 year. A number of new drugs have been approved for the treatment of
relapse myeloma in the last couple of years, including, Elotuzumab, Panobinostat, Ixazomib,
carfilzomib and Pomalidomide. However, most of these drugs either do not have good single
agent activity or still belongs to the category of immunomodulatory drugs or proteasome
inhibitors. Daratumumab is a monoclonal antibody against CD38 that is highly expressed on
myeloma plasma cells. In phase ½ studies, it has impressive single agent activity in relapse
and refractory myeloma with a very acceptable toxicity profile. This set the stage for
combinations with daratumumab to increase efficacy and improve outcome of patients with
myeloma. The use of immunomodulatory drugs, such as thalidomide and lenalidomide, has been
shown to augment NK cell activity. NK cells are important mediator of antibody dependent
cellular cytotoxicity. We therefore hypothesize that the combination of Daratumumab with
thalidomide may therefore improve the efficacy of the treatment.
In this study, we will plan to perform a phase II trial using the Daratumumab, Thalidomide,
Dexamethasone combination in 100 myeloma patients with relapse myeloma in Asia.
Detailed Description
Daratumumab is a humanized antibody against CD38 which is expressed on myeloma cells.
Daratumumab exhibited single agent activity in myeloma and is a promising new treatment.
Recently, 2 phase 1 / 2 studies establishes the dosing regimen for Daratumumab and impressive
single agent activity of about 30% response rates in patients who relapse after prior
lenalidomide and bortezomib. Daratumumab also appear to be well tolerated. The most common
toxicity is infusion-related and almost all confined to the first cycle. On the whole these
are manageable with early intervention, concurrent corticosteroids and anti-histamines as
well as slowing infusion rate. More recently, early results from 2 randomise study comparing
Daratumumab plus lenalidomide and dexamethasone compared to lenalidomide and dexamethasone,
and Daratumumab plus bortezomib and dexamethasone compared to bortezomib and dexamethasone,
showed that the addition of Daratumumab significantly improved response and progression free
survival, including a high minimal residual disease (MRD) negative rate of more than 20% in
the relapse myeloma populations.
In addition, the use of immunomodulatory drugs, such as thalidomide and lenalidomide, has
been shown to augment NK cell activity. NK cells are important mediator of antibody dependent
cellular cytotoxicity, which is an important mechanism of action for Daratumumab.
Furthermore, in the studies using another antibody target SLAMF7, Elotuzumab, the addition of
dexamethasone greatly improve efficacy. Furthermore, thalidomide plus dexamethasone
combination have a long history in myeloma and is relatively well tolerated and
cost-effective. We therefore propose to add Daratumumab to thalidomide and dexamethasone, as
this combination will be relatively easy to deliver in the Asian population because of
availability and there is good rationale that such a combination will be synergistic and
well-tolerated
Patients will be assessed every 28 days (+/-10 days). Patients shall receive the treatment
until disease progression, unacceptable toxicity as determined by treating physician,
withdrawal of consent or mortality (whichever occurs first). After disease progression, the
treating physician should provide long-term follow-up data on disease status and survival.
For patients who discontinued treatment before disease progression occurred, disease
assessment measurements shall be performed once every 28 days (+/- 10 days) until disease
progression. After patients have documented progression of disease, they will be followed for
survival every 3 months (+/-10 days) until study closure or until patients withdraws consent,
is lost to follow-up or until death, whichever comes first. For any patient who is lost to
follow-up, the study site shall attempt to ascertain survival information via public database
search.
Trial Arms
Name | Type | Description | Interventions |
---|
Daratumumab, thalidomide and dexamethasone | Experimental | | - Daratumumab, thalidomide and dexamethasone
|
Eligibility Criteria
Inclusion Criteria:
1. Multiple myeloma, diagnosed according to standard criteria, with relapsing and
refractory disease at study entry
2. Patients must have evaluable multiple myeloma with at least one of the following
(within 21 days of starting treatment)
1. Serum M-protein ≥ 0.5g/dL, or
2. In subjects without detectable serum M-protein, Urine M-protein ≥ 200mg/24 hour,
or serum free light chai (sFLC) > 100mg/L (involved light chain) and an abnormal
kappa/Lambda ratio
3. Must receive at least 1 line of prior treatment. (Induction therapy followed by stem
cell transplantation and consolidation/maintenance therapy will be considered as one
line of treatment)
4. Must have relapsed disease and/or be refractory to prior treatment except for
thalidomide or lenalidomide. Refractoriness is defined as disease progression on
treatment or progression within 6 months after the last dose of a given therapy.
Relapse is defined according to the criteria of IMWG
5. Males and females ≥ 18 years of age or > country's legal age for adult consent
6. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 2
7. Patients must meet the following clinical laboratory criteria with 21 days of starting
treatment:
1. Absolute neutrophil count (ANC) ≥ 1,000/mm3 and platelet ≥ 50,000/mm3 (≥
30,000/mm3 if myeloma involvement in the bone marrow is >50%)
2. Total bilirubin ≤ 1.5 x the upper limit of the normal range (ULN). Alanine
aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 x ULN.
3. Calculated creatinine clearance ≥ 30mL/min.
8. Written informed consent in accordance with federal, local and institutional
guidelines
Exclusion Criteria:
1. Female patients who are lactating or pregnant
2. Multiple Myeloma of IgM subtype
3. Glucocorticoid therapy (prednisolone > 30mg/day or equivalent) within 14 days prior to
informed consent obtained
4. POEMS syndrome
5. Plasma cell leukemia or circulating plasma cells ≥ 2 x 109/L
6. Waldenstrom's Macroglobulinaemia
7. Existing peripheral neuropathy of grade 2 or higher or presence of neuropathic pain
8. Patients with known amyloidosis
9. Chemotherapy with approved or investigation anticancer therapeutics within 21 days
prior to starting Dara-TD treatment
10. Focal radiation therapy within 7 days prior to start of Dara-TD. Radiation therapy to
an extended field involving a significant volume of bone marrow within 21 days prior
to start of pomalidomide
11. Immunotherapy (excluding steroids) 21 days prior to start of Dara-TD
12. Major surgery (excluding kyphoplasty) within 28 days prior to start of Dara-TD
13. Active congestive heart failure (New York Heart Association [NYHA] Class III or IV),
symptomatic ischaemia, or conduction abnormalities uncontrolled by conventional
intervention. Myocardial infarction within 4 months prior to informed consent obtained
14. Known HIV seropositive, hepatitis C infection, and/or hepatitis B (except for patients
with hepatitis B surface antigen or core antibody receiving and responding to
antiviral therapy directed at hepatitis B: these patients are allowed)
15. Patients with known cirrhosis
16. Patients with creatinine clearance <30m/min
17. Second malignancy within the past 3 years except:
1. Adequately treated basal cell or squamous cell skin cancer
2. Carcinoma in situ of the cervix
3. Breast carcinoma in situ with full surgical resection
18. Patients with myelodysplastic syndrome
19. Patients with steroid or thalidomide hypersensitivity
20. Patients previously treated with daratumumab or other anti-CD38 antibodies.
21. Ongoing graft-versus-host disease
22. Patients with pleural effusions requiring thoracentesis or ascites requiring
paracentesis within 14 days prior to starting Dara-TD treatment
23. Disease refractory to thalidomide or lenalidomide
24. Contraindication to any of the required concomitant drugs or supportive treatments
25. Any clinically significant medical disease or psychiatric condition that, in the
investigator's opinion, may interfere with protocol adherence or a patient's ability
to give informed consent.
Maximum Eligible Age: | 99 Years |
Minimum Eligible Age: | 21 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Progression free survival (PFS) |
Time Frame: | Time from commencement of treatment to disease progression or death, whichever occurs first, assessed up to 100 months |
Safety Issue: | |
Description: | To assess the progression free survival (PFS) for daratumumab in combination with thalidomide and dexamethasone in Asian patients with relapsed myeloma. |
Secondary Outcome Measures
Measure: | Overall Response Rate (ORR) |
Time Frame: | anytime from commencement of treatment with daratumumab, thalidomide and dexamethasone to the end of studyaseline until disease progression, unmanageable adverse event or death, whichever occurs first, approximately up to 3 years |
Safety Issue: | |
Description: | percentage of patients enrolled that achieve a complete response (CR), or stringent complete response (sCR), or very good partial response (VGPR), or partial response (PR) based on the International Myeloma Working Group criteria |
Measure: | Overall survival (OS) |
Time Frame: | Up to approximately 5 years (anticipated) after the last participant is enrolled |
Safety Issue: | |
Description: | Time from commencement of treatment with daratumumab, thalidomide and dexamethasone to the date of death. |
Measure: | Duration of response (DOR) |
Time Frame: | the time from first evidence of PR or VGPR, or CR, or sCR to confirmation of disease progression or death due to any cause, assessed up to 100 months |
Safety Issue: | |
Description: | the time from first evidence of PR or VGPR, or CR, or sCR to confirmation of disease progression or death due to any cause. |
Measure: | Number of Participants affected by Adverse Events |
Time Frame: | from the time of enrolment into study till 3 years from the date of the last patient randomized |
Safety Issue: | |
Description: | assessed on the basis of the frequency and severity of adverse events |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | National University Hospital, Singapore |
Trial Keywords
Last Updated
June 7, 2018