Clinical Trials /

Study of Lenalidomide/Ixazomib/Dexamethasone/Daratumumab in Transplant-Ineligible Patients With Newly Diagnosed MM

NCT04009109

Description:

A randomized Phase II clinical trial will be conducted to assess the impact on progression free survival (PFS) with the addition of ixazomib and daratumumab to lenalidomide as a maintenance treatment following induction with lenalidomide, ixazomib, dexamethasone, and daratumumab. Patients will be randomized to either: Arm A: 12 cycles of lenalidomide, ixazomib, daratumumab, and dexamethasone followed by lenalidomide until disease progression or unacceptable toxicity or a maximum of 2 years of maintenance therapy. Arm B: 12 cycles of lenalidomide, ixazomib, daratumumab and dexamethasone, followed by lenalidomide, ixazomib, and daratumumab until disease progression or unacceptable toxicity or a maximum of 2 years maintenance therapy.

Related Conditions:
  • Multiple Myeloma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Study of Lenalidomide/Ixazomib/Dexamethasone/Daratumumab in Transplant-Ineligible Patients With Newly Diagnosed MM
  • Official Title: A Phase II Study of Lenalidomide, Ixazomib, Dexamethasone, and Daratumumab in Transplant-Ineligible Patients With Newly Diagnosed Multiple Myeloma

Clinical Trial IDs

  • ORG STUDY ID: AFT-41
  • NCT ID: NCT04009109

Conditions

  • Myeloma, Multiple

Interventions

DrugSynonymsArms
LenalidomideRevlimidLenalidomide
IxazomibNinlaroLenalidomide
Daratumumab InjectionDarzalexLenalidomide
DexamethasoneOzurdexLenalidomide

Purpose

A randomized Phase II clinical trial will be conducted to assess the impact on progression free survival (PFS) with the addition of ixazomib and daratumumab to lenalidomide as a maintenance treatment following induction with lenalidomide, ixazomib, dexamethasone, and daratumumab. Patients will be randomized to either: Arm A: 12 cycles of lenalidomide, ixazomib, daratumumab, and dexamethasone followed by lenalidomide until disease progression or unacceptable toxicity or a maximum of 2 years of maintenance therapy. Arm B: 12 cycles of lenalidomide, ixazomib, daratumumab and dexamethasone, followed by lenalidomide, ixazomib, and daratumumab until disease progression or unacceptable toxicity or a maximum of 2 years maintenance therapy.

Detailed Description

      Induction Phase: 28-day treatment cycle for 12 cycles:

        -  Lenalidomide 15 mg PO QD on Days 1-21

        -  Ixazomib 4 mg PO on Days 1, 8, 15

        -  Daratumumab 16 mg/kg IV Q1W week for 8 weeks, then Q2W weeks for 16 weeks, thereafter
           Q4W weeks

        -  Dexamethasone 20 mg PO will be administered day of and day after all doses of
           daratumumab and ixazomib (Days 1, 2, 8, 9, 15, and 16). The dexamethasone 20 mg PO oral
           or IV dose administered as a pre-infusion medication on daratumumab infusion days (Days
           1, 8, 15, 22) replaces the oral dexamethasone dose for that day.

      Maintenance Phase: 28-day treatment cycle until progression or excessive toxicity or a
      maximum of 2 years of maintenance treatment:

      Arm A

        -  Lenalidomide 10 mg PO QD on Days 1-21 Arm B

        -  Lenalidomide 10 mg PO QD on Days 1-21

        -  Ixazomib 3 mg (or last tolerated dose from the induction phase) PO on Days 1, 8, and 15

        -  Daratumumab 16 mg/kg IV on Day 1

      In the maintenance phase, dexamethasone, 20 mg PO orally or IV will be administered to
      patients as a pre-infusion medication prior to daratumumab dosing. When dexamethasone is
      reduced to 20 mg/week and is given as pre-infusion medication, patients may receive low-dose
      methylprednisolone (≤20 mg) orally (or equivalent in accordance with local standards) for the
      prevention of delayed IRRs as clinically indicated.

      If the investigator wishes to continue the maintenance regimen at the end of the 2 years
      maintenance treatment, patients may continue current maintenance as per standard of care.
    

Trial Arms

NameTypeDescriptionInterventions
LenalidomideExperimental12 cycles of lenalidomide, ixazomib, daratumumab, and dexamethasone followed by lenalidomide until disease progression or unacceptable toxicity or a maximum of 2 years of maintenance therapy.
  • Lenalidomide
  • Ixazomib
  • Daratumumab Injection
  • Dexamethasone
Lenalidomide, Ixazomib, Daratumumab, and DexamethasoneExperimental12 cycles of lenalidomide, ixazomib, dexamethasone, and daratumumab followed by lenalidomide, ixazomib, and daratumumab until disease progression or unacceptable toxicity or a maximum of 2 year maintenance therapy.
  • Lenalidomide
  • Ixazomib
  • Daratumumab Injection
  • Dexamethasone

Eligibility Criteria

        Inclusion Criteria:

          1. Patient must be at least 18 years of age.

          2. Documentation of a multiple myeloma-defining event (MDE):

             Clonal bone marrow plasma cells ≥10% or biopsy-proven bony or extramedullary
             plasmacytoma and any one or more of the following CRAB features and myeloma-defining
             events:

             Evidence of end organ damage that can be attributed to the underlying plasma cell
             proliferative disorder, specifically:

               -  Hypercalcemia: serum calcium >0.25 mmol/L (>1 mg/dL) higher than the upper limit
                  of normal (ULN) or >2.75 mmol/L (>11 mg/dL).

               -  Renal insufficiency: creatinine clearance <40 mL per minute or serum creatinine
                  >177 mol/L (>2 mg/dL).

               -  Anemia: hemoglobin value of >20 g/L below the lowest limit of normal, or a
                  hemoglobin value <100 g/L.

               -  Bone lesions: one or more osteolytic lesion on skeletal radiography, CT, or
                  PET/CT. If bone marrow has <10% clonal plasma cells, more than one bone lesion is
                  required to distinguish from solitary plasmacytoma with minimal marrow
                  involvement.

             Any one or more of the following biomarkers of malignancy (MDEs):

               -  Sixty percent (60%) or greater clonal plasma cells on bone marrow examination.

               -  Serum involved/uninvolved free light chain ratio of 100 or greater, provided the
                  absolute level of the involved light chain is at least 100 mg/L (a patient's
                  involved free light chain, either kappa or lambda, is the one that is above the
                  normal reference range; the uninvolved free light chain is the one that is
                  typically in, or below, the normal range).

               -  More than one focal lesion on MRI that is at least 5 mm or greater in size.

          3. Newly diagnosed and not considered candidate for high-dose chemotherapy with stem cell
             transplant due to:

               -  Being age ≥75 years, OR

               -  In patients <75 years: presence of important comorbid condition(s) likely to have
                  a negative impact on tolerability of high dose chemotherapy with stem cell
                  transplantation (ASCT) and/or Investigator's discretion due to concern regarding
                  acute and long-term toxicity.

               -  Including dysfunction (such as cardiac, pulmonary, hepatic, GI, renal) and
                  limitations in mental/mobility and logistical function precluding safe use of
                  ASCT as a treatment modality.

          4. Patient must have an ECOG performance status score of 0, 1, or 2.

          5. Patient must have adequate pretreatment clinical laboratory values meeting the
             following criteria ≤14 days of initial study drug administration:

               -  hemoglobin ≥7.5 g/dL (prior red blood cell transfusion or recombinant human
                  erythropoietin use is permitted).

               -  absolute neutrophil count (ANC) ≥1.0x109/L (granulocyte colony stimulating factor
                  (GCSF use is permitted).

               -  platelet count ≥75x109/L for patients in whom <50% of bone marrow nucleated cells
                  are plasma cells; otherwise, platelet count >50×109/L (transfusions are not
                  permitted to achieve this minimum platelet count).

               -  aspartate aminotransferase (AST) ≤3xULN.

               -  alanine aminotransferase (ALT) ≤3xULN.

               -  total bilirubin ≤1.5xULN, except in patients with congenital bilirubinemia, such
                  as Gilbert syndrome (direct bilirubin ≤2.0xULN).

               -  creatinine clearance (CrCl) ≥30 mL/min. (Creatinine clearance may be calculated
                  using the Cockcroft-Gault formula provided in corrected serum calcium ≤14 mg/dL
                  (≤3.5 mmol/L); or free ionized calcium <6.5 mg/dL (<1.6 mmol/L).

          6. Women of childbearing potential (WOCBP) must commit to either abstain continuously
             from heterosexual sexual intercourse or to use 2 methods of reliable birth control
             simultaneously. This includes one highly effective form of contraception (tubal
             ligation, intrauterine device [IUD], hormonal [birth control pills, injections,
             hormonal patches, vaginal rings or implants] or partner's vasectomy) and one
             additional effective contraceptive method (male latex or synthetic condom, diaphragm,
             or cervical cap). Contraception must begin 4 weeks prior to initial dosing. Reliable
             contraception is indicated even where there has been a history of infertility, unless
             due to hysterectomy or bilateral oophorectomy.

          7. A man who is sexually active with a WOCBP must agree to use a latex or synthetic
             condom, even if they had a successful vasectomy. All men must also not donate sperm
             during the study, for 4 weeks after the last dose of lenalidomide, and for 4 months
             after the last dose of daratumumab.

          8. A WOCBP must have 2 negative serum or urine pregnancy tests first within 10 to 14 days
             prior to initial dosing.

          9. All study patients must be registered into the mandatory Revlimid REMS® program and be
             willing and able to comply with the requirements of the REMS® program.

         10. Females of reproductive potential must agree to adhere to the scheduled pregnancy
             testing as required in the Revlimid REMS® program.

         11. Ability to understand and the willingness to sign a written informed consent document

        Exclusion Criteria:

          1. Prior history of primary amyloidosis, monoclonal gammopathy of undetermined
             significance, or smoldering multiple myeloma (MM). Note: Monoclonal gammopathy of
             undetermined significance is defined by presence of serum M-protein <3 g/dL; absence
             of lytic bone lesions, anemia, hypercalcemia, and renal insufficiency related to the
             M-protein; and (if determined) proportion of plasma cells in the bone marrow of 10% or
             less. Smoldering multiple myeloma is defined as asymptomatic MM with absence of
             related organ or tissue impairment end organ damage

          2. Prior history of Waldenström's disease, or other conditions in which IgM M-protein is
             present in the absence of a clonal plasma cell infiltration with lytic bone lesions.

          3. Prior or current systemic therapy or stem cell transplantation (SCT) for MM, with the
             exception of an emergency use of a short course (equivalent of dexamethasone 40 mg/day
             for a maximum 4 days) of corticosteroids before initial dosing.

          4. History of malignancy (other than MM) within 5 years prior to screening (exceptions
             are squamous and basal cell carcinomas of the skin and carcinoma in situ of the
             cervix).

          5. Radiation therapy ≤14 days prior to screening.

          6. Plasmapheresis ≤28 days prior to screening.

          7. Exhibiting clinical signs of meningeal involvement of MM ≤28 days prior to screening.

          8. Known chronic obstructive pulmonary disease (COPD) (defined as a forced expiratory
             volume [FEV] in 1 second <60% of predicted normal), persistent asthma, or a history of
             asthma ≤ 2 years prior to screening (intermittent asthma is allowed). Note: Patients
             with known or suspected COPD or asthma must have a FEV1 test within 28 days prior to
             screening.

          9. Patient has history or evidence of unstable/uncontrolled medical or psychiatric
             disorder, condition or disease (e.g., active systemic infection, uncontrolled
             diabetes, acute diffuse infiltrative pulmonary disease) that is likely to interfere
             with the study procedures or results, or that in the opinion of the investigator,
             would pose a risk to subject safety or interfere with study evaluation, procedures or
             completion.

         10. Clinically significant cardiac disease, including:

               -  myocardial infarction ≤1 year prior to screening, or an unstable or uncontrolled
                  disease/condition related to or affecting cardiac function (eg, unstable angina,
                  congestive heart failure, New York Heart Association Class III-IV).

               -  uncontrolled cardiac arrhythmia (National Cancer Institute Common Terminology
                  Criteria for Adverse Events [NCI CTCAE] Version 5.0 Grade ≥2) or clinically
                  significant ECG abnormalities;

               -  12-lead ECG performed ≤28 days prior to screening showing a baseline QT interval
                  as corrected by Fridericia's formula (QTcF) >470 msec.

         11. Known allergies, hypersensitivity, or intolerance to corticosteroids, monoclonal
             antibodies, or human proteins, or their excipients (refer to respective package
             inserts or Investigator's Brochure) or known sensitivity to mammalian-derived
             products.

         12. History of plasma cell leukemia (by WHO criterion: ≥20% of cells in the peripheral
             blood with an absolute plasma cell count of more than 2×109/L) or POEMS syndrome (ie,
             polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes).

         13. Patient is:

               -  seropositive for human immunodeficiency virus (HIV)

               -  seropositive for hepatitis B (defined by a positive test for hepatitis B surface
                  antigen [HBsAg]). Subjects with resolved infection (ie, subjects who are HBsAg
                  negative but positive for antibodies to hepatitis B core antigen [anti-HBc]
                  and/or antibodies to hepatitis B surface antigen [anti-HBs]) must be screened
                  using real-time polymerase chain reaction (PCR) measurement of hepatitis B virus
                  (HBV) DNA levels. Those who are PCR positive will be excluded. EXCEPTION:
                  Subjects with serologic findings suggestive of HBV vaccination (anti-HBs
                  positivity as the only serologic marker) AND a known history of prior HBV
                  vaccination, do not need to be tested for HBV DNA by PCR.

               -  seropositive for hepatitis C (except in the setting of a sustained virologic
                  response [SVR], defined as aviremia at least 12 weeks after completion of
                  antiviral therapy).

         14. A woman who is pregnant, or breast-feeding, or planning to become pregnant during the
             study period or a man who plans to father a child during the study period. See Section
             12.8 for further details.

         15. Major surgery ≤14 days prior to screening or has not fully recovered from surgery, or
             has surgery planned during the time the patient is expected to participate in the
             study. Note: Kyphoplasty or vertebroplasty is not considered major surgery.

         16. Received an investigational drug (including investigational vaccines) or used an
             invasive investigational medical device ≤28 days prior to initial dosing or is
             currently enrolled in an interventional investigational study.

         17. Contraindications to required protocol prophylaxis for deep vein thrombosis and
             pulmonary embolism.

         18. Peripheral neuropathy Grade 2 or severe ≤28 days prior to screening.

         19. Systemic treatment with strong CYP3A inducers (rifampin, rifapentine, rifabutin,
             carbamazepine, phenytoin, phenobarbital), or use of St. John's wort ≤14 days prior to
             screening.
      
Maximum Eligible Age:75 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Impact of Study Treatment on Progression Free Survival (PFS)
Time Frame:5 Years
Safety Issue:
Description:Time interval between registration and progression or death.

Secondary Outcome Measures

Measure:Minimal Residual Disease (MRD)
Time Frame:5 Years
Safety Issue:
Description:Minimal residual disease (MRD) negativity in the blood and marrow will be determined using the IMWG criteria.
Measure:Toxicity Profile of Treatment Arm Based on Patient Response
Time Frame:5 Years
Safety Issue:
Description:Evaluation of incidence and severity of adverse events by summaries of toxicity data/contingency tables.
Measure:Overall Response Rate (ORR)
Time Frame:5 Years
Safety Issue:
Description:Proportion of patients with reduction in tumor burden of a predefined amount.
Measure:Overall Survival (OS)
Time Frame:5 Years
Safety Issue:
Description:Time from registration to death due to any cause.
Measure:Quality of Life with the EQ 5D 5L Questionnaire
Time Frame:5 Years
Safety Issue:
Description:Consists of 2 parts: the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS). The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions. This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state. The EQ VAS records the patient's self-rated health on a vertical visual analogue scale, where the endpoints are labelled 'The best health you can imagine' and 'The worst health you can imagine'. The VAS can be used as a quantitative measure of health outcome that reflect the patient's own judgement.
Measure:Quality of Life with the EORTC QLQ-MY20 Questionnaire
Time Frame:5 Years
Safety Issue:
Description:The EORTC QLQ-MY20 module was developed as an addition to the QLQ-C30 for use specifically in MM. It has 4 domains (disease symptoms, side effects of treatment, body image, future perspectives). Scores range from 0 to 100; good HRQoL is indicated by high scores for future perspective and body image, and low scores for disease symptoms and side effects of treatment.
Measure:Quality of Life with the EORTC QLQ-C30 Questionnaire
Time Frame:5 Years
Safety Issue:
Description:The EORTC QLQ-C30 is composed of both multi-item scales and single-item measures. These include five functional scales, three symptom scales, a global health status/QoL scale, and six single items. Each of the multi-item scales includes a different set of items - no item occurs in more than one scale. All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level. Thus a high score for a functional scale represents a high/healthy level of functioning, a high score for the global health status/QoL represents a high QoL, but a high score for a symptom scale/item represents a high level of symptomatology/problems.
Measure:Rate of Adherence to Lenalidomide and Ixazomib
Time Frame:5 Years
Safety Issue:
Description:All patients who have begun treatment will be included in the estimate of adherence rate to lenalidomide and the estimate of the adherence rate to ixazomib.
Measure:Alliance Geriatric Assessment with IMWG Fragility Score
Time Frame:5 Years
Safety Issue:
Description:To describe functional status, comorbidity, psychological state, social activity, social support, chemotherapy toxicity, and nutrition using the geriatric assessment tool.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Alliance Foundation Trials, LLC.

Last Updated

June 15, 2021