Clinical Trials /

Escalation of Daratumumab Frequency Following Biochemical Progression in Relapsed/Refractory Multiple Myeloma

NCT04150692

Description:

In a small case series, the investigators identified five patients who had an initial response to standard daratumumab (weekly for 2 cycles, every other week for 4 cycles, then monthly thereafter) either as mono- or combination therapy, who then had daratumumab frequency escalated when early biochemical progression was noted, an investigational endeavor. In this series, patients received a median of 5 additional cycles of daratumumab at an escalated frequency (range: 2-8). Additionally, the median change in involved paraprotein after one cycle of weekly-escalated dara was -40% (range: -67% to +5%), with most achieving prior partial response or stable disease. In patients who initially have at least a partial response (PR) to daratumumab, who then have biochemical progression following de-escalation, it is conceivable that CD38 saturation is not optimized at the every 4 weeks dosing interval. The investigators believe that escalating the frequency of daratumumab in patients with biochemical progression, in this investigational setting, may recapture the initial response, delay clinical progression, and/or delay treatment changes.

Related Conditions:
  • Multiple Myeloma
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Escalation of Daratumumab Frequency Following Biochemical Progression in Relapsed/Refractory Multiple Myeloma
  • Official Title: ESCALADARA: Escalation of Daratumumab Frequency Following Biochemical Progression in Relapsed/Refractory Multiple Myeloma

Clinical Trial IDs

  • ORG STUDY ID: 201910200
  • NCT ID: NCT04150692

Conditions

  • Multiple Myeloma

Interventions

DrugSynonymsArms
DaratumumabDarzalexArm 1: Daratumumab Re-Escalation

Purpose

In a small case series, the investigators identified five patients who had an initial response to standard daratumumab (weekly for 2 cycles, every other week for 4 cycles, then monthly thereafter) either as mono- or combination therapy, who then had daratumumab frequency escalated when early biochemical progression was noted, an investigational endeavor. In this series, patients received a median of 5 additional cycles of daratumumab at an escalated frequency (range: 2-8). Additionally, the median change in involved paraprotein after one cycle of weekly-escalated dara was -40% (range: -67% to +5%), with most achieving prior partial response or stable disease. In patients who initially have at least a partial response (PR) to daratumumab, who then have biochemical progression following de-escalation, it is conceivable that CD38 saturation is not optimized at the every 4 weeks dosing interval. The investigators believe that escalating the frequency of daratumumab in patients with biochemical progression, in this investigational setting, may recapture the initial response, delay clinical progression, and/or delay treatment changes.

Trial Arms

NameTypeDescriptionInterventions
Arm 1: Daratumumab Re-EscalationExperimental-Re-escalation of daratumumab will include weekly infusions for 2 4-week cycles (8 doses, Days 1, 8, 15, and 22 of each 28-day cycle) followed by dosing every-other-week thereafter (Days 1 and 15 of each 28-day cycle). Patients will remain on study treatment until meeting clinical progression.
  • Daratumumab
Arm 2: Daratumumab Monthly InfusionsActive Comparator-Continued monthly infusions of 16 mg/kg of daratumumab
  • Daratumumab

Eligibility Criteria

        Inclusion Criteria:

          -  Multiple myeloma diagnosis according to IMWG criteria

          -  Prior achievement of PR or better on standard daratumumab (single-agent or combination
             therapy)

          -  On daratumumab for at least 7 months, currently on once-monthly dosing

          -  Evidence of biochemical progression only, confirmed via two consecutive assessments.

        The interval between labs would generally be 1 to 4 weeks, and the second set of labs may
        be the screening assessment. Biochemical progression is defined as an increase of > 25%
        from lowest response value in any one or more of the following:

          -  Serum M-component (the absolute increase must be > 0.5 g/dL)

          -  Urine M-component (the absolute increase must be > 200 mg/24 h)

          -  The difference between involved and uninvolved FLC levels (the absolute increase must
             be > 10 mg/dL; only in patients without measurable serum and urine M-protein levels)

               -  Age ≥ 18 years

               -  Eastern Cooperative Oncology Group (ECOG) performance status 0-2

               -  Adequate bone marrow reserve, with ANC >1500 and Platelets >75k without
                  transfusion or growth factors within 7 days prior to assessment

               -  Adequate hepatic function, with AST and ALT ≤ 3.5 times the upper limit of normal
                  and bilirubin ≤ 2 mg/dL

               -  Creatinine clearance (CrCl) ≥ 15 mL/minute within 7 days prior to enrollment,
                  either measured or calculated using a standard formula

               -  HBV DNA Tests: Subjects who are positive for Anti-HBc or Anti-HBs will undergo
                  testing for hepatitis B DNA by PCR. 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.
                  During and following study treatment, subjects who have history of HBV infection
                  will be closely monitored for clinical and laboratory signs of reactivation of
                  HBV as specified in the Time and Events Schedule. Where required by local law,
                  the results of HBV testing may be reported to the local health authorities.

               -  Able to understand and willing to sign an IRB-approved written informed consent
                  document

        Exclusion Criteria:

          -  Evidence of clinical progression/relapse as defined as:

               -  Bone marrow plasma cell percentage; the absolute percentage must be > 10%

               -  Development of new soft tissue plasmacytomas or bone lesions

               -  Definite increase in the size of existing plasmacytomas or bone lesions. A
                  definite increase is defined as a 50% (and at least 1 cm) increase as measured
                  serially by the sum of the products of the cross-diameters of the measurable
                  lesion

               -  Hypercalcemia (> 11.5 mg/dL) [2.65 mmol/L]

               -  Decrease in hemoglobin of > 2 g/dL [1.25 mmol/L] not attributable to another
                  cause

               -  Rise in serum creatinine by 2 mg/dL or more [177 mmol/L or more] not attributable
                  to another cause

          -  Evidence of myeloma with in the CNS

          -  Diagnosis of plasma cell leukemia

          -  Prior allergic reaction to daratumumab or medications used in the treatment backbone

          -  Interruption in daratumumab therapy for any reason in the preceding 6 months longer
             than 8 weeks.

          -  Pregnant or lactating females - woman and men of childbearing potential are required
             to employ an effective contraceptive method as outlined in the ICF

          -  Concurrent malignancy other than MM requiring active treatment excluding skin cancer
             managed with local therapy

          -  Compromised cardiovascular function defined as any of the following:

               -  EKG evidence of acute ischemia;

               -  EKG evidence of medically significant conduction system abnormalities;

               -  history of myocardial infarction within the last 6 months;

               -  unstable angina pectoris or cardiac arrhythmia; (history of Class 3 or Class 4
                  New York Heart Association congestive heart failure.

          -  Severe persistent asthma (FEV1<60% and/or daily symptoms) or severe COPD defined
             clinically or by historical pulmonary function tests with an FEV1 <50% predicted

          -  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)

          -  Any other clinically significant medical disease or condition that, in the judgement
             of the investigator, would prevent the participant from safely participating in the
             trials.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Progression-free survival (PFS)
Time Frame:Up to 3 years following initiation of treatment (estimated to 3 years and 8 months)
Safety Issue:
Description:-Defined as the length of time between Cycle 1 Day 1 and progressive disease or death. Patients who are alive and progression-free or were lost to follow-up at the time of data analyses will be censored on the last known alive date.

Secondary Outcome Measures

Measure:Overall response rate (ORR)
Time Frame:Up to 6 months following initiation of treatment
Safety Issue:
Description:-Defined as the proportion of patients with a partial response (PR) or better following first treatment with daratumumab following randomization, as defined by IMWG criteria
Measure:Proportion of patients on treatment following 3 cycles
Time Frame:Completion of cycle 3 by all enrolled patients (estimated to be 12 weeks)
Safety Issue:
Description:
Measure:Paraprotein change between Cycle 1 and Cycle 2 of treatment
Time Frame:From cycle 1 through cycle 2 (estimated to be 8 weeks)
Safety Issue:
Description:
Measure:Overall survival
Time Frame:Up to 2 years following treatment removal (estimated to be 2 years and 8 months)
Safety Issue:
Description:-Overall survival (OS) will be defined as time from Cycle 1 Day 1 to death due to any causes. Patients who are alive or were lost to follow-up at the time of data analyses will be censored on the last known alive date.
Measure:Duration of response (DOR)
Time Frame:Up to 3 years following initiation of treatment (estimated to be 3 years and 8 months)
Safety Issue:
Description:-Defined as the length of time between first treatment with daratumumab following randomization and progressive disease (in responders).

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Washington University School of Medicine

Last Updated

October 31, 2019