This study is the first study of tasquinimod, an inhibitor of S100A9, in patients with
multiple myeloma.
Tasquinimod has previously been studied as an anti-cancer agent in patients with other
cancers, including a phase 3 randomized trial in patients with metastatic prostate cancer
that showed an improvement in radiographic progression-free survival. The side effect profile
of tasquinimod is well-characterized based on this previous experience. This trial will
establish a maximum tolerated dose and optimal schedule for administration of tasquinimod in
patients with multiple myeloma and then investigate the maximum tolerated dose of tasquinimod
in combination with a standard myeloma regimen of ixazomib, lenalidomide, and dexamethasone
(IRd). For both single agent tasquinimod and the combination of tasquinimod with IRd,
exploratory expansion cohorts will be enrolled to preliminarily characterize the antimyeloma
activity of each regimen.
Inclusion Criteria:
1. Signed informed consent
2. 18 years of age or older
3. Multiple myeloma (MM) diagnosed according to IMWG criteria
4. Measurable disease (this is defined differently in different arms)
5. Multiple myeloma relapsed or refractory to treatment (this is defined differently in
different arms)
6. Meet certain clinical laboratory criteria
7. ECOG performance status ≤2
8. Life expectancy of at least 3 months
9. For women of childbearing potential, a negative serum or urine pregnancy test prior to
study treatment.
10. For women who are not postmenopausal (12 months of amenorrhea) or surgically sterile
(absence of ovaries and/or uterus): agreement to use two methods of contraception one
of which must be highly effective
11. For men: agreement to use a barrier method of contraception for 1 month before start
of study treatment, during the treatment period and for 6 months after the last dose
of study treatment.
Exclusion Criteria:
1. Failure to have fully recovered (i.e. ≤ Grade 1 toxicity) from the effects of prior
chemotherapy (except for alopecia)
2. Active graft versus host disease
3. Treatment with any of the following:
1. Cytotoxic chemotherapy within 3 weeks prior to the initiation of study treatment
2. Proteasome inhibitors, Imids, or monoclonal antibodies within 2 weeks prior to
the initiation of study treatment
3. Experimental therapy within 4 weeks or 5 half-lives, whichever is shorter
4. Systemic corticosteroids >=10 mg prednisone or equivalent within 7 days prior to
the initiation of study treatment
5. Radiotherapy within 7 days prior to initiating study treatment
6. Plasmapheresis within 4 weeks prior to the initiation of study treatment
7. Tasquinimod at any time
4. Known central nervous system involvement by myeloma
5. Diagnosis of smoldering multiple myeloma
6. Diagnosis of POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly,
endocrinopathy, monoclonal protein, and skin changes)
7. Active plasma cell leukemia
8. Symptomatic primary (AL) amyloidosis
9. Diagnosis of myelodysplastic syndrome or myeloproliferative syndrome
10. Active other malignancy
11. Major surgery within 4 weeks prior to initiating study treatment
12. Evidence of severe or currently uncontrolled cardiovascular condition
13. Ongoing or active systemic infection that requires systemic antibiotic or parenteral
anti-infective therapy
14. Active tuberculosis, active hepatitis A, B or C virus infection, or known human
immunodeficiency virus (HIV) positive
15. History of pancreatitis
16. History of malabsorption or other condition that would interfere with absorption of
study drugs
17. Systemic treatment within 14 days prior to the initiation of study treatment with
moderate or strong inhibitor or moderate or strong inducer of cytochrome P-3A4
(CYP3A4)
18. Need for ongoing therapy drug substances of narrow therapeutic range that are
metabolized mainly by CYP3A4 (alfentanil, fentanyl, quinidine, astemizole,
terfenadine, sirolimus, tacrolimus, cyclosporine, cisapride, ergotamine)
19. Need for ongoing therapy with drug substances of narrow therapeutic range metabolized
mainly by CYP1A2 (duloxetine, alosetron, theophylline, tizanidine, ondansetron)
20. Ongoing treatment with warfarin, unless the INR is <=3.0.
21. For subjects enrolled on the IRd combination arms, prior dose-limiting toxicity with
lenalidomide or ixazomib or absolute contraindication to concomitant thrombosis
prophylaxis
22. Peripheral neuropathy grade ≥2 (NCI-CTCAE)
23. Known hypersensitivity to tasquinimod or any excipients in the study treatments
24. Pregnant or nursing (lactating) women
25. Any other condition that would, in the Investigator's judgment, contraindicate
subject's participation in the clinical study due to safety concerns or compliance
with clinical study procedures
26. Prior inclusion in this study