Clinical Trials /

Panobinostat in Combination With Daratumumab, Bortezomib and Dexamethasone for the Treatment of Relapsed/Refractory Multiple Myeloma

NCT04956302

Description:

This phase I trial studies the possible benefits and side effects of adding panobinostat to a combination of daratumumab, bortezomib and dexamethasone in treating patients with multiple myeloma that has come back (relapsed) or has not responded to treatment (refractory). Panobinostat may stop or slow multiple myeloma by blocking the growth of new blood vessels necessary for cancer growth. Giving panobinostat in combination with daratumumab, bortezomib and dexamethasone may work better in treating relapsed/refractory multiple myeloma.

Related Conditions:
  • Multiple Myeloma
Recruiting Status:

Not yet recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Panobinostat in Combination With Daratumumab, Bortezomib and Dexamethasone for the Treatment of Relapsed/Refractory Multiple Myeloma
  • Official Title: A Phase I Study of Panobinostat in Combination With Daratumumab, Bortezomib, and Dexamethasone in Patients With Relapsed/Refractory Multiple Myeloma

Clinical Trial IDs

  • ORG STUDY ID: OSU-21005
  • SECONDARY ID: NCI-2021-04261
  • NCT ID: NCT04956302

Conditions

  • Recurrent Plasma Cell Myeloma
  • Refractory Plasma Cell Myeloma

Interventions

DrugSynonymsArms
Bortezomib[(1R)-3-Methyl-1-[[(2S)-1-oxo-3-phenyl-2-[(pyrazinylcarbonyl)amino]propyl]amino]butyl]boronic Acid, LDP 341, MLN341, PS-341, PS341, VelcadeTreatment (panobinostat, daratumumab, bortezomib, dexa)
Daratumumab and Hyaluronidase-fihjDARA Co-formulated with rHuPH20, DARA/rHuPH20, Daratumumab + rHuPH20, Daratumumab with rHuPH20, Daratumumab-rHuPH20, Daratumumab/Hyaluronidase-fihj, Daratumumab/rHuPH20 Co-formulation, Darzalex Faspro, Darzalex/rHuPH20, HuMax-CD38-rHuPH20, Recombinant Human Hyaluronidase Mixed with DaratumumabTreatment (panobinostat, daratumumab, bortezomib, dexa)
DexamethasoneAacidexam, Adexone, Aknichthol Dexa, Alba-Dex, Alin, Alin Depot, Alin Oftalmico, Amplidermis, Anemul mono, Auricularum, Auxiloson, Baycadron, Baycuten, Baycuten N, Cortidexason, Cortisumman, Decacort, Decadrol, Decadron, Decadron DP, Decalix, Decameth, Decasone R.p., Dectancyl, Dekacort, Deltafluorene, Deronil, Desamethasone, Desameton, Dexa-Mamallet, Dexa-Rhinosan, Dexa-Scheroson, Dexa-sine, Dexacortal, Dexacortin, Dexafarma, Dexafluorene, Dexalocal, Dexamecortin, Dexameth, Dexamethasone Intensol, Dexamethasonum, Dexamonozon, Dexapos, Dexinoral, Dexone, Dinormon, Dxevo, Fluorodelta, Fortecortin, Gammacorten, Hemady, Hexadecadrol, Hexadrol, Lokalison-F, Loverine, Methylfluorprednisolone, Millicorten, Mymethasone, Orgadrone, Spersadex, TaperDex, Visumetazone, ZoDexTreatment (panobinostat, daratumumab, bortezomib, dexa)
Panobinostat LactateFarydakTreatment (panobinostat, daratumumab, bortezomib, dexa)

Purpose

This phase I trial studies the possible benefits and side effects of adding panobinostat to a combination of daratumumab, bortezomib and dexamethasone in treating patients with multiple myeloma that has come back (relapsed) or has not responded to treatment (refractory). Panobinostat may stop or slow multiple myeloma by blocking the growth of new blood vessels necessary for cancer growth. Giving panobinostat in combination with daratumumab, bortezomib and dexamethasone may work better in treating relapsed/refractory multiple myeloma.

Detailed Description

      PRIMARY OBJECTIVE:

      I. To evaluate the safety and tolerability of Farydak (panobinostat lactate)/Darzalex Faspro
      (daratumumab and hyaluronidase-fihj)/Velcade (bortezomib)/dexamethasone (FDVd) in patients
      with relapsed/refractory multiple myeloma (RRMM) who have previously received one line of
      therapy including lenalidomide or cyclophosphamide, bortezomib (V) or other proteasome
      inhibitor (PI), with or without autologous stem cell transplant (ASCT).

      SECONDARY OBJECTIVES:

      I. To evaluate the overall response rate (ORR) (per International Myeloma Working Group
      [IMWG] criteria) of FDVd.

      II. Determine the time to response (TTR). III. Determine the duration of response (DOR). IV.
      Determine the progression-free survival (PFS) at 1 year. V. Determine the overall survival
      (OS) at 1 year.

      CORRELATIVE OBJECTIVES:

      I. Baseline and end of-study plasma cell expression of CD38. II. Changes in lymphocyte
      subsets with therapy. III. Baseline and end-of study analysis of total number and ratio of
      regulatory T cells (Tregs) with CD38+ expression.

      IV. Check minimal residual disease (MRD) negativity rates by next generation sequencing in
      patients who attain and maintain very good partial response (VGPR) or better for at least
      three months.

      OUTLINE: This is a dose-escalation study of panobinostat.

      Patients receive panobinostat orally (PO) once daily (QD) on days 1, 3, 5, 15, 17, 19,
      daratumumab and hyaluronidase-fihj subcutaneously (SC) on days 1, 8, 15, 22 of cycles 1-2,
      days 1 and 15 of cycles 3-6, and day 1 of subsequent cycles, bortezomib SC on days 1, 8, 15,
      22 and dexamethasone PO (intravenously [IV] on days of daratumumab and hyaluronidase-fihj
      administration) QD on days 1, 8, 15, 22. Cycles repeat every 28 days in the absence of
      disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up on days 30 and 60.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (panobinostat, daratumumab, bortezomib, dexa)ExperimentalPatients receive panobinostat PO QD on days 1, 3, 5, 15, 17, 19, daratumumab and hyaluronidase-fihj SC on days 1, 8, 15, 22 of cycles 1-2, days 1 and 15 of cycles 3-6, and day 1 of subsequent cycles, bortezomib SC on days 1, 8, 15, 22 and dexamethasone PO (IV on days of daratumumab and hyaluronidase-fihj administration) QD on days 1, 8, 15, 22. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Bortezomib
  • Daratumumab and Hyaluronidase-fihj
  • Dexamethasone
  • Panobinostat Lactate

Eligibility Criteria

        Inclusion Criteria:

          -  Patients 18-75 years of age with evidence of relapsed or refractory disease as defined
             by IMWG criteria and measurable disease as defined by any of the following:

               -  Serum M-protein >= 0.5 g/dl (>= 10 g/l)

               -  Urine monoclonal protein >= 200 mg/24h

               -  Involved free light chain (FLC) level >= 10mg/dl (>= 100mg/l) and an abnormal
                  serum free light chain ratio (< 0.26, or > 1.65)

          -  Patients must have had at least 1 prior line of therapy including lenalidomide or
             cyclophosphamide, V or other PI, with or without ASCT

               -  Patients with progressive disease (PD) as best response on V are excluded

               -  Patients with PD on D-based therapy may be eligible at the discretion of the
                  treating physician

          -  Refractory (progressed on or within 120 days of treatment) to their last treatment

               -  Patients must be off last treatment for at least 2 weeks by the beginning of
                  treatment on this protocol

          -  Hemoglobin >= 7g/dL

          -  Absolute neutrophil count (ANC) >= 1000/uL

          -  Platelets >= 70,000/uL

               -  If plasma cell percentage on bone marrow biopsy aspirate or core is > 30%,
                  platelet requirement will be adjusted to 50,000/ul

          -  Total bilirubin < 1.5 mg/dL

          -  Aspartate aminotransferase (AST)/alanine aminotransferase (ALT)/alkaline phosphatase <
             2 x the upper limit of normal (ULN)

          -  Serum creatinine < 2mg/dL or calculated creatinine clearance of >= 30ml/min using
             Modification of Diet in Renal Disease Study (MDRD) formula

          -  Left ventricular ejection fraction >= 30%; baseline echocardiogram (ECHO) is not
             required

          -  No uncontrolled arrhythmias

          -  No New York Heart Association class III-IV heart failure

          -  12-lead electrocardiogram (ECG) with QT interval calculated by Fridericia Formula
             (QTcF) interval of =< 450 msec

          -  Patient must be able to swallow capsule or tablet

          -  Patients must provide informed consent

          -  Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status
             (PS) score of < 2

          -  Women of child bearing 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 dosing and continue to 6
             months after study treatment ending. Reliable contraception is indicated even where
             there has been a history of infertility, unless due to hysterectomy

          -  Investigators shall counsel WOCBP and male participants who are sexually active with
             WOCBP on the importance of pregnancy prevention and the implications of an unexpected
             pregnancy

          -  A negative pregnancy test will be required for all WOCBP within 24 hours before
             starting treatment drugs

          -  Breast feeding is not permitted

          -  Male patients must agree to use an adequate method of contraception (latex or
             synthetic condom) for the duration of the study and up to 6 months after study
             treatment ending

               -  Criteria also applies to azoospermic males

          -  Males should refrain from sperm donation during this time and continue for 6 months
             after study treatment ending

        Exclusion Criteria:

          -  Patients with active (untreated or relapsed) central nervous system (CNS) metastasis
             of myeloma

          -  Patients with Waldenstrom macroglobulinemia, primary amyloid light-chain (AL)
             amyloidosis, primary plasma cell leukemia, or polyneuropathy, organomegaly,
             endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome

               -  Patients with secondary plasma cell leukemia are permitted

          -  Patients with peripheral neuropathy > National Cancer Institute (NCI) Common
             Terminology Criteria for Adverse Events (CTCAE) grade 2

          -  Patients receiving concurrent corticosteroids at the time protocol therapy is
             initiated other than for physiologic maintenance treatment

          -  Concurrent use of complementary or alternative medicines that would confound the
             interpretation of toxicities and antitumor activity of the study drugs

          -  Patients with known allergies, hypersensitivity, or intolerance to panobinostat,
             daratumumab, or bortezomib

          -  Unacceptable respiratory risk factors defined by any one of the following criteria:

               -  Chronic obstructive pulmonary disease (COPD) with a forced expiratory volume in 1
                  second (FEV1) less than 50% of predicted normal

               -  Moderate or severe persistent asthma within the past 2 years, or currently has
                  uncontrolled asthma of any classification

          -  Unacceptable cardiac risk factors defined by any of the following criteria:

               -  Patients with congenital long QT syndrome

               -  Any history of ventricular fibrillation or torsade de pointes

               -  Bradycardia defined as heart rate (HR) < 50 beats per minute (bpm)

               -  Left ventricular ejection fraction < 30%

          -  Patients who have received targeted or investigational agents within 2 weeks or within
             5 half-lives of the agent and active metabolites (whichever is shorter) and who have
             not recovered from side effects of those therapies

          -  Patients who have undergone major surgery =< 2 weeks prior to starting study drug or
             who have not recovered from the side-effects of surgery

          -  Patients with known positivity for human immunodeficiency virus (HIV) or hepatitis C;
             baseline testing for HIV and hepatitis C is not required

          -  Patients with active hepatitis B (defined as hepatitis B virus surface antigen
             positive [HBsAg+]); HBV screening is required prior to beginning therapy

               -  Patients with prior hepatitis B vaccine are permitted (defined as hepatitis B
                  virus surface antigen negative [HBsAg-], hepatitis B virus surface antibody
                  positive [Anti-HBs+], hepatitis B virus core antibody negative (Anti-HBc-])

               -  Non-active hepatitis B (HBsAg-, Anti-HBs+, hepatitis B virus core antibody
                  positive [Anti-HBc+]) may only be enrolled following approval by the sponsor
                  after consideration of risk of reactivation (additional screening and monitoring
                  for hepatitis B and consultation with a liver disease specialist may be required)

          -  Patients with a history of another primary malignancy that is currently clinically
             significant or currently requires active intervention, other than non-melanoma skin
             cancer and carcinoma in situ of the cervix, should not be enrolled

               -  Patients are not considered to have a "currently active" malignancy if they have
                  completed therapy for a prior malignancy, are disease free from a prior
                  malignancy for >= 3 yrs, and are considered by their physician to be less than
                  30% risk of relapse

          -  Patients with a history of gastrointestinal surgery or other procedure that might, in
             the opinion of the investigator(s), interfere with the absorption or swallowing of the
             study drugs

          -  Patients with any significant history of non-compliance to medical regimens or
             unwilling or unable to comply with the instructions given to them by the study staff

          -  Any other medical condition, including mental illness or substance abuse, deemed by
             the investigator(s) to likely interfere with the patient's ability to sign informed
             consent, cooperate and participate in the study, or interfere with the interpretation
             of the results
      
Maximum Eligible Age:75 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Recommended phase 2 dose
Time Frame:End of cycle 1 (1 cycle = 28 days)
Safety Issue:
Description:A standard "3+3" design will be used to determine the safe and tolerable dose level.

Secondary Outcome Measures

Measure:Time to progression
Time Frame:From start of treatment until objective tumor progression, assessed up to 3 years
Safety Issue:
Description:Cumulative incidence rates will be calculated and compared using Gray's test accounting for competing risks.
Measure:Progression-free survival
Time Frame:From start of treatment until disease progression or death, assessed at 1 year
Safety Issue:
Description:Will be calculated using the Kaplan-Meier method. Will be calculated together with 95% confidence intervals, and log-rank test will be used for the comparison between patient subgroups.
Measure:Objective response rate (ORR)
Time Frame:Up to 3 years
Safety Issue:
Description:ORR will be defined as the total number of subjects whose best response is partial response (PR) or better divided by the number of patients. ORR will be reported overall as well as by dose level, with 95% binomial exact confidence intervals. Comparison of ORR among patient subgroups will be conducted using Fisher exact test.
Measure:Time to response
Time Frame:From start of treatment until measurement criteria are first met for PR, very good partial response, or complete response, assessed up to 3 years
Safety Issue:
Description:Cumulative incidence rates will be calculated and compared using Gray's test accounting for competing risks.
Measure:Duration of overall response
Time Frame:From the time measurement criteria are first met for partial response or better (whichever status is recorded first) until the first date of progressive disease or death, assessed up to 3 years
Safety Issue:
Description:Will be calculated using the Kaplan-Meier method. Will be calculated together with 95% confidence intervals, and log-rank test will be used for the comparison between patient subgroups.
Measure:Overall survival
Time Frame:From start of treatment to the date of his or her death, assessed at 1 year
Safety Issue:
Description:Will be calculated using the Kaplan-Meier method. Will be calculated together with 95% confidence intervals, and log-rank test will be used for the comparison between patient subgroups.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Abdullah Khan

Last Updated

July 9, 2021