A prospective phase I/II, one-arm, one-stage multi-center, open label study of lenalidomide in combination with pioglitazone, dexamethasone and metronomic low-dose chemotherapy with treosulfan in patients with relapsed or refractory or progressive multiple myeloma: Third-line therapy

Phase 1

• Conditions: Multiple myeloma; MedDRA version: 21.0Level: LLTClassification code 10028228Term: Multiple myelomaSystem Organ Class: 100000004864; Therapeutic area: Diseases [C] - Cancer [C04]

• Registration Number: EUCTR2008-002768-32-DE
• Lead Sponsor: Freistaat Bayern

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Results First Posted: 1900-01-01
• Study Start: 2009-03-30
• Last Update Posted: 27 July 2020

Recruitment & Eligibility

• Status: ot Recruiting
• Sex: All
• Target Recruitment: 54

Inclusion Criteria

-At least 18 years of age
-Must be able to adhere to the study visit schedule and other protocol requirements
-Must be diagnosed with multiple myeloma that is progressing or has relapsed with progressive disease after at least two different anti-myeloma treatments (including lenalidomide in one schedule phase II part only)
-In case of patients that have progressive disease after complete remission during preceding treatment: Serum monoclonal paraprotein (M-protein) level =0.5 g/dL for IgG, IgA myeloma and =0.05 g/dL for IgD myeloma or urine M-protein level = 0.2 g excreted in a 24-hour collection sample
or
In case of progressive disease without complete remission during preceding treatment: > 25% increase of serum monoclonal paraprotein or urine M-protein in comparison to the preceding monoclonal paraprotein (M-protein) nadir in serum /urine M-protein nadir in a 24 hour collection sample
-Subjects must have been previously treated with lenalidomide for the phase II part. Any first- and second-line treatment is allowed for the phase I part. Phase I study inclusion is independent of pre-treatment in 1st line
-Sufficient bone marrow function: neutrophils = 1x10E9/l, hemoglobin =10 g/dl, and platelets = 100x10E9/l
-ECOG performance status score of 0, 1, or 2
-Subjects must discontinue all anti-myeloma drug or non-drug therapy prior to the first dose of study drug (at least 4 weeks)
-Required laboratory results: a) Liver function: Total bilirubin < 1.5 times of upper limit of local institution (ULN), SGPT, SGOT = 2.5 times of upper limit of local institution . b) Renal function: serum creatinine = 1.5 ULN c)PT-INR/PT <1.5 ULN
-Normal cardiac function
-Patients with prior thrombembolic event with adequate anticoagulation
-Life expectancy at least 3 months
-Written informed consent of the patient prior to screening procedures
•Female subjects of childbearing potential must:
•Understand that the study medication has a teratogenic risk
•Be capable of complying with effective contraceptive measures
•Be informed and understand the potential consequences of pregnancy and the need to notify her study doctor immediately if there is a risk of pregnancy
•Understand the need to commence lenalidomide as soon as it is dispensed following a negative pregnancy test
•Agree to use, two reliable forms of contraception simultaneously or practice complete abstinence (True abstinence is acceptable when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence [eg calendar, ovulation, symptothermal or post-ovulation methods] and withdrawal are not acceptable methods of contraception.) from heterosexual contact during the following time periods related to this study: 1) for at least 28 days before starting lenalidomid; 2) while taking lenalidomide; 3) during dose interruptions; and 4) for at least 28 days after thelast dose of lenalidomide.. The two methods of reliable contraception must include one highly effective method and one additional effective (barrier) method. If the below contraception methods are not appropriate for the FCBP, she must be referred to a qualified provider of contraception methods to determine the medically effective contraception method appropriate to the subject. The following are examples of highly effective and additional effective methods of contraception
•Examples of highly effective methods:
?Intrauterine device (IUD)
?Hormonal (birth control pills, injections, implants

Exclusion Criteria

-Patients who require vitamin K antagonists except for low dose (INR = 2,5)
-Known hypersensitivity to dexamethasone. Prior history of uncontrollable side effects to dexamethasone therapy.
-Active infection > grade 2 NCI-CTC version 3.0
-Known positive for HIV; active or chronic infectious hepatitis, type A, B or C infection (including patients who are tested anti-HBC positive and/or HBsAg positive) –serological testing for hepatitis A, B, C required
-Severe, unstable, or uncontrolled medical disease which would confound diagnoses or evaluations required by the protocol, including cardiac insufficiency (NYHA I –IV) uncontrolled diabetes, chronic hepatic or renal disease, active uncontrolled infection and chronic inflammatory intestinal disease, autoimmune diseases.
-Prior radiation therapy > 25% of bone marrow
-Regular blood transfusions
-Treatment with other experimental substances within 30 days before study start
-Participation in another clinical trial within 30 days before study start or during the trial
-Unwilling or unable to comply with the protocol
-Pregnant or lactating females.
-Patients with seizure disorders requiring medication (such as steroids or antiepileptics)
-Known hypersensitivity to one of the medications
-Patients with evidence or history of bleeding diathesis
-Patients undergoing renal dialysis
-Major surgery within 4 weeks prior to start of study or incomplete wound healing
-Drug or alcohol abuse
-Psychological or social conditions that may interfere with the patients participation in the study or evaluation of the study results
-Known (at time of entry) gastrointestinal disorder, including malabsorbtion or active gastric ulcer, present to the extent that it might interfere with oral intake and absorption of study medication
-Any previous or concurrent malignancy or any cancer unless curatively treated > 3 years prior to study entry except cervical carcinoma in situ or adequately treated basal cell carcinoma
-Neuropathy > Grade 2
- Patients with bladder cancer or bladder cancer in their medical history
- Macrohematuria of unknown origin
- Patients with risk factors for bladder cancer (such as exposure to aromatic amines or heavy tobacco smokers)

Study & Design

• Study Type: Interventional clinical trial of medicinal product
• Study Design: Not specified