A study to assess the safety and efficacy of dexamethasone plus MLN9708 or physician choice of treatment in patients with relapsed or refacroty amyloidosis.

• Conditions: Relapsed or Refractory Systemic Light Chain (AL) Amyloidosis; MedDRA version: 15.0Level: PTClassification code 10024459Term: Light chain diseaseSystem Organ Class: 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps); Therapeutic area: Diseases [C] - Cancer [C04]

• Registration Number: EUCTR2011-005468-10-IT
• Lead Sponsor: MILLENNIUM PHARMACEUTICALS, INC.

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Study Start: 2012-09-13
• Last Update Posted: 10 February 2014

Recruitment & Eligibility

• Status: Authorised-recruitment may be ongoing or finished
• Sex: All
• Target Recruitment: 248

Inclusion Criteria

1.Male or female patients 18years or older. 2.Biopsy-proven diagnosis of AL amyloidosis according to the following standard criteria:a.Histochemical diagnosis of amyloidosis,as based on tissue specimens with Congo red staining with exhibition of an apple-green birefringence b.If clinical and laboratory parameters insufficient to establish AL amyloidosis or in cases of doubt,amyloid typing may be necessary(see Section 15.1)3.measurable disease as defined by serum differential free light chain concentration(dFLC,difference between amyloid forming[involved]and nonamyloid forming[uninvolved]free light chain [FLC])=50mg/L).4.Objective,measurable major(cardiac or renal)organ amyloid involvement as defined as follows (amyloid involvement of at least 1 required):a.Cardiac involvement is defined as the presence of a mean left ventricular wall thickness on echocardiogram greater than 12 mm in the absence of a history of hypertension or valvular heart disease,or in the presence of unexplained low voltage(<0.5 mV)on the electrocardiogram b.Renal involvement is defined as proteinuria(predominantly albumin)>0.5g/day in a 24- hour urine collection Note:Amyloid involvement of other organ systems is allowed,but not required. 5.Must be relapsed or refractory after 1 or 2 prior therapies.For this protocol,relapsed is defined as PD documented more than 60days after last dose;refractory is defined as documented absence of hematologic response or hematologic progression on or within 60days after last dose of prior therapy. a.Patient may not be refractory to proteasome inhibitor therapy b. Given that the physician may select from an offered list of regimens to treat a specific patient,the patient may be refractory to an agent/s listed within the list of offered treatment choices c.Must have recovered(ie,= Grade1 toxicity or patient's baseline status)from the reversible effects of prior therapy d.If a patient has received a transplant as his/her first-line therapy,he/she must be at least 3months posttransplantation and recovered from the side effects of the stem cell transplant 6.Patient must meet criteria for 1 of the following AL Amyloidosis Risk Stages(as defined by NT-proBNP cut off of<332pg/mL and troponin T cut-off of 0.035ng/mL as thresholds): a.Stage1: both NT-proBNP and troponin T under threshold b.Stage2:either NT-proBNP or troponin T[but not both]over threshold;c.Stage3: both NT-proBNP and troponin T over threshold (but NTproBNP<8000pg/mL) 7.ECOG Performance Status=2 8.Clinical laboratory values:a.Absolute neutrophil count=1000/µL b.Platelet count=75,000/µL c.Total bilirubin=1.5xULN d.Alkaline phosphatase=5xULN, e.ALT or AST=3xULN f.Calculated creatinine clearance=30mL/min 9.Female patients who: a.If they are of childbearing potential,agree to practice 2effective methods of contraception,at the same time,from the time of signing the informed consent through 30days after the last dose of study treatment, AND b.Must also adhere to the guidelines of any treatment-specific pregnancy prevention program,if applicable,OR c.Agree to completely abstain from heterosexual intercourse Male patients,even if surgically sterilized (ie,status post vasectomy),who: a.Agree to practice effective barrier contraception during the entire study treatment period and through 4months after the last dose of study drug, AND b.Must also adhere to the guidelines of any treatment-specific pregnancy prevention program, if applicable,OR c.Agree to complete

Exclusion Criteria

the following criteria: 1. Amyloidosis due to mutations of the transthyretin gene or presence of other non-AL amyloidosis. 2. Female patients who are lactating, breastfeeding, or pregnant. 3. Medically documented cardiac syncope, uncompensated NYHA Class 3 or 4 congestive heart failure (Section 15.6), myocardial infarction within the previous 6 months, unstable angina pectoris, clinically significant repetitive ventricular arrhythmias despite antiarrhythmic treatment, or severe orthostatic hypotension or clinically important autonomic disease. 4. Clinically overt multiple myeloma, including monoclonal BM plasma cells =10% to = 30%, and at least 1 of the following: a. Bone lesions b. Hypercalcemia, defined as a calcium of > 11 g/dL 5. Inability to swallow oral medication, inability or unwillingness to comply with the drug administration requirements, or GI procedure that could interfere with the oral absorption or tolerance of treatment. 6. Requirement for other concomitant chemotherapy, immunotherapy, radiotherapy, or any ancillary therapy considered to be investigational or which would be considered as a treatment of AL amyloidosis. However, patients may be on chronic steroids (maximum dose 20 mg/day prednisone or equivalent [Section 15.7]) if they are being given for disorders other than amyloidosis (eg, adrenal insufficiency, rheumatoid arthritis, etc.). 7. Comorbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens. 8. Ongoing or active infection, known HIV positive, known to be hepatitis B surface antigen-positive or has known or suspected active hepatitis C infection. 9. Psychiatric illness/social situations that would limit compliance with study requirements. 10. Known allergy to boron, MLN9708, any of the study treatments, their analogues, or excipients. 11. Systemic treatment with strong inhibitors of CYP1A2 (fluvoxamine, enoxacin, ciprofloxacin), strong inhibitors of CYP3A (clarithromycin, telithromycin, itraconazole, voriconazole, ketoconazole, nefazodone, posaconazole) or strong CYP3A inducers (rifampin, rifapentine, rifabutin, carbamazepine, phenytoin, phenobarbital), or use of Ginkgo biloba or St. John's wort within 14 days before the first dose of study treatment

Study & Design

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