A Phase 1/2 Study of MLN9708 (Ixazomib [I]), Venetoclax (V), and Dexamethasone (D) Regimen (IVD) to Restore or Enhance Proteasome Inhibitor (PI) Sensitivity in Non-t(11;14) Relapsed/Refractory Multiple Myeloma (RRMM)
试验速览
- 阶段
- 1 期
- 状态
- 撤回
- 主要终点
- Overall response rate (ORR) (Phase II)
研究概览
简要总结
This phase I/II trial studies the best dose and side effects of venetoclax and how well it works in combination with ixazomib and dexamethasone in treating patients with t(11;14) negative multiple myeloma that has come back or does not respond to treatment. Ixazomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as venetoclax and dexamethasone work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known how well venetoclax works with ixazomib and dexamethasone in treating patients with multiple myeloma.
详细描述
PRIMARY OBJECTIVES:
I. To evaluate the safety profile and tolerability of oral combination therapy with ixazomib citrate (ixazomib) (I), venetoclax (V), dexamethasone (D) in non-t(11;14) relapsed/refractory multiple myeloma (RRMM) with dose-escalating design to determine the maximum tolerated dose (MTD) and recommended phase II dose (RP2D). (Phase I) II. To compare overall response rate (ORR; measured as best response) of IVD and ID in a proteasome inhibitor (PI)-non-refractory cohort. (Phase II, Cohort 1) III. To evaluate ORR of IVD in PI-refractory cohort. (Phase II, Cohort 2)
SECONDARY OBJECTIVES:
I. To observe and record anti-tumor activity. II. To determine the rate of very good partial response (VGPR) or better. III. To determine time to progression (TTP). IV. To determine duration of response (DOR). V. To determine progression-free survival (PFS). VI. To determine overall survival (OS).
EXPLORATORY OBJECTIVES:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •ELIGIBILITY CRITERIA FOR PHASE I AND PHASE II
- •Patients must have RRMM without t(11;14), confirmed by fluorescence in situ hybridization (FISH).
- •RRMM with measurable disease with at least one of the following: M-protein >= 0.5 g/dL in serum or >= 200 mg/24-hour in urine, or serum free light chain (FLC) >= 10 mg/dL with abnormal serum FLC ratio for subjects without measurable disease by serum protein electrophoresis (SPEP) or urine protein electrophoresis (UPEP) criteria.
- •Prior multiple myeloma (MM) treatment:
- •Received at least 2 lines of prior therapy (including at least one PI, excluding MLN9708), or
- •Received 1 prior line of therapy with both a PI (excluding MLN9708) and an immunomodulatory (IMiD) agent.
- •PI-refractory (only applicable to phase 2, cohort 2): progressing =< 60 days of the last PI therapy or < 25% response while on therapy.
- •PI-non-refractory (only applicable to phase 2, cohort 1): not meeting PI-refractory criteria, i.e., (a) did not progress =< 60 days of the last PI therapy and (b) had >= 25% response while on therapy.
- •Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%).
- •Absolute neutrophil count (ANC) >= 1,000/mcL (patients may not use growth factor support to achieve ANC criteria for eligibility assessment).
- •Platelets >= 50,000/mcL (patients may not receive a platelet transfusion within 72 hours of eligibility assessment).
- •Total bilirubin =< 1.5 x institutional upper limit of normal (ULN).
- •Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase [SGPT]) =< 3.0 x institutional ULN.
- •Calculated creatinine clearance >= 30 mL/min (measured by either 24-hour urine collection or calculated using the Cockcroft-Gault formula).
- •For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated.
- •Patients with a history of hepatitis C virus (HCV) infection must have completed treatment previously and cured (i.e., undetectable HCV viral load).
- •Patients with treated brain metastases are eligible if there is no evidence of progression for at least 4 weeks after central nervous system (CNS)- directed treatment, as ascertained by clinical examination and brain imaging (magnetic resonance imaging [MRI] or computed tomography [CT] scan) during the screening period.
- •Patients with new or progressive brain metastases (active brain metastases) or leptomeningeal disease are eligible if the treating physician determines that immediate central nervous system (CNS) specific treatment is not required and is unlikely to be required for at least 4 weeks (or scheduled assessment after the first cycle of treatment), and a risk-benefit analysis (discussion) by the patient and the investigator favors participation in the clinical trial.
- •The effects of MLN9708 and venetoclax in combination with dexamethasone on the developing human fetus are unknown. For this reason and because corticosteroids like dexamethasone are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and 3 months after completion of the administration of the study agents. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.
- •Ability to understand and the willingness to sign a written informed consent document.
- •Known human immunodeficiency virus (HIV)-positive patients who meet the following criteria will be considered eligible:
- •CD4 count > 350 cells/mm^3
- •Undetectable viral load
- •Maintained on modern therapeutic regimens (utilizing non-CYP-interactive agents)
- •No history of acquired immunodeficiency syndrome (AIDS)-defining opportunistic infections.
排除标准
- •Patients who have been previously treated with MLN9708 or venetoclax or other direct BCL2 inhibitor.
- •Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities grade > 1), except for grade 2 peripheral sensory neuropathy.
- •Patients who are receiving any other anti-myeloma chemotherapy or radiotherapy, immunotherapy, or investigational agents within 2 weeks or 5 half-lives (whichever is longer and/or applicable) of the start of the trial.
- •Patients receiving dexamethasone >= 40 mg/day or equivalent of any corticosteroids within 2 weeks of the start of the trial.
- •Patients with non-secretory MM, plasma cell leukemia (i.e., >= 20% plasma cells in peripheral blood differential or >= 2,000/mcL circulating plasma cells), symptomatic primary light chain (AL) amyloidosis, POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes).
- •Prior allogeneic hematopoietic cell transplantation (HCT) within the last 12 months and evidence of active graft-versus-host disease (GVHD).
- •Prior autologous HCT within the last 3 months.
- •History of active malignancies other than MM within the last 2 years unless treated with curative intent and has no evidence of active disease. Basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin are excluded from this criterion.
- •History of allergic reactions attributed to compounds of similar chemical or biologic composition to MLN9708, venetoclax, or dexamethasone. This includes boron and boron-containing products.
- •Patients requiring chronic administration of any medications or substances that are strong inhibitors or inducers of CYP3A4 enzyme are ineligible. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product.
- •Patients with uncontrolled intercurrent illness.
- •Female patients who are lactating or have a positive serum pregnancy test during the screening period are excluded from this study because MLN9708 is a proteasome inhibitor with the potential for embryo-lethal effects, and an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with MLN
- •Patients must stop breastfeeding while on MLN9708 and until 90 days have passed since their last dose. These potential risks may also apply to other agents used in this study.
研究组 & 干预措施
Arm II (ixazomib, dexamethasone)
Patients receive ixazomib citrate PO on days 1, 8, and 15, and dexamethasone PO on days 1, 8, 15, and 22. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
干预措施: Ixazomib Citrate (Drug)
Arm I (ixazomib, venetoclax, dexamethasone)
Patients receive ixazomib citrate PO on days 1, 8, and 15, venetoclax PO QD on days 1-28 and dexamethasone PO on days 1, 8, 15, and 22. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
干预措施: Dexamethasone (Drug)
Arm I (ixazomib, venetoclax, dexamethasone)
Patients receive ixazomib citrate PO on days 1, 8, and 15, venetoclax PO QD on days 1-28 and dexamethasone PO on days 1, 8, 15, and 22. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
干预措施: Ixazomib (Drug)
Arm I (ixazomib, venetoclax, dexamethasone)
Patients receive ixazomib citrate PO on days 1, 8, and 15, venetoclax PO QD on days 1-28 and dexamethasone PO on days 1, 8, 15, and 22. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
干预措施: Ixazomib Citrate (Drug)
Arm I (ixazomib, venetoclax, dexamethasone)
Patients receive ixazomib citrate PO on days 1, 8, and 15, venetoclax PO QD on days 1-28 and dexamethasone PO on days 1, 8, 15, and 22. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
干预措施: Venetoclax (Drug)
Arm II (ixazomib, dexamethasone)
Patients receive ixazomib citrate PO on days 1, 8, and 15, and dexamethasone PO on days 1, 8, 15, and 22. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
干预措施: Dexamethasone (Drug)
Arm II (ixazomib, dexamethasone)
Patients receive ixazomib citrate PO on days 1, 8, and 15, and dexamethasone PO on days 1, 8, 15, and 22. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
干预措施: Ixazomib (Drug)
Arm III (ixazomib, venetoclax, dexamethasone)
PI-refractory patients receive ixazomib citrate, venetoclax and dexamethasone as Arm I.
干预措施: Dexamethasone (Drug)
Arm III (ixazomib, venetoclax, dexamethasone)
PI-refractory patients receive ixazomib citrate, venetoclax and dexamethasone as Arm I.
干预措施: Ixazomib (Drug)
Arm III (ixazomib, venetoclax, dexamethasone)
PI-refractory patients receive ixazomib citrate, venetoclax and dexamethasone as Arm I.
干预措施: Ixazomib Citrate (Drug)
Arm III (ixazomib, venetoclax, dexamethasone)
PI-refractory patients receive ixazomib citrate, venetoclax and dexamethasone as Arm I.
干预措施: Venetoclax (Drug)
结局指标
主要结局
Overall response rate (ORR) (Phase II)
时间窗: Up to 2.5 years
For cohort 2, the ORR will be estimated, and the lower limit of the one-sided 90% confidence interval (CI) will be computed using the Atkinson and Brown method (Atkinson and Brown 1985), which accounts for the nature of a two-stage design.
Maximum tolerated dose/recommended phase II dose (MTD/RP2D) of venetoclax (Phase I)
时间窗: Up to 28 days
The MTD is defined as the highest dose level in which 1 or fewer of 6 patients experience a dose limiting toxicity. That dose level is considered the MTD/RP2D.
次要结局
- Progression-free survival (PFS)(From the date of the first dose of study drug (cohort 2) or date of randomization (cohort 1) to the date of first documented PD or death due to any cause, whichever occurs first, assessed up to 2.5 years)
- Duration of response (DOR)(From the subject's date of first documented response (PR or better) to the date of first documented PD or death due to MM, whichever occurs first, assessed up to 2.5 years)
- Very good partial response (VGPR) or better response rate(Up to 2.5 years)
- Time to progression (TTP)(From the date of the first dose of study drug (cohort 2) or date of randomization (cohort 1) to the date of first documented PD or death due to multiple myeloma, whichever occurs first, assessed up to 2.5 years)
- Overall survival (OS)(From the subject's date of the first dose of study drug (cohort 2) or date of randomization (cohort 1) to the date of death due to any cause, assessed up to 2.5 years)