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Arsenic Trioxide Plus Vitamin C in Treating Patients With Recurrent or Refractory Multiple Myeloma

Primary Purpose

Multiple Myeloma and Plasma Cell Neoplasm

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
ascorbic acid
arsenic trioxide
Sponsored by
University of Miami
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma and Plasma Cell Neoplasm focused on measuring refractory multiple myeloma, stage II multiple myeloma, stage III multiple myeloma

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically confirmed multiple myeloma M-protein by serum protein electrophoresis or urine protein electrophoresis Quantitative determination of immunoglobulin Bone marrow biopsy and aspirate with a plasma cell count greater than 10% Refractory or chemoresistant disease defined as failure to respond (less than 50% reduction in M protein level) or progression within 2 months after receiving at least 2 chemotherapy regimens including: Alkylating based regimen (melphalan) in combination with steroids (prednisone) or other chemotherapy regimens (e.g., vincristine, bleomycin, melphalan, cyclophosphamide, and prednisone or vincristine, carmustine, doxorubicin, and prednisone) Vincristine, doxorubicin, and dexamethasone (VAD) regimen Pulse therapy with high dose steroids alone High dose alkylating agent and autologous stem cell transplantation Allogeneic bone marrow transplantation Plateau phase defined as M protein in the serum or urine for more than 6 weeks despite response to prior therapy Must have received at least 2 of the chemotherapy regimens listed above or equivalent regimens Recurrent disease defined as progression more than 2 months after initial therapy and failure to respond (less than 50% reduction or progression in M protein levels) to 1 chemotherapy regimen listed above or other salvage regimens (e.g., high-dose cyclophosphamide or topotecan) Must have received VAD or other equivalent chemotherapy regimen Should be considered for autologous or allogenic transplantation Prior local radiotherapy allowed PATIENT CHARACTERISTICS: Age: Over 18 Performance status: Karnofsky 60-100% Life expectancy: Not specified Hematopoietic: WBC at least 2,000/mm^3* Platelet count at least 50,000/mm^3* NOTE: *Unless attributable to bone marrow infiltration by multiple myeloma Hepatic: Bilirubin less than 3 mg/dL Transaminases less than 2.5 times upper limit of normal (ULN) Renal: Creatinine less than 1.5 times ULN OR Creatinine clearance at least 60 mL/min Cardiovascular: No cardiac arrhythmias including recurrent supraventricular arrhythmia, any type of sustained ventricular arrhythmia, or conduction block (atrioventricular block grade II or III, left bundle branch block) Ejection fraction at least 30% No uncontrolled ischemic heart disease Other: Not pregnant or nursing Negative pregnancy test Fertile patients must use effective barrier contraception during and for 4 months after study HIV negative No grade 3 or higher neurological disorder, including seizure disorders No underlying medical condition that would preclude study No other active malignancy except adequately treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix PRIOR CONCURRENT THERAPY: Biologic therapy: See Disease Characteristics Chemotherapy: See Disease Characteristics At least 2 weeks since prior chemotherapy Endocrine therapy: See Disease Characteristics Concurrent steroid treatment allowed except for primary treatment of myeloma Radiotherapy: See Disease Characteristics Concurrent local radiotherapy for pain or symptom control allowed provided the pain or symptom is not related to disease progression Surgery: Not specified Other: No other concurrent ascorbic acid supplements No other concurrent investigational drug or therapy Concurrent bisphosphonates allowed

Sites / Locations

  • Mount Sinai Comprehensive Cancer Center at Mount Sinai Medical Center
  • Cedars Medical Center
  • University of Miami Sylvester Comprehensive Cancer Center
  • Baptist-South Miami Regional Cancer Program

Outcomes

Primary Outcome Measures

Disease response as measured by M protein quantitation and the percentage of plasma cell infiltration in bone marrow biopsies after every course

Secondary Outcome Measures

Toxicity as measured by CTCAE criteria

Full Information

First Posted
July 5, 2000
Last Updated
December 14, 2016
Sponsor
University of Miami
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00006021
Brief Title
Arsenic Trioxide Plus Vitamin C in Treating Patients With Recurrent or Refractory Multiple Myeloma
Official Title
Phase I/II Trial of Arsenic Trioxide (As2O3) With Ascorbic Acid in the Treatment of Relapsed/Refractory Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
December 2016
Overall Recruitment Status
Completed
Study Start Date
June 2000 (undefined)
Primary Completion Date
May 2006 (Actual)
Study Completion Date
March 2007 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Miami
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Vitamin C may increase the effectiveness of arsenic trioxide by making cancer cells more sensitive to the drug. PURPOSE: Phase I/II trial to determine the effectiveness of arsenic trioxide plus vitamin C in treating patients who have recurrent or refractory multiple myeloma.
Detailed Description
OBJECTIVES: Determine the maximum tolerated dose of arsenic trioxide when administered with ascorbic acid in patients with recurrent or refractory multiple myeloma. Determine the therapeutic efficacy of this treatment combination in these patients. Determine the expression of MDR and Bcl-xL genes and the intracellular levels of GSH in these patients before and after this treatment regimen and assess whether these measures have prognostic value. OUTLINE: This is a multicenter, dose-escalation study of arsenic trioxide. Phase I: Patients receive arsenic trioxide IV over 1-4 hours and ascorbic acid IV over 5-10 minutes on days 1-5 weekly for 5 weeks. Treatment continues every 7 weeks for up to 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of arsenic trioxide until the maximum tolerated dose (MTD) is reached. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Phase II: Patients receive the MTD of arsenic trioxide with ascorbic acid as outlined above. Patients are followed monthly for up to 5 years. PROJECTED ACCRUAL: A total of 31-43 patients (6-18 for phase I and 16-25 for phase II) will be accrued for this study within 2.5 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma and Plasma Cell Neoplasm
Keywords
refractory multiple myeloma, stage II multiple myeloma, stage III multiple myeloma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
22 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Dietary Supplement
Intervention Name(s)
ascorbic acid
Intervention Type
Drug
Intervention Name(s)
arsenic trioxide
Primary Outcome Measure Information:
Title
Disease response as measured by M protein quantitation and the percentage of plasma cell infiltration in bone marrow biopsies after every course
Secondary Outcome Measure Information:
Title
Toxicity as measured by CTCAE criteria

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed multiple myeloma M-protein by serum protein electrophoresis or urine protein electrophoresis Quantitative determination of immunoglobulin Bone marrow biopsy and aspirate with a plasma cell count greater than 10% Refractory or chemoresistant disease defined as failure to respond (less than 50% reduction in M protein level) or progression within 2 months after receiving at least 2 chemotherapy regimens including: Alkylating based regimen (melphalan) in combination with steroids (prednisone) or other chemotherapy regimens (e.g., vincristine, bleomycin, melphalan, cyclophosphamide, and prednisone or vincristine, carmustine, doxorubicin, and prednisone) Vincristine, doxorubicin, and dexamethasone (VAD) regimen Pulse therapy with high dose steroids alone High dose alkylating agent and autologous stem cell transplantation Allogeneic bone marrow transplantation Plateau phase defined as M protein in the serum or urine for more than 6 weeks despite response to prior therapy Must have received at least 2 of the chemotherapy regimens listed above or equivalent regimens Recurrent disease defined as progression more than 2 months after initial therapy and failure to respond (less than 50% reduction or progression in M protein levels) to 1 chemotherapy regimen listed above or other salvage regimens (e.g., high-dose cyclophosphamide or topotecan) Must have received VAD or other equivalent chemotherapy regimen Should be considered for autologous or allogenic transplantation Prior local radiotherapy allowed PATIENT CHARACTERISTICS: Age: Over 18 Performance status: Karnofsky 60-100% Life expectancy: Not specified Hematopoietic: WBC at least 2,000/mm^3* Platelet count at least 50,000/mm^3* NOTE: *Unless attributable to bone marrow infiltration by multiple myeloma Hepatic: Bilirubin less than 3 mg/dL Transaminases less than 2.5 times upper limit of normal (ULN) Renal: Creatinine less than 1.5 times ULN OR Creatinine clearance at least 60 mL/min Cardiovascular: No cardiac arrhythmias including recurrent supraventricular arrhythmia, any type of sustained ventricular arrhythmia, or conduction block (atrioventricular block grade II or III, left bundle branch block) Ejection fraction at least 30% No uncontrolled ischemic heart disease Other: Not pregnant or nursing Negative pregnancy test Fertile patients must use effective barrier contraception during and for 4 months after study HIV negative No grade 3 or higher neurological disorder, including seizure disorders No underlying medical condition that would preclude study No other active malignancy except adequately treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix PRIOR CONCURRENT THERAPY: Biologic therapy: See Disease Characteristics Chemotherapy: See Disease Characteristics At least 2 weeks since prior chemotherapy Endocrine therapy: See Disease Characteristics Concurrent steroid treatment allowed except for primary treatment of myeloma Radiotherapy: See Disease Characteristics Concurrent local radiotherapy for pain or symptom control allowed provided the pain or symptom is not related to disease progression Surgery: Not specified Other: No other concurrent ascorbic acid supplements No other concurrent investigational drug or therapy Concurrent bisphosphonates allowed
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kelvin Lee, MD
Organizational Affiliation
University of Miami Sylvester Comprehensive Cancer Center
Official's Role
Study Chair
Facility Information:
Facility Name
Mount Sinai Comprehensive Cancer Center at Mount Sinai Medical Center
City
Miami Beach
State/Province
Florida
ZIP/Postal Code
33140
Country
United States
Facility Name
Cedars Medical Center
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
University of Miami Sylvester Comprehensive Cancer Center
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Baptist-South Miami Regional Cancer Program
City
Miami
State/Province
Florida
ZIP/Postal Code
33176-2197
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
12473574
Citation
Bahlis NJ, McCafferty-Grad J, Jordan-McMurry I, Neil J, Reis I, Kharfan-Dabaja M, Eckman J, Goodman M, Fernandez HF, Boise LH, Lee KP. Feasibility and correlates of arsenic trioxide combined with ascorbic acid-mediated depletion of intracellular glutathione for the treatment of relapsed/refractory multiple myeloma. Clin Cancer Res. 2002 Dec;8(12):3658-68.
Results Reference
result

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Arsenic Trioxide Plus Vitamin C in Treating Patients With Recurrent or Refractory Multiple Myeloma

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