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Bevacizumab With or Without Thalidomide in Treating Patients With Relapsed or Refractory Multiple Myeloma

Primary Purpose

Multiple Myeloma and Plasma Cell Neoplasm

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
bevacizumab
thalidomide
Sponsored by
California Cancer Consortium
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 I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically confirmed progressing multiple myeloma Stages I, II, or III More than 25% increase in urine or plasma paraprotein levels More than 5% malignant plasma cell involvement in bone marrow Smoldering myeloma is eligible provided there is evidence of progressive disease requiring therapy At least 25% increase in M protein levels or Bence Jones excretion Hemoglobin no greater than 10.5 g/dL Frequent infections Hypercalcemia Rise in serum creatinine above normal on 2 separate occasions Nonsecretory multiple myeloma that is bidimensionally measurable by MRI or CT scan is eligible provided the disease site is new or has shown an increase in M protein levels or Bence Jones excretion is greater than 30% from baseline No prior or concurrent CNS involvement with primary or metastatic tumor No nonquantifiable monoclonal proteins or IgM peaks unless there is evidence of bidimensionally measurable disease by MRI or CT scan No history of hemorrhagic tumor or hemorrhagic metastasis PATIENT CHARACTERISTICS: Age: 18 and over Performance status: Karnofsky 70-100% Life expectancy: At least 3 months Hematopoietic: See Disease Characteristics Absolute neutrophil count ≥1,000/mm^3 Platelet count ≥ 50,000/mm^3 No hemorrhagic illness within the past 3 weeks Hepatic: Bilirubin ≤ 1.5 mg/dL SGOT/SGPT≤ 2.5 times upper limit of normal (ULN) INR ≤ 1.5 aPTT < 1.5 times ULN Renal: See Disease Characteristics Creatinine ≤ 2 mg/dL Creatinine clearance ≥ 40 mL/min Calcium ≤ 12 mg/dL No nephrotic syndrome Cardiovascular: No active coronary artery disease No New York Heart Association class II-IV congestive heart failure No grade II or greater peripheral vascular disease (i.e, ischemic rest pain, non-healing ulcer, or tissue loss) No uncontrolled hypertension No history of deep venous thrombosis No vascular illness within the past 3 weeks No arterial thromboembolic event within the past 6 months, including any of the following: Transient ischemic attack Cerebrovascular accident Unstable angina Myocardial infarction Pulmonary: No history of pulmonary embolus Other: No other prior malignancy unless the patient has been in complete remission for at least 2 years No peripheral neuropathy or CNS abnormalities ≥ grade 2 Patients with prior exposure to thalidomide and assigned to arm I may have grade 2 peripheral or CNS abnormalities No seizure disorder No serious non-healing wound, ulcer, or bone fracture No trauma within the past 3 weeks No significant inflammatory illness within the past 3 weeks No known hypersensitivity to Chinese hamster ovary cell products No known hypersensitivity to other recombinant human or humanized antibodies and/or positive human antimurine antibodies/human antichimeric antibodies No other significant medical, psychological, or social problem that would preclude study participation Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception for at least 2 weeks before and during study participation PRIOR CONCURRENT THERAPY: Biologic therapy: See Chemotherapy Prior nonmyeloablative transplantation allowed provided the following are true: Patient is not receiving concurrent immunosuppressive therapy Patient has no signs of graft-versus-host disease Concurrent epoetin alfa allowed if started at least 4 weeks prior to study entry Chemotherapy: No more than 5 prior chemotherapy regimens Thalidomide, steroids, and interferon are not considered part of prior regimens Mobilization with chemotherapy followed by either single or tandem autologous transplantation is counted as 1 prior regimen Mobilization with chemotherapy followed by autologous and subsequent nonmyeloablative HLA-matched sibling allogeneic transplantation is counted as 1 prior regimen At least 3 weeks since prior chemotherapy No concurrent chemotherapy Endocrine therapy: See Chemotherapy At least 2 weeks since prior steroids No concurrent steroids Radiotherapy: At least 3 weeks since prior radiotherapy No concurrent radiotherapy Surgery: At least 3 weeks since prior surgery, including biopsy of a visceral organ Other: At least 10 days since prior anticoagulants, including aspirin At least 2 days since prior nonsteroidal anti-inflammatory agents Concurrent bisphosphonates allowed

Sites / Locations

  • City of Hope Comprehensive Cancer Center
  • USC/Norris Comprehensive Cancer Center and Hospital
  • University of California Davis Cancer Center
  • University of Chicago Cancer Research Center

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
August 10, 2001
Last Updated
June 20, 2013
Sponsor
California Cancer Consortium
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00022607
Brief Title
Bevacizumab With or Without Thalidomide in Treating Patients With Relapsed or Refractory Multiple Myeloma
Official Title
Phase II Randomized Trial of Bevacizumab Versus Bevacizumab and Thalidomide for Relapsed/Refractory Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
October 2004
Overall Recruitment Status
Completed
Study Start Date
January 2002 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
May 2006 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
California Cancer Consortium
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Monoclonal antibodies, such as bevacizumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or deliver cancer-killing substances to them. Thalidomide may stop the growth of cancer cells by stopping blood flow to the tumor. It is not yet known whether bevacizumab works better with or without thalidomide for multiple myeloma. PURPOSE: This randomized phase II trial is to see if bevacizumab works better with or without thalidomide in treating patients who have relapsed or refractory multiple myeloma.
Detailed Description
OBJECTIVES: Compare the response rate and time to progression in patients with relapsed or refractory multiple myeloma treated with bevacizumab with or without thalidomide. Compare the toxicity of these regimens in these patients. Compare the effects of these regimens on histological and molecular biomarkers of angiogenesis, tumor invasion, and cell death in these patients. Correlate plasma and urine vascular endothelial growth factor and basic fibroblast growth factor levels and other potential markers of angiogenesis and myeloma cell proliferation with outcome in patients treated with these regimens. Determine the pharmacokinetics of thalidomide in these patients. Compare the effects of these regimens on the psychological/physical well being of these patients. OUTLINE: This is a randomized, multicenter study. Patients are stratified according to prior treatment with thalidomide (yes vs no). Patients who have received no prior treatment with thalidomide are randomized to 1 of 2 treatment arms. Arm I: Patients receive bevacizumab IV over 30-90 minutes on days 1, 15, 29, and 43. Patients also receive oral thalidomide once daily. Arm II: Patients receive bevacizumab as in arm I. Patients who have received prior treatment with thalidomide receive bevacizumab as in arm I. Courses repeat every 56 days in the absence of disease progression or unacceptable toxicity. Patients are followed monthly for 3 months and then every 3-4 months for 3 years. PROJECTED ACCRUAL: A total of 55-103 patients (16-32 who have received prior thalidomide, 16-32 in arm I, and 23-39 in arm 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 I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Allocation
Randomized

8. Arms, Groups, and Interventions

Intervention Type
Biological
Intervention Name(s)
bevacizumab
Intervention Type
Drug
Intervention Name(s)
thalidomide

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed progressing multiple myeloma Stages I, II, or III More than 25% increase in urine or plasma paraprotein levels More than 5% malignant plasma cell involvement in bone marrow Smoldering myeloma is eligible provided there is evidence of progressive disease requiring therapy At least 25% increase in M protein levels or Bence Jones excretion Hemoglobin no greater than 10.5 g/dL Frequent infections Hypercalcemia Rise in serum creatinine above normal on 2 separate occasions Nonsecretory multiple myeloma that is bidimensionally measurable by MRI or CT scan is eligible provided the disease site is new or has shown an increase in M protein levels or Bence Jones excretion is greater than 30% from baseline No prior or concurrent CNS involvement with primary or metastatic tumor No nonquantifiable monoclonal proteins or IgM peaks unless there is evidence of bidimensionally measurable disease by MRI or CT scan No history of hemorrhagic tumor or hemorrhagic metastasis PATIENT CHARACTERISTICS: Age: 18 and over Performance status: Karnofsky 70-100% Life expectancy: At least 3 months Hematopoietic: See Disease Characteristics Absolute neutrophil count ≥1,000/mm^3 Platelet count ≥ 50,000/mm^3 No hemorrhagic illness within the past 3 weeks Hepatic: Bilirubin ≤ 1.5 mg/dL SGOT/SGPT≤ 2.5 times upper limit of normal (ULN) INR ≤ 1.5 aPTT < 1.5 times ULN Renal: See Disease Characteristics Creatinine ≤ 2 mg/dL Creatinine clearance ≥ 40 mL/min Calcium ≤ 12 mg/dL No nephrotic syndrome Cardiovascular: No active coronary artery disease No New York Heart Association class II-IV congestive heart failure No grade II or greater peripheral vascular disease (i.e, ischemic rest pain, non-healing ulcer, or tissue loss) No uncontrolled hypertension No history of deep venous thrombosis No vascular illness within the past 3 weeks No arterial thromboembolic event within the past 6 months, including any of the following: Transient ischemic attack Cerebrovascular accident Unstable angina Myocardial infarction Pulmonary: No history of pulmonary embolus Other: No other prior malignancy unless the patient has been in complete remission for at least 2 years No peripheral neuropathy or CNS abnormalities ≥ grade 2 Patients with prior exposure to thalidomide and assigned to arm I may have grade 2 peripheral or CNS abnormalities No seizure disorder No serious non-healing wound, ulcer, or bone fracture No trauma within the past 3 weeks No significant inflammatory illness within the past 3 weeks No known hypersensitivity to Chinese hamster ovary cell products No known hypersensitivity to other recombinant human or humanized antibodies and/or positive human antimurine antibodies/human antichimeric antibodies No other significant medical, psychological, or social problem that would preclude study participation Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception for at least 2 weeks before and during study participation PRIOR CONCURRENT THERAPY: Biologic therapy: See Chemotherapy Prior nonmyeloablative transplantation allowed provided the following are true: Patient is not receiving concurrent immunosuppressive therapy Patient has no signs of graft-versus-host disease Concurrent epoetin alfa allowed if started at least 4 weeks prior to study entry Chemotherapy: No more than 5 prior chemotherapy regimens Thalidomide, steroids, and interferon are not considered part of prior regimens Mobilization with chemotherapy followed by either single or tandem autologous transplantation is counted as 1 prior regimen Mobilization with chemotherapy followed by autologous and subsequent nonmyeloablative HLA-matched sibling allogeneic transplantation is counted as 1 prior regimen At least 3 weeks since prior chemotherapy No concurrent chemotherapy Endocrine therapy: See Chemotherapy At least 2 weeks since prior steroids No concurrent steroids Radiotherapy: At least 3 weeks since prior radiotherapy No concurrent radiotherapy Surgery: At least 3 weeks since prior surgery, including biopsy of a visceral organ Other: At least 10 days since prior anticoagulants, including aspirin At least 2 days since prior nonsteroidal anti-inflammatory agents Concurrent bisphosphonates allowed
Facility Information:
Facility Name
City of Hope Comprehensive Cancer Center
City
Duarte
State/Province
California
ZIP/Postal Code
91010-3000
Country
United States
Facility Name
USC/Norris Comprehensive Cancer Center and Hospital
City
Los Angeles
State/Province
California
ZIP/Postal Code
90089
Country
United States
Facility Name
University of California Davis Cancer Center
City
Sacramento
State/Province
California
ZIP/Postal Code
95817
Country
United States
Facility Name
University of Chicago Cancer Research Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637-1470
Country
United States

12. IPD Sharing Statement

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Bevacizumab With or Without Thalidomide in Treating Patients With Relapsed or Refractory Multiple Myeloma

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