Phase III Randomized Trial of Thalidomide/Dexamethasone Versus Vincristine+Adriamycin+Dexamethasone (VAD)
Multiple Myeloma
About this trial
This is an interventional treatment trial for Multiple Myeloma focused on measuring hematologic malignancy
Eligibility Criteria
Inclusion Criteria: Patients must have newly diagnosed MM confirmed by the presence of bone marrow plasmacytosis with > 10 percent plasma cells, sheets of plasma cells, or biopsy-proven plasmacytoma. Patients must have Durie-Salmon Stage IIA-B or IIIA-B. Patients with non-secretory myeloma are eligible. (These patients will not be included in the analysis of response rates, but will be assessed for toxicity and survival). Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, 2, or 3 ≥ 18 years of age. Signed informed consent form Expected survival of greater than 8 weeks Capable of swallowing study medication tablets Capable of following directions regarding taking study medication, or has a daily care provider who will be responsible for administering study medication. Patients will be eligible for study even if they lack socioeconomic access to autologous transplantation. (These patients will be identified prior to randomization so as not to confound study results). All patients (in the event that they are randomized to the thalidomide/dexamethasone arm) must agree to take part in the "System for Education and Prescribing Safety" (S.T.E.P.S.)™. They must sign a separate informed consent for this program. Exclusion Criteria: Elevated direct bilirubin > 2 mg/dl Serum alanine aminotransferase (ALT) or serum aspartate aminotransferase (AST) > 2 times the upper limit of normal (ULN) Absolute neutrophil count (ANC) <1000/mL, unless felt to be secondary to myeloma Ongoing radiation therapy, or radiation therapy within 3 weeks prior to first treatment, unless the acute side effects associated with such therapy are resolved. Prior treatment for multiple myeloma Prior bisphosphonate use is allowed but they must be discontinued before starting treatment. Concurrent uncontrolled serious infection Patients with peripheral (sensory) neuropathy, grade 3 or higher Life-threatening illness (unrelated to tumor) History of any other ACTIVE and INVASIVE cancer other than the present condition (except non-melanoma skin cancer), unless in complete remission and off of all therapy for that disease for a minimum of 3 years. Women of childbearing potential (unless utilizing birth control) or who are pregnant or nursing will be excluded from this study. Patients with comorbid conditions that would contraindicate the use of vincristine, doxorubicin, dexamethasone, thalidomide, or zoledronate. Plasma Cell Leukemia
Sites / Locations
- Morton Plant Hospital
- Watson Clinic
- Fawcett Memorial Hospital
- H. Lee Moffitt Cancer Center & Research Institute
- San Juan VA Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
VAD Treatment
Thalidomide and Dexamethasone Treatment
VAD (vincristine, adriamycin, dexamethasone). Vincristine and adriamycin was administered by continuous infusion via a venous catheter for 96 hours every 28 days. Each 28 days is considered one "cycle" of therapy. Patients were to receive 4 to 6 cycles of therapy. Dexamethasone was taken in pill form. During the first 2 cycles it was taken on days 1-4, 9-12, 17-20. For all other cycles dexamethasone was taken only on days 1-4. Patients were randomized to receive zoledronic acid IV on either Day 1 or 15 of each cycle.
Thalidomide was taken orally once every day in the evening for four to six months. The dexamethasone was taken in a pill form. During the first 2 cycles it was taken on days 1-4, 9-12, 17-20. For all other cycles dexamethasone was taken only on days 1-4.