Study Comparing Carfilzomib, Lenalidomide, and Dexamethasone (CRd) vs Lenalidomide and Dexamethasone (Rd) in Subjects With Relapsed Multiple Myeloma
Relapsed Multiple Myeloma

About this trial
This is an interventional treatment trial for Relapsed Multiple Myeloma focused on measuring Multiple Myeloma
Eligibility Criteria
Inclusion Criteria:
- Symptomatic multiple myeloma
Measurable disease, as defined by one or more of the following (assessed within 21 days prior to randomization):
- Serum M-protein ≥ 0.5 g/dL
- Urine Bence-Jones protein ≥ 200 mg/24 hours
- For immunoglobulin A (IgA) patients whose disease can only be reliably measured by serum quantitative immunoglobulin (qIgA) ≥ 750 mg/dL (0.75 g/dL)
- Prior treatment with at least one, but no more than three, regimens for multiple myeloma
- Documented relapse or progressive disease on or after any regimen
- Achieved a response to at least one prior regimen
- Age ≥ 18 years
- Life expectancy ≥ 3 months
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2
- Adequate hepatic function, with serum alanine aminotransferase (ALT) ≤ 3.5 times the upper limit of normal and serum direct bilirubin ≤ 2 mg/dL (34 µmol/L) within 21 days prior to randomization
- Absolute neutrophil count ≥ 1.0 × 10^9/L within 21 days prior to randomization
- Hemoglobin ≥ 8 g/dL (80 g/L) within 21 days prior to randomization
- Platelet count ≥ 50 × 10^9/L (≥ 30 × 10^9/L if myeloma involvement in the bone marrow is > 50%) within 21 days prior to randomization
- Creatinine clearance (CrCl) ≥ 50 mL/minute within 21 days prior to randomization
- Written informed consent in accordance with federal, local, and institutional guidelines
- Females of childbearing potential must agree to ongoing pregnancy testing and to practice contraception
- Male subjects must agree to practice contraception
Exclusion Criteria:
- If previously treated with bortezomib (alone or in combination), progression during treatment
If previously treated with a lenalidomide and dexamethasone (len/dex) combination:
- Progression during the first 3 months of initiating treatment
- Any progression during treatment if the len/dex combination was the subject's most recent line of therapy
- Discontinuation of previous lenalidomide or dexamethasone due to intolerance; subjects intolerant to bortezomib are not excluded
- Prior carfilzomib treatment
- POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes)
- Waldenström's macroglobulinemia or IgM myeloma
- Plasma cell leukemia (> 2.0 × 10^9/L circulating plasma cells by standard differential)
- Chemotherapy or investigational agent within 3 weeks prior to randomization or antibody therapy within 6 weeks prior to randomization
- Radiotherapy to multiple sites or immunotherapy/antibody therapy within 28 days prior to randomization; localized radiotherapy to a single site within 7 days prior to randomization
- Corticosteroid therapy at a dose equivalent to dexamethasone > 4 mg/day within 21 days prior to randomization
- Pregnant or lactating females
- Major surgery within 21 days prior to randomization
- Acute active infection requiring treatment (systemic antibiotics, antivirals, or antifungals) within 14 days prior to randomization
- Known human immunodeficiency virus infection
- Active hepatitis B or C infection
- Myocardial infarction within 4 months prior to randomization, New York Hear Association (NYHA) Class III or IV heart failure, uncontrolled angina, history of severe coronary artery disease, severe uncontrolled ventricular arrhythmias, sick sinus syndrome, or electrocardiographic evidence of acute ischemia or Grade 3 conduction system abnormalities unless subject has a pacemaker
- Uncontrolled hypertension or uncontrolled diabetes within 14 days prior to randomization
- Other malignancy, including myelodysplastic syndromes (MDS), within the past 3 years with the exception of a) adequately treated basal cell carcinoma, squamous cell skin cancer, or thyroid cancer; b) carcinoma in situ of the cervix or breast; c) prostate cancer of Gleason Grade 6 or less with stable prostate-specific antigen levels; or d) cancer considered cured by surgical resection or unlikely to impact survival during the duration of the study, such as localized transitional cell carcinoma of the bladder or benign tumors of the adrenal or pancreas
- Significant neuropathy (Grades 3-4, or Grade 2 with pain) within 14 days prior to randomization
- Known history of allergy to Captisol® (a cyclodextrin derivative used to solubilize carfilzomib)
- Contraindication to any of the required concomitant drugs or supportive treatments, including hypersensitivity to all anticoagulation and antiplatelet options, antiviral drugs, or intolerance to hydration due to preexisting pulmonary or cardiac impairment
- Ongoing graft-vs-host disease
- Subjects with pleural effusions requiring thoracentesis or ascites requiring paracentesis within 14 days prior to randomization
- Any other clinically significant medical disease or condition that, in the Investigator's opinion, may interfere with protocol adherence or a subject's ability to give informed consent
Sites / Locations
- Mayo Clinic
- Providence St. Joseph Medical Center
- St. Jude Hospital Yorba Linda dba; St. Joseph Heritage Healthcare
- Stanford University
- Colorado Blood Cancer Institute
- Cancer and Blood Disease Center
- Rush University Medical Center
- Indiana University Health Melvin and Bren Simon Cancer Center
- University of Kansas Cancer Center
- The University of Michigan - Comprehensive Cancer Center
- Mayo Clinic
- John Theurer Cancer Center at Hackensack University Medical Center
- NYU Clinical Cancer Center
- Weill Cornell Medical College
- Associates in Oncology and Hematology
- The Don & Sybil Harrington Cancer Center
- Baylor Sammons Cancer Center
- UT Southwestern Medical Center at Dallas
- The University of Texas, MD Anderson Cancer Center
- Scott and White Memorial Hospital
- Fred Hutchinson Cancer Research Center
- Froedtert & Medical College of Wisconsin
- Medizinische Universitat Wien
- Wilhelminspital der Stadt Wien, Zentrum fur Onkologie und Hamatologie
- Ziekenhuisnetwerk Antwerpen - AZ Stuivenberg
- AZ Sint-Jan AV
- UZ Brussel
- Institut Jules Bordet
- Cliniques Universitaires Saint-Luc
- UZ Leuven
- University Multiprofile Hospital for Active Treatment, "Dr. Georgi Stranski"
- University Multiprofile Hospital for Active Treatment "Sveti Georgi"
- Military Medical Academy Multiprofile Hospital for Active Treatment
- Specialized Hospital for Active Treatment of Hematological Diseases
- Multiprofile Hospital for Active Treatment "Sveta Marina"
- Tom Baker Cancer Centre
- University of Alberta, Cross Cancer Institute
- Vancouver General Hospital
- Cancer Care Manitoba
- General Hospital, Health Sciences Centre
- Princess Margaret Hospital
- McGill University Health Center, Royal Victoria Hospital
- Sir Mortimer B. Davis - Jewish General Hospital
- University Hospital Brno, Department of Internal Medicine - Hematooncology
- University Hospital Hradec Kralove
- University Hospital Olomouc
- University Hospital Kralovske Vinohrady - Prague
- General University Hospital Prague
- Hospital Antoine Beclere
- Clinique Victor Hugo - Centre Jean Bernard
- Hopital Claude Huriez
- CH de Mulhouse, Hopital Emile Muller
- CHU Nantes Hotel Dieu
- Hopital Saint-Antoine
- Groupe Hospitalier Necker - Enfants Malades
- Cancer Institut Universitaire de Toulouse-Oncopole (iUCT)
- Hopitaux de Brabois
- University of Dusseldorf
- Krankenhaus Nordwest
- University of Hamburg-Eppendorf
- Universitat Heidelberg
- Stiftungsklinikum Mittelrhein
- LMU Klinikum der Universitat
- Universitatsklinikum Munster
- Universitatsklinikum Wurzburg
- Alexandra Hospital
- University General Hospital of Patras
- St. Istvan and St. Laszlo Hospital of Budapest
- University of Debrecen, Medical and Health Science Center
- Petz Aladar County Teaching Hospital
- Bekes County Pandy Kalman Hospital
- Kaposi Mor County Teaching Hospital
- University of Pecs
- University of Szeged, Albert Szent-Gyorgi Clinical Center
- Rambam Medical Center
- Hadassah Medical Center, Ein Kerem
- Western Gailee Hospital - Nahariya
- Rabin Medical Center
- The Chaim Sheba Medical Center
- Kaplan Medical Center
- Azienda Ospedallera Niguarda Ca Granda
- Azienda Ospedllero Maggiore della Carita
- Azienda Ospedaliera Pisana Ospendale Santa Chiara - Main
- Ospedale S. Eugenio
- Azienda Ospedaliera Citta della Salute e della Scienza di Torino
- Erasmus MC, Department of Haematology
- University Clinical Centre, Department of Hematologii Transplantologii
- Samodzielny Publ. Szp. Wojewodzki w Gorzow Wlkp.
- Independent Public Teaching Hospital of Medical University of Silesia in Katowice
- Nicolaus Copernicus Memorial Provincial Specialist Hospital in Lodz
- Szpital Wojewwodzki im. dr Ludwika Rydygiera w Suwalkach
- Nicolaus Copernicus Municipal Specialist Hospital
- Maria Sklodowska-Curie Institute of Oncology
- Zamojski Non-Public Hospital
- Fundeni Clinical Institute, "Stefan Berceanu" Center for Hematology and Bone Marrow Transplantation
- Coltea Clinical Hospital
- Bucharest University Emergency Hospital
- Regional Institute of Iasi
- State Medical Institution Komi Republican Oncological Center
- First Republican Clinical Hospital under the Ministry of Healthcare of the Republic of Udmurtia
- Federal State Budgetary Scientific Institution: N.N. Blokhin Russian Cancer Research Center
- Moscow State Medical Institution Municipal City Clinical Hospital n.a. S.P. Botkin
- Federal State Budget Institution: Hematology Research Center under MoH
- FSBI: Russian Research Institute of Hematology and Blood Transfusion under the Ferderal Agency for M&B
- State Higher Educational Institution: St Petersburg State Medical University n.a.I.P Pavlov
- SHEI: First St. Petersburg State Medical University N.a.I.P Pavlov under MoH, Clinic of Bone Marrow Transplant
- Federal State Budget Institute: Federal Almalov Medical Research Centre under Ministry of Healthcare
- Clinical Center of Serbia, Clinic of Hematology
- Clinical Hospital Center Bezanijska Kosa
- Military Medical Academy, Clinic of Hematology
- Clinical Center Nis, Clinic of Hematology
- Clinical Center of Vojvodina, Clinic of Hematology
- Hospital Universitario Germans Trias i Pujol
- Hospital Clinic I Provincial
- Hospital Universitario de Salamanca
- Hospital Donostia
- Hospital Universitario y Politeecnico La Fe
- Hospital Universitario Miguel Servet
- Sahlgrenska Universitetssjukhuset
- Karolinska Universitetsjukhuset i Huddinge
- Karolinska Universitetssjukhuset Solna, Hematologiskt Centrum
- St. Bartholomew's Hospital
- Royal Free Hampstead
- St. Georges Hospital
- Nottingham University Hospitals (City Campus)
- Royal Marsden Hospital
- The Royal Wolverhampton Hospital NHS Trust
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Lenalidomide and Dexamethasone (Rd)
Carfilzomib, Lenalidomide, and Dexamethasone (CRd)
Treatment was administered in cycles repeated every 28 days. Lenalidomide 25 mg was administered orally on days 1 to 21 and dexamethasone 40 mg was administered orally or IV on days 1, 8, 15, and 22.
Treatment was administered in cycles every 28 days. Carfilzomib 20 mg/m² was administered intravenously (IV) on days 1 and 2 of cycle 1, escalating to 27 mg/m² on days 8, 9, 15, and 16 of cycle 1 and continuing on days 1, 2, 8, 9, 15, and 16 of cycle 2 through cycle 12 and then from cycle 13 through cycle 18, 27 mg/m² on days 1, 2, 15, and 16. Lenalidomide 25 mg was administered orally on days 1 to 21 from cycle 1 through cycle 18 and from cycle 19 and higher. Dexamethasone 40 mg was administered orally or IV on days 1, 8, 15, and 22 from cycle 1 through cycle 18 and from cycle 19 and higher.