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Vorinostat, Bortezomib and Dexamethasone in Multiple Myeloma (MUKFour) (MUKfour)

Primary Purpose

Multiple Myeloma

Status
Completed
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Vorinostat Velcade Dexamethasone
Sponsored by
University of Leeds
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma

Eligibility Criteria

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

Inclusion Criteria:

  • Able to give informed consent - Aged 18 years or over
  • Participants with relapsed myeloma who have received 1-3 prior lines of treatment and now require further treatment
  • ECOG Performance Status ≤ 2
  • Required laboratory values within 14 days of registration:

    • Absolute neutrophil count ≥1.0 x 10^9/L.
    • Platelet count ≥75x10^9/L.
    • Haemoglobin > 9 g/dL.
    • Bilirubin ≤1.5 x upper limit of normal
    • ALT and / or AST ≤2.5 x upper limit of normal
    • Serum creatinine ≤ 2.0 x upper limit of normal
    • Corrected calcium ≤ 2.8 mmol/L
  • Life expectancy of at least 3 months
  • Female participants of child-bearing potential must have a negative pregnancy test at baseline and agree to use dual methods of contraception for the duration of the study and must continue to do so for 3 months after the end of treatment. Male participants must agree to use a barrier method of contraception for the duration of the study if sexually active with a female of child-bearing potential and must continue to do so for 3 months after the end of treatment
  • Participant is able to swallow capsules and is able to take or tolerate oral medications on a continuous basis.

Exclusion Criteria:

  • Previous anti-tumour therapies, including prior experimental agents or approved anti-tumour small molecules and biologics, within 28 days before the start of protocol treatment. Steroid therapy to stop rapid relapse during this period is permitted, but must be stopped 7 days prior to study drug administration.
  • Prior HDAC inhibitor treatment.
  • Previous or concurrent active malignancies (<12 months post end of treatment) at other sites with the exception of appropriately treated localised epithelial skin or cervical cancer.
  • Participants considered to be refractory to prior bortezomib treatment or unable to tolerate treatment with bortezomib.
  • Peripheral neuropathy of ≥ grade 2 severity
  • Participants who have received growth factor support or platelet support within 14 days prior to registration
  • Participants with uncontrolled concurrent illness or circumstances that could limit compliance with the study.
  • Patients with significant cardiovascular or pulmonary disease
  • Active symptomatic fungal, bacterial, and/or viral infection including known active HIV or known viral (A, B, or C) hepatitis.
  • Pregnant or breast feeding females
  • Unable to take corticosteroid therapy at study entry
  • Participants with known hypersensitivity to any components of bortezomib, (such as boron, mannitol), vorinostat or dexamethasone.
  • Participant has known CNS metastases and/or carcinomatous meningitis.
  • Participants with a history of a gastrointestinal surgery or other procedures that might, in the opinion of the Investigator, interfere with the absorption or swallowing of the study drug(s)

Sites / Locations

  • Nottingham University Hospital
  • University Hospital Southampton

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Vorinostat Velcade Dexamethasone (VVD)

Arm Description

Up to 8 cycles of VVD followed by vorinostat maintenance until disease progression. Cycles 1-8 (21-day cycle) Velcade: 1.3mg/m2 (subcutaneous) on days 1, 4, 8 and 11 Dexamethasone: 20 mg (PO) on days 1, 2, 4, 5, 8, 9, 11 and 12 Vorinostat: 400mg (PO) on days 1-4, 8-11, 15-18 Maintenance (28-day cycle) Vorinostat: 400mg PO on 1-4 and 15-18

Outcomes

Primary Outcome Measures

Overall response rate to vorinostat, bortezomib and dexamethasone.
To assess the number and proportion of participants with at least a partial response (PR) or better within 8 cycles of protocol treatment with vorinostat, bortezomib and dexamethasone.

Secondary Outcome Measures

Number of dose reductions during treatment with vorinostat, bortezomib and dexamethasone.
To assess the dose reduction profile of combination treatment with vorinostat, bortezomib and dexamethasone. The proportion of participants experiencing a dose reduction or terminating treatment early due to toxicity will be assessed.
Overall numbers and rates of adverse events
Safety and toxicity analyses will summarise the overall serious adverse event and adverse events rates including the number and proportion of participants with at least one safety event. SAEs will be additionally presented by the relationship to study treatment, seriousness criteria, event outcome, duration and by MedDRA body system coding.
Progression free survival
A progression-free survival curve will be calculated using the Kaplan Meier method and median PFS estimates will be presented
Maximum response to treatment
The overall number and proportion of participants in each response category within 8 cycles of treatment and overall across all treatment including the maintenance phase
Time to maximum response
The time to maximum response will be calculated from the date of registration to the date of maximum response. Participant's who progress and do not achieve a maximum response will be censored at the time of progression. Median time to maximum response will be presented.

Full Information

First Posted
October 31, 2012
Last Updated
August 9, 2021
Sponsor
University of Leeds
Collaborators
Myeloma UK, Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT01720875
Brief Title
Vorinostat, Bortezomib and Dexamethasone in Multiple Myeloma (MUKFour)
Acronym
MUKfour
Official Title
A Phase II Trial of Combination Treatment With Vorinostat, Bortezomib and Dexamethasone in Patients With Relapsed and Relapsed Refractory Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
August 9, 2013 (Actual)
Primary Completion Date
August 2015 (Actual)
Study Completion Date
August 29, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Leeds
Collaborators
Myeloma UK, Merck Sharp & Dohme LLC

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Bortezomib is an established treatment in multiple myeloma; it is common practice in the UK to administer bortezomib with dexamethasone. This practice is based on data that supports improved response rates with this combination. Recent trial data indicates that the addition of vorinostat to bortezomib treatment overcomes treatment resistance to bortezomib. As such this current trial is designed to investigate the efficacy, safety and tolerability of combination treatment with vorinostat, bortezomib and dexamethasone in patients with relapsed and relapsed refractory myeloma. A comparison of this Phase II trial with the pivotal Phase III trial conducted by MSD (using the labelled bortezomib indication without dexamethasone) will address the impact of dexamethasone in regards to tolerability and additional efficacy in myeloma patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Vorinostat Velcade Dexamethasone (VVD)
Arm Type
Experimental
Arm Description
Up to 8 cycles of VVD followed by vorinostat maintenance until disease progression. Cycles 1-8 (21-day cycle) Velcade: 1.3mg/m2 (subcutaneous) on days 1, 4, 8 and 11 Dexamethasone: 20 mg (PO) on days 1, 2, 4, 5, 8, 9, 11 and 12 Vorinostat: 400mg (PO) on days 1-4, 8-11, 15-18 Maintenance (28-day cycle) Vorinostat: 400mg PO on 1-4 and 15-18
Intervention Type
Drug
Intervention Name(s)
Vorinostat Velcade Dexamethasone
Other Intervention Name(s)
Bortezomib (velcade)
Primary Outcome Measure Information:
Title
Overall response rate to vorinostat, bortezomib and dexamethasone.
Description
To assess the number and proportion of participants with at least a partial response (PR) or better within 8 cycles of protocol treatment with vorinostat, bortezomib and dexamethasone.
Time Frame
up to 24 weeks
Secondary Outcome Measure Information:
Title
Number of dose reductions during treatment with vorinostat, bortezomib and dexamethasone.
Description
To assess the dose reduction profile of combination treatment with vorinostat, bortezomib and dexamethasone. The proportion of participants experiencing a dose reduction or terminating treatment early due to toxicity will be assessed.
Time Frame
up to 24 weeks
Title
Overall numbers and rates of adverse events
Description
Safety and toxicity analyses will summarise the overall serious adverse event and adverse events rates including the number and proportion of participants with at least one safety event. SAEs will be additionally presented by the relationship to study treatment, seriousness criteria, event outcome, duration and by MedDRA body system coding.
Time Frame
Up to 18 months
Title
Progression free survival
Description
A progression-free survival curve will be calculated using the Kaplan Meier method and median PFS estimates will be presented
Time Frame
Up to 18 months
Title
Maximum response to treatment
Description
The overall number and proportion of participants in each response category within 8 cycles of treatment and overall across all treatment including the maintenance phase
Time Frame
Up to 24 weeks
Title
Time to maximum response
Description
The time to maximum response will be calculated from the date of registration to the date of maximum response. Participant's who progress and do not achieve a maximum response will be censored at the time of progression. Median time to maximum response will be presented.
Time Frame
Up to 18 months
Other Pre-specified Outcome Measures:
Title
Matched pairs analysis
Description
A matched pairs analysis will be carried out looking at overall response, PFS, dose reductions and toxicity in participants treated with vorinostat in combination with bortezomib and dexamethasone (VVD) in this current study compared to participants randomised to the bortezomib/vorinostat (VV) arm in the pivotal MSD phase III study.
Time Frame
Up to 24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Able to give informed consent - Aged 18 years or over Participants with relapsed myeloma who have received 1-3 prior lines of treatment and now require further treatment ECOG Performance Status ≤ 2 Required laboratory values within 14 days of registration: Absolute neutrophil count ≥1.0 x 10^9/L. Platelet count ≥75x10^9/L. Haemoglobin > 9 g/dL. Bilirubin ≤1.5 x upper limit of normal ALT and / or AST ≤2.5 x upper limit of normal Serum creatinine ≤ 2.0 x upper limit of normal Corrected calcium ≤ 2.8 mmol/L Life expectancy of at least 3 months Female participants of child-bearing potential must have a negative pregnancy test at baseline and agree to use dual methods of contraception for the duration of the study and must continue to do so for 3 months after the end of treatment. Male participants must agree to use a barrier method of contraception for the duration of the study if sexually active with a female of child-bearing potential and must continue to do so for 3 months after the end of treatment Participant is able to swallow capsules and is able to take or tolerate oral medications on a continuous basis. Exclusion Criteria: Previous anti-tumour therapies, including prior experimental agents or approved anti-tumour small molecules and biologics, within 28 days before the start of protocol treatment. Steroid therapy to stop rapid relapse during this period is permitted, but must be stopped 7 days prior to study drug administration. Prior HDAC inhibitor treatment. Previous or concurrent active malignancies (<12 months post end of treatment) at other sites with the exception of appropriately treated localised epithelial skin or cervical cancer. Participants considered to be refractory to prior bortezomib treatment or unable to tolerate treatment with bortezomib. Peripheral neuropathy of ≥ grade 2 severity Participants who have received growth factor support or platelet support within 14 days prior to registration Participants with uncontrolled concurrent illness or circumstances that could limit compliance with the study. Patients with significant cardiovascular or pulmonary disease Active symptomatic fungal, bacterial, and/or viral infection including known active HIV or known viral (A, B, or C) hepatitis. Pregnant or breast feeding females Unable to take corticosteroid therapy at study entry Participants with known hypersensitivity to any components of bortezomib, (such as boron, mannitol), vorinostat or dexamethasone. Participant has known CNS metastases and/or carcinomatous meningitis. Participants with a history of a gastrointestinal surgery or other procedures that might, in the opinion of the Investigator, interfere with the absorption or swallowing of the study drug(s)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Matthew Jenner
Organizational Affiliation
University Hospital of Southampton
Official's Role
Principal Investigator
Facility Information:
Facility Name
Nottingham University Hospital
City
Nottingham
State/Province
Nottinghamshire
ZIP/Postal Code
NG5 1PB
Country
United Kingdom
Facility Name
University Hospital Southampton
City
Southampton
ZIP/Postal Code
SO16 6YD
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
33478922
Citation
Brown S, Pawlyn C, Tillotson AL, Sherratt D, Flanagan L, Low E, Morgan GJ, Williams C, Kaiser M, Davies FE, Jenner MW; Myeloma UK Early Phase Clinical Trial Network. Bortezomib, Vorinostat, and Dexamethasone Combination Therapy in Relapsed Myeloma: Results of the Phase 2 MUK four Trial. Clin Lymphoma Myeloma Leuk. 2021 Mar;21(3):154-161.e3. doi: 10.1016/j.clml.2020.11.019. Epub 2020 Dec 3.
Results Reference
result

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Vorinostat, Bortezomib and Dexamethasone in Multiple Myeloma (MUKFour)

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