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Carfilzomib With Bendamustine and Dexamethasone in Multiple Myeloma

Primary Purpose

Multiple Myeloma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Bendamustine
Carfilzomib
Dexamethasone
Sponsored by
Siyang Leng
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma focused on measuring Newly diagnosed, multiple myeloma, myeloma, bendamustine, Treanda, carfilzomib, dexamethasone, phase I, phase II, dose escalation, transplant, non-transplant, plasma cell, Kyprolis

Eligibility Criteria

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

Inclusion Criteria:

  1. Age ≥ 18 years.
  2. Life expectancy ≥ 3 months.
  3. Eastern Cooperative Oncology Group (ECOG) performance status 0-2.
  4. Adequate hepatic function.
  5. Sufficient Absolute neutrophil count (ANC) within 14 days prior to randomization.
  6. Sufficient Hemoglobin within 14 days prior to randomization (subjects may be receiving red blood cell (RBC) transfusions in accordance with institutional guidelines).
  7. Sufficient platelet count 14 days prior to randomization.
  8. Creatinine Clearance ≥ 30 mL/minute within 7 days prior to randomization.
  9. Left Ventricular Ejection Fraction ≥ 40%.
  10. Written informed consent in accordance with federal, local, and institutional guidelines.
  11. Females of childbearing potential (FCBP) must agree to ongoing pregnancy testing and to practice contraception.
  12. Male subjects must agree to practice contraception.
  13. Patients must have histologically or cytologically confirmed symptomatic multiple myeloma (MM). Patients should not have previously been treated.
  14. Prior kyphoplasty, vertebroplasty, local radiation therapy for symptomatic bone lesions (e.g., uncontrolled pain or high risk of pathologic fracture) are permitted.
  15. Patients are allowed up to two cycles of high dose steroids if needed for symptomatic disease before study enrollment.

Exclusion Criteria:

  1. Patients who have had chemotherapy for Multiple Myeloma. Exception: local radiation therapy for symptomatic bone lesions (e.g., uncontrolled pain or high risk of pathologic fracture).
  2. Patients currently receiving high dose systemic steroids for treatment of Multiple Myeloma in excess of 320mg total dose of dexamethasone or equivalent, patients who received an investigational agent within 5 half-lives of the agent.
  3. Patients with non-measurable Multiple Myeloma or primary plasma cell leukemia.
  4. Pregnant or lactating females.
  5. Major surgery within 21 days prior to enrollment.
  6. Acute active infection requiring treatment (systemic antibiotics, antivirals, or antifungals) within 14 days prior to enrollment.
  7. Known human immunodeficiency virus (HIV) infection.
  8. Known active hepatitis B or C infection.
  9. Unstable angina or myocardial infarction within 4 months prior to enrollment.
  10. Uncontrolled hypertension or uncontrolled diabetes within 14 days prior to enrollment.
  11. Uncontrolled, non-hematologic malignancy requiring active treatment.
  12. Patients with known brain metastases (treated or not) will be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
  13. Significant neuropathy within 14 days prior to randomization.
  14. Known history of allergy to Captisol, or to other agents in the study.
  15. 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.
  16. Subjects with pleural effusions requiring thoracentesis or ascites requiring paracentesis within 14 days prior to enrollment.
  17. 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

  • Columbia University Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

CFZ with bendamustine and dexamethasone

Arm Description

Subjects will receive Carfilzomib on Days 1, 2, 8, 9, 15, and 16 every 28 days with dose escalation from 27, 36, 45 to 56 mg/ m2 . No matter what target dose the subject will receive, days 1 and 2 doses in the first cycle will always be 20 mg/m2, followed by target dose for all subsequent dates and cycles. Bendamustine will be given IV on days 1 and 2 with dose escalation up to 90 mg/m2 and dexamethasone 20 mg orally or intravenously on 1, 2, 8, 9, 15, 16, 22 and 23 of each 28-day cycle. Study treatment will be given until 8 cycles of treatment are completed or until disease progression, whichever comes first.

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose (MTD) of Carfilzomib in combination with bendamustine and dexamethasone
The primary endpoint of this study is dose-limiting toxicity (DLT), to define the recommended phase II dose.

Secondary Outcome Measures

Overall response rate (ORR)
Includes complete response and partial response.
Duration of response (DOR)
The duration of overall response is measured from the time measurement criteria are met for complete response (CR) or partial response (PR) (whichever is first recorded) until the first date that recurrent or progressive disease (PD) is objectively documented (taking as reference for PD the smallest measurements recorded since the study treatment started).
Progression free survival (PFS)
PFS is defined as the duration of time from start of study treatment to time of progression or death, whichever occurs first.
Time to best response
Time to the best response recorded.
Overall survival (OS) rate
The percentage of people who are still alive.
Number of adverse events (AEs)
Total number of AEs observed.
Number of adverse events in relation to carfilzomib maintenance
Total number of AEs observed that are determined to be related to carfilzomib.

Full Information

First Posted
December 2, 2013
Last Updated
June 12, 2019
Sponsor
Siyang Leng
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1. Study Identification

Unique Protocol Identification Number
NCT02002598
Brief Title
Carfilzomib With Bendamustine and Dexamethasone in Multiple Myeloma
Official Title
Phase I/II Study of Carfilzomib in Combination With Bendamustine and Dexamethasone in Patients With Newly Diagnosed Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
June 2019
Overall Recruitment Status
Completed
Study Start Date
November 2013 (undefined)
Primary Completion Date
March 1, 2019 (Actual)
Study Completion Date
March 1, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Siyang Leng

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is designed to define dose-limiting toxicity and determine preliminary evidence of efficacy of carfilzomib (CFZ) in combination with bendamustine and dexamethasone for patients with newly diagnosed multiple myeloma (MM).
Detailed Description
Multiple myeloma (MM) is a malignant plasma cell disorder resulting in approximately 11,000 deaths in the United States each year. It is estimated that between 60,000-80,000 people are currently under treatment for refractory or relapsed MM. Prognosis and survival have improved over the last 20 years, but the disease is still universally fatal despite efforts to develop new and more effective chemotherapeutic regimens. Therefore, new regimens need to be developed for patients prior to peripheral blood stem cell transplant and for those unable to tolerate the toxicity of transplant.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma
Keywords
Newly diagnosed, multiple myeloma, myeloma, bendamustine, Treanda, carfilzomib, dexamethasone, phase I, phase II, dose escalation, transplant, non-transplant, plasma cell, Kyprolis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CFZ with bendamustine and dexamethasone
Arm Type
Experimental
Arm Description
Subjects will receive Carfilzomib on Days 1, 2, 8, 9, 15, and 16 every 28 days with dose escalation from 27, 36, 45 to 56 mg/ m2 . No matter what target dose the subject will receive, days 1 and 2 doses in the first cycle will always be 20 mg/m2, followed by target dose for all subsequent dates and cycles. Bendamustine will be given IV on days 1 and 2 with dose escalation up to 90 mg/m2 and dexamethasone 20 mg orally or intravenously on 1, 2, 8, 9, 15, 16, 22 and 23 of each 28-day cycle. Study treatment will be given until 8 cycles of treatment are completed or until disease progression, whichever comes first.
Intervention Type
Drug
Intervention Name(s)
Bendamustine
Other Intervention Name(s)
Treanda
Intervention Description
Bendamustine will be administered IV on days 1 and 2 with dose escalation up to 90 mg/m2 of each 28-day cycle. Dose escalation is as follows: -1 | 60 mg/m2 | 70 mg/m2 | 70 mg/m2 | 90 mg/m2 | 90mg/m2 | 90 mg/m2
Intervention Type
Drug
Intervention Name(s)
Carfilzomib
Other Intervention Name(s)
Kyprolis, CFZ
Intervention Description
Carfilzomib will be administered IV on Days 1, 2, 8, 9, 15, and 16 every 28 days. Dose Escalation is as follows: -1 | 27 mg/m2 | 27 mg/m2 | 36 mg/m2 | 36 mg/m2 | 45 mg/m2 | 56 mg/m2
Intervention Type
Drug
Intervention Name(s)
Dexamethasone
Other Intervention Name(s)
Decadron, Dexamethasone Intensol, Dexpak Taperpak
Intervention Description
Dexamethasone will be administered PO or IV, 20 mg, on 1, 2, 8, 9, 15, 16 and 22, 23 of each 28-day cycle.
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose (MTD) of Carfilzomib in combination with bendamustine and dexamethasone
Description
The primary endpoint of this study is dose-limiting toxicity (DLT), to define the recommended phase II dose.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Overall response rate (ORR)
Description
Includes complete response and partial response.
Time Frame
2 years
Title
Duration of response (DOR)
Description
The duration of overall response is measured from the time measurement criteria are met for complete response (CR) or partial response (PR) (whichever is first recorded) until the first date that recurrent or progressive disease (PD) is objectively documented (taking as reference for PD the smallest measurements recorded since the study treatment started).
Time Frame
2 years
Title
Progression free survival (PFS)
Description
PFS is defined as the duration of time from start of study treatment to time of progression or death, whichever occurs first.
Time Frame
2 years
Title
Time to best response
Description
Time to the best response recorded.
Time Frame
2 years
Title
Overall survival (OS) rate
Description
The percentage of people who are still alive.
Time Frame
2 years
Title
Number of adverse events (AEs)
Description
Total number of AEs observed.
Time Frame
2 years
Title
Number of adverse events in relation to carfilzomib maintenance
Description
Total number of AEs observed that are determined to be related to carfilzomib.
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 18 years. Life expectancy ≥ 3 months. Eastern Cooperative Oncology Group (ECOG) performance status 0-2. Adequate hepatic function. Sufficient Absolute neutrophil count (ANC) within 14 days prior to randomization. Sufficient Hemoglobin within 14 days prior to randomization (subjects may be receiving red blood cell (RBC) transfusions in accordance with institutional guidelines). Sufficient platelet count 14 days prior to randomization. Creatinine Clearance ≥ 30 mL/minute within 7 days prior to randomization. Left Ventricular Ejection Fraction ≥ 40%. Written informed consent in accordance with federal, local, and institutional guidelines. Females of childbearing potential (FCBP) must agree to ongoing pregnancy testing and to practice contraception. Male subjects must agree to practice contraception. Patients must have histologically or cytologically confirmed symptomatic multiple myeloma (MM). Patients should not have previously been treated. Prior kyphoplasty, vertebroplasty, local radiation therapy for symptomatic bone lesions (e.g., uncontrolled pain or high risk of pathologic fracture) are permitted. Patients are allowed up to two cycles of high dose steroids if needed for symptomatic disease before study enrollment. Exclusion Criteria: Patients who have had chemotherapy for Multiple Myeloma. Exception: local radiation therapy for symptomatic bone lesions (e.g., uncontrolled pain or high risk of pathologic fracture). Patients currently receiving high dose systemic steroids for treatment of Multiple Myeloma in excess of 320mg total dose of dexamethasone or equivalent, patients who received an investigational agent within 5 half-lives of the agent. Patients with non-measurable Multiple Myeloma or primary plasma cell leukemia. Pregnant or lactating females. Major surgery within 21 days prior to enrollment. Acute active infection requiring treatment (systemic antibiotics, antivirals, or antifungals) within 14 days prior to enrollment. Known human immunodeficiency virus (HIV) infection. Known active hepatitis B or C infection. Unstable angina or myocardial infarction within 4 months prior to enrollment. Uncontrolled hypertension or uncontrolled diabetes within 14 days prior to enrollment. Uncontrolled, non-hematologic malignancy requiring active treatment. Patients with known brain metastases (treated or not) will be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events. Significant neuropathy within 14 days prior to randomization. Known history of allergy to Captisol, or to other agents in the study. 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. Subjects with pleural effusions requiring thoracentesis or ascites requiring paracentesis within 14 days prior to enrollment. 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.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Siyang Leng, MD
Organizational Affiliation
Columbia University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Columbia University Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Carfilzomib With Bendamustine and Dexamethasone in Multiple Myeloma

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