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Dose Escalation Study of I-131-CLR1404 in Patients With Relapsed or Refractory Multiple Myeloma

Primary Purpose

Multiple Myeloma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
I-131-CLR1404
dexamethasone
I-131-CLR1404
Sponsored by
Cellectar Biosciences, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma focused on measuring Multiple Myeloma, Radiopharmaceutical, Therapy, Phase 1

Eligibility Criteria

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

Inclusion Criteria:

  • Histologically or cytologically confirmed multiple myeloma
  • Prior treatment with or intolerance to proteasome inhibitor and immunomodulator
  • Bone marrow biopsy within 28 days of study drug infusion demonstrating at least 5% plasma cell involvement
  • Progressive disease defined by any of following:

    25% increase in serum M-protein from lowest response value during (or after) last therapy and/or absolute increase in serum M-protein of > or equal to 0.5 g/dL; 25% increase in urine M-protein from lowest response value during (or after) last therapy and/or absolute increase in urine M-protein of > or equal to 200 mg/24h; 25% increase in bone marrow plasma cell percentage from lowest response value during (or after) last therapy - absolute bone marrow plasma cell percentage must be > or equal to 10% unless prior complete response when absolute bone marrow plasma cell percentage must be > or equal to 5%; 25% increase in serum FLC level from the lowest response value during (or after) last therapy - the absolute increase must be > 10 mg/dL; new onset hypercalcemia > 11.5 mg/dL

  • Measurable disease defined by any of following: Serum M-protein > 1 g/dL; Urine M-protein > 200 mg/24h; Serum free light chain (FLC) assay: involved FLC level > or equal to 10 mg/dL provided serum FLC ratio is abnormal; subjects who are non-secretors will be considered on a case-by-case basis
  • Eastern Cooperative Oncology Group performance status of 0 to 2
  • Life expectancy of at least 6 months
  • Have initiative and means to be compliant with protocol and within geographical proximity to make required study visits as judged by Investigator
  • Subject or legal representative has ability to read, understand and provide written informed consent for study related procedures
  • Women of childbearing potential must have negative pregnancy test within 24 hours of enrollment
  • Women of childbearing potential and men who are able to father a child, must agree to use an effective contraception method during study and for 12 months following study drug administration

Exclusion Criteria:

  • Grade 2 or greater toxicities due to previous therapies, subject to laboratory abnormalities listed below. Stable, tolerable Grade 2 adverse events may be allowed at discretion of Investigator
  • Prior external beam radiation therapy resulting in greater than 20% total bone marrow receiving greater than 20 Gy
  • Prior radioisotope therapy
  • Prior total body or hemi-body irradiation
  • Extradural tumor in contact with the spinal cord or tumor located where swelling in response to therapy may impinge upon spinal cord
  • Subject has any of following laboratory abnormalities: WBC < 3000/uL; ANC < 1500/uL; Hemoglobin < 8 g/dL; Estimated glomerular filtration rate < 30 mL/min/1.73 m2; ALT > 3 x ULN ; Bilirubin > 1.5 x ULN
  • Platelet count < 100,000/uL without full-dose anticogulation therapy
  • Platelet count < 150,000/uL with ongoing full-dose anticoagulation therapy
  • Clinically significant bleeding event, as judged by investigator, within prior 6 months
  • Chronic immunosuppressive therapy
  • Anti-platelet therapy, except low-dose aspirin for cardioprotection
  • PTT > 1.3 x ULN
  • INR > 1.3
  • Radiation therapy, chemotherapy, immunotherapy, investigational therapy or corticosteroid use within 2 weeks of or after eligibility-defining bone marrow biopsy. Bisphosphonates and denosumab are permitted if subject has been receiving for at least 90 days
  • History of hypersensitivity to iodine
  • Any other concomitant serious illness or organ system dysfunction in opinion of Investigator would either compromise subject safety or interfere with test drug safety evaluation
  • Major surgery within 6 weeks of enrollment
  • Known history of HIV, hepatitis C or hepatitis B infection
  • Pregnancy or breast-feeding

Sites / Locations

  • Mayo Clinic
  • Loyola University Medical Center
  • Karmanos Cancer Institute
  • University of Wisconsin Hospital and Clinics

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Single

Arm Description

I-131-CLR1404 with or without concurrent dexamethasone

Outcomes

Primary Outcome Measures

Number of participants with dose limiting toxicities (DLT)
DLT will be assessed by physical examination, vital signs, ECG, and laboratory values

Secondary Outcome Measures

Identification of recommended phase 2 dose of I-131-CLR1404 with concurrent weekly dexamethasone
Largest administered dose with concurrent weekly dexamethasone with at most a 17% dose limiting toxicity rate
Identification of recommended phase 2 dose of I-131-CLR1404 without dexamethasone
Largest administered dose without dexamethasone with at most a 17% dose limiting toxicity rate
Identify the recommended dosing schedule of I-131-CLR1404, in relapsed or refractory MM

Full Information

First Posted
October 22, 2014
Last Updated
February 21, 2023
Sponsor
Cellectar Biosciences, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02278315
Brief Title
Dose Escalation Study of I-131-CLR1404 in Patients With Relapsed or Refractory Multiple Myeloma
Official Title
Phase 1, Open-Label, Dose Escalation Study of I-131-CLR1404 in Patients With Relapsed or Refractory Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Completed
Study Start Date
February 2015 (Actual)
Primary Completion Date
December 9, 2020 (Actual)
Study Completion Date
August 10, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cellectar Biosciences, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The primary objective of the study is to determine the safety and tolerability of I-131-CLR1404 as a single or multiple dose, with and without concurrent weekly dexamethasone, in patients with relapsed or refractory multiple myeloma who have previously been treated with, or are intolerant of, an immunomodulator and a proteasome inhibitor.
Detailed Description
Multiple myeloma (MM) is an incurable, monoclonal proliferation of plasma cells. Approximately 80,000 Americans are affected by MM with approximately 22,000 new cases diagnosed and 11,000 deaths each year. The introduction of newer therapies in the past twenty years, such as autologous stem cell transplantation and novel agents such as proteasome inhibitors and immune modulating drugs has improved outcomes, with current median overall survival estimates of 3-10 years depending on a number of patient-, disease- and treatment-related factors. However, despite these innovations, myeloma relapse is inevitable. Therefore, there is a clear need for improved therapies for MM and, in particular, for relapsed disease. I-131-CLR1404 is a radioiodinated therapeutic that exploits the selective uptake and retention of phospholipid ethers (PLEs) by malignant cells. Cellectar Biosciences' novel cancer-targeted small-molecule compound (CLR1404) is radiolabeled with the isotope iodine-131 (I-131). Radioiodinated CLR1404 has been evaluated in over 60 xenograft and spontaneous (transgenic) tumor models. In all but two cases of hepatocellular carcinoma, CLR1404 demonstrated selective cancer cell uptake and retention. In various rodent tumor models, I-131-CLR1404 has also demonstrated tumor growth delay and prolongation of survival. Based on the critical unmet medical need for effective agents with novel mechanisms of action in MM, the exquisite radiosensitivity of MM, and initial preclinical and clinical experience with radioiodinated CLR1404, Cellectar Biosciences has chosen to assess I-131-CLR1404 in a MM-specific phase 1 trial.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma
Keywords
Multiple Myeloma, Radiopharmaceutical, Therapy, Phase 1

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Single
Arm Type
Experimental
Arm Description
I-131-CLR1404 with or without concurrent dexamethasone
Intervention Type
Drug
Intervention Name(s)
I-131-CLR1404
Other Intervention Name(s)
131I-CLR1404, 18-(p-[I-131]-iodophenyl)octadecyl phosphocholine, CLR 131
Intervention Description
Single IV dose of I-131-CLR1404, increased/decreased by cohort
Intervention Type
Drug
Intervention Name(s)
dexamethasone
Other Intervention Name(s)
Decadron
Intervention Description
40 mg dexamethasone orally once weekly for up to 12 weeks
Intervention Type
Drug
Intervention Name(s)
I-131-CLR1404
Other Intervention Name(s)
131I-CLR1404, 18-(p-[I-131]-iodophenyl)octadecyl phosphocholine, CLR 131
Intervention Description
Multiple IV dose of I-131-CLR1404, increased/decreased by cohort
Primary Outcome Measure Information:
Title
Number of participants with dose limiting toxicities (DLT)
Description
DLT will be assessed by physical examination, vital signs, ECG, and laboratory values
Time Frame
up to 85 days
Secondary Outcome Measure Information:
Title
Identification of recommended phase 2 dose of I-131-CLR1404 with concurrent weekly dexamethasone
Description
Largest administered dose with concurrent weekly dexamethasone with at most a 17% dose limiting toxicity rate
Time Frame
until non-tolerated dose is defined; dose escalation descision made upon review of data from a complete cohort (85 days after all subjects in cohort have received infusion)
Title
Identification of recommended phase 2 dose of I-131-CLR1404 without dexamethasone
Description
Largest administered dose without dexamethasone with at most a 17% dose limiting toxicity rate
Time Frame
until non-tolerated dose is defined; dose escalation descision made upon review of data from a complete cohort (85 days after all subjects in cohort have received infusion)
Title
Identify the recommended dosing schedule of I-131-CLR1404, in relapsed or refractory MM
Time Frame
until non-tolerated dose is defined with both dosing regimens; dose escalation decision made upon review of data from a complete cohort (85 days after all subjects in cohort have received infusion)
Other Pre-specified Outcome Measures:
Title
Determination of therapeutic activity of I-131-CLR1404 in relapsed or refractory multiple myeloma
Description
Response assessment per International Uniform Response Criteria for Multiple Myeloma
Time Frame
through Day 85

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically or cytologically confirmed multiple myeloma Prior treatment with or intolerance to proteasome inhibitor and immunomodulator Bone marrow biopsy within 28 days of study drug infusion demonstrating at least 5% plasma cell involvement Progressive disease defined by any of following: 25% increase in serum M-protein from lowest response value during (or after) last therapy and/or absolute increase in serum M-protein of > or equal to 0.5 g/dL; 25% increase in urine M-protein from lowest response value during (or after) last therapy and/or absolute increase in urine M-protein of > or equal to 200 mg/24h; 25% increase in bone marrow plasma cell percentage from lowest response value during (or after) last therapy - absolute bone marrow plasma cell percentage must be > or equal to 10% unless prior complete response when absolute bone marrow plasma cell percentage must be > or equal to 5%; 25% increase in serum FLC level from the lowest response value during (or after) last therapy - the absolute increase must be > 10 mg/dL; new onset hypercalcemia > 11.5 mg/dL Measurable disease defined by any of following: Serum M-protein > 1 g/dL; Urine M-protein > 200 mg/24h; Serum free light chain (FLC) assay: involved FLC level > or equal to 10 mg/dL provided serum FLC ratio is abnormal; subjects who are non-secretors will be considered on a case-by-case basis Eastern Cooperative Oncology Group performance status of 0 to 2 Life expectancy of at least 6 months Have initiative and means to be compliant with protocol and within geographical proximity to make required study visits as judged by Investigator Subject or legal representative has ability to read, understand and provide written informed consent for study related procedures Women of childbearing potential must have negative pregnancy test within 24 hours of enrollment Women of childbearing potential and men who are able to father a child, must agree to use an effective contraception method during study and for 12 months following study drug administration Exclusion Criteria: Grade 2 or greater toxicities due to previous therapies, subject to laboratory abnormalities listed below. Stable, tolerable Grade 2 adverse events may be allowed at discretion of Investigator Prior external beam radiation therapy resulting in greater than 20% total bone marrow receiving greater than 20 Gy Prior radioisotope therapy Prior total body or hemi-body irradiation Extradural tumor in contact with the spinal cord or tumor located where swelling in response to therapy may impinge upon spinal cord Subject has any of following laboratory abnormalities: WBC < 3000/uL; ANC < 1500/uL; Hemoglobin < 8 g/dL; Estimated glomerular filtration rate < 30 mL/min/1.73 m2; ALT > 3 x ULN ; Bilirubin > 1.5 x ULN Platelet count < 100,000/uL without full-dose anticogulation therapy Platelet count < 150,000/uL with ongoing full-dose anticoagulation therapy Clinically significant bleeding event, as judged by investigator, within prior 6 months Chronic immunosuppressive therapy Anti-platelet therapy, except low-dose aspirin for cardioprotection PTT > 1.3 x ULN INR > 1.3 Radiation therapy, chemotherapy, immunotherapy, investigational therapy or corticosteroid use within 2 weeks of or after eligibility-defining bone marrow biopsy. Bisphosphonates and denosumab are permitted if subject has been receiving for at least 90 days History of hypersensitivity to iodine Any other concomitant serious illness or organ system dysfunction in opinion of Investigator would either compromise subject safety or interfere with test drug safety evaluation Major surgery within 6 weeks of enrollment Known history of HIV, hepatitis C or hepatitis B infection Pregnancy or breast-feeding
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Natalie S Callander, MD
Organizational Affiliation
University of Wisconsin, Madison
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mayo Clinic
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32224
Country
United States
Facility Name
Loyola University Medical Center
City
Maywood
State/Province
Illinois
ZIP/Postal Code
60153
Country
United States
Facility Name
Karmanos Cancer Institute
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
University of Wisconsin Hospital and Clinics
City
Madison
State/Province
Wisconsin
ZIP/Postal Code
53792
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
24920661
Citation
Weichert JP, Clark PA, Kandela IK, Vaccaro AM, Clarke W, Longino MA, Pinchuk AN, Farhoud M, Swanson KI, Floberg JM, Grudzinski J, Titz B, Traynor AM, Chen HE, Hall LT, Pazoles CJ, Pickhardt PJ, Kuo JS. Alkylphosphocholine analogs for broad-spectrum cancer imaging and therapy. Sci Transl Med. 2014 Jun 11;6(240):240ra75. doi: 10.1126/scitranslmed.3007646.
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Dose Escalation Study of I-131-CLR1404 in Patients With Relapsed or Refractory Multiple Myeloma

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