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CURATE.AI Optimized Modulation for Multiple Myeloma

Primary Purpose

Multiple Myeloma

Status
Recruiting
Phase
Phase 2
Locations
Singapore
Study Type
Interventional
Intervention
Bortezomib
Cyclophosphamide
Dexamethasone
CURATE.AI-Guided dosage modulation
Thalidomide
Bortezomib
Cyclophosphamide
Thalidomide
Dexamethasone
Lenalidomide
Lenalidomide
Sponsored by
National University Hospital, Singapore
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma

Eligibility Criteria

21 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Adults diagnosed with multiple myeloma diagnosed according to standard criteria, without prior anti-myeloma treatment at study entry
  2. Patients must have evaluable multiple myeloma with at least one of the following (within 21 days of starting treatment)a.

    1. Serum M-protein = 0.5g/dL,or
    2. b. In subjects without detectable serum M-protein, Urine M-protein = 200mg/24 hour, or serum free light chai (sFLC) > 100mg/L (involved light chain) and an abnormal kappa/Lambda ratio
  3. Males and females = 21 years of age or > country's legal age for adult Consent
  4. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 2
  5. Patients must meet the following clinical laboratory criteria with 21 days of starting treatment:

    1. Absolute neutrophil count (ANC) = 1,000/mm3 and platelet = 50,000/mm3 (= 30,000/mm3 if myeloma involvement in the bone marrow is >50%)
    2. Total bilirubin = 1.5 x the upper limit of the normal range (ULN). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST = 3 xULN.
    3. Calculated creatinine clearance = 45mL/min or creatinine < 3mg/dL.
  6. Written informed consent in accordance with federal, local and institutional guidelines

Exclusion Criteria:

  1. Female patients who are lactating or pregnant
  2. Multiple Myeloma of immunoglobulin M subtype
  3. Glucocorticoid therapy (prednisolone > 30mg/day or equivalent) within 14 days prior to informed consent obtained
  4. POEMS syndrome
  5. Plasma cell leukemia or circulating plasma cells = 2 x 109/L
  6. Waldenstrom's Macroglobulinaemia
  7. Patients with known amyloidosis
  8. Chemotherapy with approved or investigation anticancer therapeutics within 21 days prior to starting pomalidomide treatment
  9. Focal radiation therapy within 7 days prior to start of treatment. Radiation therapy to an extended field involving a significant volume of bone marrow within 21 days prior to start of treatment
  10. Immunotherapy (excluding steroids) 21 days prior to start of treatment
  11. Major surgery (excluding kyphoplasty) within 28 days prior to start of treatment
  12. Active congestive heart failure (New York Heart Association [NYHA] Class III or IV), symptomatic ischaemia, or conduction abnormalities uncontrolled by conventional intervention. Myocardial infarction within 4 months prior to informed consent obtained
  13. Known HIV seropositive, hepatitis C infection, and/or hepatitis B (except for patients with hepatitis B surface antigen or core antibody receiving and responding to antiviral therapy directed at hepatitis B: these patients are allowed)
  14. Patients with known cirrhosis
  15. Second malignancy within the past 3 years except:

    1. Adequately treated basal cell or squamous cell skin cancer,
    2. Carcinoma in situ of the cervix.
    3. Breast carcinoma in situ with full surgical resection
  16. Patients with myelodysplastic syndrome
  17. Patients with steroid, bortezomib, cyclophosphamide or thalidomide hypersensitivity
  18. Prior treatment with Bortezomib
  19. Ongoing graft-versus-host disease
  20. Patients with pleural effusions requiring thoracentesis or ascites requiring aracentesis within 14 days prior to starting treatment
  21. Contraindication to any of the required concomitant drugs or supportive treatments
  22. Any clinically significant medical disease or psychiatric condition that, in the investigator's opinion, may interfere with protocol adherence or a patient's ability to give informed consent.

Sites / Locations

  • National University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Standard of Care

CURATE.AI-guided dosing

Arm Description

Dosing of VCD(bortezomib, cyclophosphamide,dexamethasone), VTD (bortezomib,thalidomide, dexamethasone), or VRD (Bortezomib, Lenalidomide, Dexamethasone) combinations according to standard of care

CURATE.AI optimized modulation of bortezomib and cyclophosphamide dosages in the VCD (bortezomib, cyclophosphamide, dexamethasone), bortezomib and thalidomide in the VTD (bortezomib, thalidomide, dexamethasone) or bortezomib and lenalidomide in the VRD (bortezomib, lenalidomide, dexamethasone) combinations

Outcomes

Primary Outcome Measures

Response rate
Complete response (CR), or stringent complete response (sCR), or very good partial response (VGPR), or partial response (PR) based on IMWG criteria at the end of cycle 4

Secondary Outcome Measures

Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability)
Occurrence of adverse events throughout the study, graded via Common Terminology Criteria for Adverse Events (CTCAE) v 4.03 criteria.

Full Information

First Posted
November 20, 2018
Last Updated
August 31, 2023
Sponsor
National University Hospital, Singapore
Collaborators
National University of Singapore
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1. Study Identification

Unique Protocol Identification Number
NCT03759093
Brief Title
CURATE.AI Optimized Modulation for Multiple Myeloma
Official Title
Phenotypic Personalized Medicine: Systematically Optimized Combination Therapy in Multiple Myeloma Using CURATE.AI
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 10, 2023 (Anticipated)
Primary Completion Date
September 10, 2025 (Anticipated)
Study Completion Date
September 10, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
National University Hospital, Singapore
Collaborators
National University of Singapore

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Clinical trial applying CURATE.AI, a Phenotypic Precision Medicine (PPM) platform, to Bortezomib, Thalidomide, Cyclophosphamide and Lenalidomide dosing in multiple myeloma patients to show improvement in response.
Detailed Description
In conventional combination chemotherapy, drug doses are typically determined using dose escalation to reach a maximum tolerated dose (MTD) or via dose expansion to identify suitable regimen administration guideline, and the combinations are subsequently administered at fixed doses. During the course of treatment, the patient's response to therapy evolves and changes due to the time-dependent, dose dependent, and patient-specific nature of drug synergy and resulting efficacy and tolerability. To overcome this challenge, we have developed CURATE.AI, a Phenotypic Precision Medicine (PPM) platform, which has been clinically validated and used to prospectively optimize patient liver transplant immunosuppression, and tuberculosis therapy, among other indications. In this study, CURATE.AI may improve patient response by providing dose recommendations for Bortezomib, Thalidomide, Cyclophosphamide and Lenalidomide to the clinical team over the course of the patient's treatment.

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, Phase 3
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Standard of Care
Arm Type
Active Comparator
Arm Description
Dosing of VCD(bortezomib, cyclophosphamide,dexamethasone), VTD (bortezomib,thalidomide, dexamethasone), or VRD (Bortezomib, Lenalidomide, Dexamethasone) combinations according to standard of care
Arm Title
CURATE.AI-guided dosing
Arm Type
Experimental
Arm Description
CURATE.AI optimized modulation of bortezomib and cyclophosphamide dosages in the VCD (bortezomib, cyclophosphamide, dexamethasone), bortezomib and thalidomide in the VTD (bortezomib, thalidomide, dexamethasone) or bortezomib and lenalidomide in the VRD (bortezomib, lenalidomide, dexamethasone) combinations
Intervention Type
Drug
Intervention Name(s)
Bortezomib
Other Intervention Name(s)
Velcade
Intervention Description
Standard dosing based on product insert and subjected to dose adjustments as determined by clinical care team
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Intervention Description
Standard dosing based on product insert and subjected to dose adjustments as determined by clinical care team
Intervention Type
Drug
Intervention Name(s)
Dexamethasone
Intervention Description
Standard dosing based on product insert and subjected to dose adjustments as determined by clinical care team
Intervention Type
Other
Intervention Name(s)
CURATE.AI-Guided dosage modulation
Intervention Description
CURATE.AI-guided modulation of Velcade and Cyclophosphamide dosages for VCD regimen, Velcade and Thalidomide dosages for VTD regimen, and Velcade and Lenalidomide dosages for VRD regimen
Intervention Type
Drug
Intervention Name(s)
Thalidomide
Intervention Description
Standard dosing based on product insert and subjected to dose adjustments as determined by clinical care team
Intervention Type
Drug
Intervention Name(s)
Bortezomib
Other Intervention Name(s)
Velcade
Intervention Description
Dose in a range of 0.7,1.0,1.3 mg/m2 subcutaneous (SC) injection on Day 1, 8, 15 ,22 for cycles 1 to 4 , as determined and guided by CURATE.AI and approved by the clinical care team
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Intervention Description
Dosing in a range of 100, 300, 500 mg PO on Day 1, 8, 15, 22 for cycles 1 to 4 as determined and guided by CURATE.AI and approved by the clinical care team.
Intervention Type
Drug
Intervention Name(s)
Thalidomide
Intervention Description
Dose in a range of 50-200mg PO on day 1-28 for cycles 1 to 4 as determined and guided by CURATE.AI and approved by the clinical care team.
Intervention Type
Drug
Intervention Name(s)
Dexamethasone
Intervention Description
40 mg PO on Day 1 ,8 , 15, 22 for cycles 1 to 4, as determined and guided by the clinical care team according to standard of care
Intervention Type
Drug
Intervention Name(s)
Lenalidomide
Other Intervention Name(s)
Revlimid
Intervention Description
Standard dosing based on product insert and subjected to dose adjustments as determined by clinical care team
Intervention Type
Drug
Intervention Name(s)
Lenalidomide
Other Intervention Name(s)
Revlimid
Intervention Description
Dose in a range of 5-25mg PO on day 1-21 for cycles 1 to 4, as determined and guided by CURATE.AI and approved by the clinical care team.
Primary Outcome Measure Information:
Title
Response rate
Description
Complete response (CR), or stringent complete response (sCR), or very good partial response (VGPR), or partial response (PR) based on IMWG criteria at the end of cycle 4
Time Frame
Up to 16 weeks or at the end of cycle 4 of treatment (each cycle is 28 days)
Secondary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability)
Description
Occurrence of adverse events throughout the study, graded via Common Terminology Criteria for Adverse Events (CTCAE) v 4.03 criteria.
Time Frame
Up to 16 weeks or at the end of cycle 4 of treatment (each cycle is 28 days)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Multiple myeloma diagnosed according to standard criteria, without prior anti-myeloma treatment at study entry. Both transplant eligible and ineligible patients may be included. Patients must have evaluable multiple myeloma with at least one of the following (within 21 days of starting treatment) Serum M-protein ≥ 0.5g/dL, or In subjects without detectable serum M-protein, Urine M-protein ≥ 200mg/24 hour, or serum free light chai (sFLC) > 100mg/L (involved light chain) and an abnormal kappa/Lambda ratio Males and females ≥ 18 years of age or > country's legal age for adult consent Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 2 Patients must meet the following clinical laboratory criteria with 21 days of starting treatment: Absolute neutrophil count (ANC) ≥ 1,000/mm3 and platelet ≥ 50,000/mm3 (≥ 30,000/mm3 if myeloma involvement in the bone marrow is >50%) Total bilirubin ≤ 1.5 x the upper limit of the normal range (ULN). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 x ULN. Calculated creatinine clearance ≥ 30mL/min or creatinine < 3mg/dL. Written informed consent in accordance with federal, local and institutional guidelines Exclusion Criteria: Female patients who are lactating or pregnant Multiple Myeloma of IgM subtype Glucocorticoid therapy (prednisolone > 30mg/day or equivalent) within 14 days prior to informed consent obtained POEMS syndrome Plasma cell leukaemia or circulating plasma cells ≥ 2 x 109/L Waldenstrom's Macroglobulinaemia Patients with known amyloidosis Chemotherapy with approved or investigation anticancer therapeutics within 21 days prior to starting bortezomib treatment Focal radiation therapy within 7 days prior to start of treatment. Radiation therapy to an extended field involving a significant volume of bone marrow within 21 days prior to start of treatment Immunotherapy (excluding steroids) 21 days prior to start of treatment Major surgery (excluding kyphoplasty) within 28 days prior to start of treatment Active congestive heart failure (New York Heart Association [NYHA] Class III or IV), symptomatic ischaemia, or conduction abnormalities uncontrolled by conventional intervention. Myocardial infarction within 4 months prior to informed consent obtained Known HIV seropositive, hepatitis C infection, and/or hepatitis B (except for patients with hepatitis B surface antigen or core antibody receiving and responding to antiviral therapy directed at hepatitis B: these patients are allowed) Patients with known cirrhosis Second malignancy within the past 3 years except: Adequately treated basal cell or squamous cell skin cancer Carcinoma in situ of the cervix Breast carcinoma in situ with full surgical resection Patients with myelodysplastic syndrome Patients with steroid, cyclophosphamide, bortezomib, lenalidomide or thalidomide hypersensitivity Patients with a calculated creatinine clearance less than 30ml/min by the Cockroft Galt method. Prior treatment with Bortezomib Contraindication to any of the required concomitant drugs or supportive treatments Any clinically significant medical disease or psychiatric condition that, in the investigator's opinion, may interfere with protocol
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Wee Joo Chng, Prof
Phone
67795555
Email
mdccwj@nus.edu.sg
First Name & Middle Initial & Last Name or Official Title & Degree
Sanjay de Mel, Dr
Phone
67795555
Email
sanjay_widanalage@nuhs.edu.sg
Facility Information:
Facility Name
National University Hospital
City
Singapore
ZIP/Postal Code
119228
Country
Singapore
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Wee Joo Chng, Prof
Phone
67795555
Email
mdccwj@nus.edu.sg
First Name & Middle Initial & Last Name & Degree
Sanjay de Mel, Dr
Phone
67795555
Email
sanjay_widanalage@nuhs.edu.sg
First Name & Middle Initial & Last Name & Degree
Wee Joo Chng, Prof
First Name & Middle Initial & Last Name & Degree
Edward Chow, Dr
First Name & Middle Initial & Last Name & Degree
Dean Ho, Prof
First Name & Middle Initial & Last Name & Degree
Sanjay de Mel, Dr
First Name & Middle Initial & Last Name & Degree
Melissa Ooi, Dr

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
Citation
Pantuck, A.J., Lee, D.K., Kee, T., Wang, P., Lakhotia, S., Silverman, M.H., Mathis, C., Drakaki, A., Belldegrun, A.S., Ho, C.M. and Ho, D., 2018. Modulating BET Bromodomain Inhibitor ZEN-3694 and Enzalutamide Combination Dosing in a Metastatic Prostate Cancer Patient Using CURATE. AI, an Artificial Intelligence Platform. Advanced Therapeutics, 1(6), p.1800104.
Results Reference
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CURATE.AI Optimized Modulation for Multiple Myeloma

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