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Study of Pomalidomide, Oral Dexamethasone and Very Low-dose Cyclophosphamide in Patients With Refractory Multiple Myeloma Who Have Received Lenalidomide and Bortezomib (POCODEX)

Primary Purpose

Multiple Myeloma

Status
Terminated
Phase
Phase 2
Locations
Spain
Study Type
Interventional
Intervention
Pomalidomide + Cyclophosphamide + Dexamethasone
Sponsored by
Maimónides Biomedical Research Institute of Córdoba
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma focused on measuring Multiple Myeloma, Pomalidomide, Cyclophosphamide, Dexamethasone

Eligibility Criteria

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

Inclusion Criteria:

  • Patient over 18 years of age and who meets criteria 2 and / or 3.
  • Patient diagnosed with symptomatic Multiple Myeloma according to standard criteria.
  • Patients with symptomatic multiple myeloma in relapse / refractory after having received treatment with at least two cycles that include Bortezomib and with at least two cycles that include Lenalidomide, whether combined in the same therapeutic scheme or as part of different chemotherapy schemes.
  • Patients with MM with measurable disease, defined as the presence of monoclonal component of at least 0.5 g / dL in serum or at least 0.2 g / d in urine, or in those without measurable disease the presence of altered light chain radius at the time of entry into the study.
  • Patients with good general condition defined as ECOG ≤ 2.
  • The patient must understand the written informed consent and sign it of his own accord.
  • The patient must be able to meet all scheduled visits and other requirements.
  • Laboratory Criteria: Patients must present the following counts:Absolute neutrophils: ≥1000 / μL, Platelet Count: ≥50,000 / μL, Hemoglobin:> 8 gr / dL, Total bilirubin: <2 x upper limit of normal, AST and ALT: <3 x Upper limit of normal, Serum potassium: within the limits of normality.
  • Women of childbearing age should have a negative pregnancy test.
  • The male patient included in the trial must commit to always use a latex condom during any sexual contact with women of childbearing age, even if they have undergone a successful vasectomy.

Exclusion Criteria:

  • Any concomitant disease, laboratory alteration or psychiatric disorder that may presuppose the subject's inability to sign the IC.
  • PS> 3 according to the ECOG scale.
  • Previous history of non-hematologic malignancies, unless the patient has been free of the disease for ≥ 5 years. Exceptions include the following: Basal cell carcinoma of the skin, Squamous cell carcinoma of the skin, Carcinoma in situ of the cervix, Carcinoma in situ of the breast.
  • Patients who are unable or unwilling to undergo antithrombotic therapy.
  • Known positive serology for human immunodeficiency virus HIV or active infectious hepatitis, type B, or C.
  • Depressed heart function, or clinically significant heart disease
  • Severe hypercalcemia
  • Major surgical interventions within 15 days prior to inclusion or not having recovered from their side effects.
  • Any serious medical condition, including laboratory alterations that cause the patient to take an unacceptable risk if participating in this study or that may interfere with the interpretation of the study data.
  • Patients treated with any investigational drug in the previous 28 days.
  • Any severe medical condition, abnormality in laboratory tests or any psychiatric illness that prevents the signing of written consent.
  • Pregnant or breastfeeding women.
  • Known hypersensitivity to drugs or compounds of biological or chemical composition similar to those of the study.
  • Plasma Cell Leukemia

Sites / Locations

  • Hospital Universitario Reina Sofía

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Pomalidomide + Cyclophosphamide + Dexamethasone

Arm Description

Treatment Phase: Combination of Pomalidomide, Cyclophosphamide and Dexamethasone, days 1-21 every 4 weeks (28 day cycles), up to a total of 8 cycles: Pomalidomide: Treatment with Pomalidomide 4 mg / day 1-21 days in 28-day cycles is started. Cyclophosphamide: Cyclophosphamide will be administered 15 mg / day, days 1-28 in 28-day cycles. Dexamethasone: Dexamethasone will be administered 40 mg / day, days 1, 8, 15 and 22 in 28-day cycles. Maintenance Phase: Combination of Pomalidomide and Dexamethasone. The last doses prescribed in the previous cycle will be maintained.

Outcomes

Primary Outcome Measures

Best response
Evaluate the best response rate based on the criteria of the International Myeloma Working Group of the following responses at the end of each cycle or during the maintenance period.

Secondary Outcome Measures

Time to Response
From the entry into the study or the start of treatment until the first evidence of a confirmed response.
Duration of Response
Time from the first evidence of response to the progression or recurrence of the disease.
Time to Progression
From the entry into the study or the start of treatment to the progression or recurrence of the disease.
Global Survival
from the entry into the study or the start of treatment until the date of death of the patient or the last date on which it was known that the patient was alive.
Progression Free Survival
from the entry into the study or the start of treatment to the progression or recurrence of the disease (includes death from myeloma)
Tolerability of the study medication
Number of Participants With Treatment-Related Adverse Events as Assessed by CTCAE v4.0.
Angiogenesis markers of metronomic chemotherapy activity
Evaluations of treatment of Circulating Endothelial Cells by multiparameter flow cytometry.
Angiogenesis markers of metronomic chemotherapy activity 2
Evaluations of treatment of Circulating Endothelial Cells by serum levels of VEGF, TSP1.
Immune system evaluation of metronomic chemotherapy activity
Evaluation of the Immune system by the determination of regulatory T populations.

Full Information

First Posted
November 11, 2019
Last Updated
January 23, 2020
Sponsor
Maimónides Biomedical Research Institute of Córdoba
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1. Study Identification

Unique Protocol Identification Number
NCT04243109
Brief Title
Study of Pomalidomide, Oral Dexamethasone and Very Low-dose Cyclophosphamide in Patients With Refractory Multiple Myeloma Who Have Received Lenalidomide and Bortezomib
Acronym
POCODEX
Official Title
Pilot Study (Phase II) of Pomalidomide, Oral Dexamethasone and Very Low-dose Cyclophosphamide in Patients With Refractory Multiple Myeloma Who Have Received Lenalidomide and Bortezomib
Study Type
Interventional

2. Study Status

Record Verification Date
January 2020
Overall Recruitment Status
Terminated
Why Stopped
Low recruitment rate. Lack of interest of the sponsor.
Study Start Date
February 23, 2017 (Actual)
Primary Completion Date
May 7, 2019 (Actual)
Study Completion Date
May 7, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Maimónides Biomedical Research Institute of Córdoba

4. Oversight

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

5. Study Description

Brief Summary
Clinical trial with a pharmaceutical specialty in a new combination. Pomalidomide in combination with dexamethasone is indicated in the treatment of adult patients with multiple treatment-resistant or relapsing myeloma who have received at least two previous treatments, including lenalidomide and bortezomib, and who have experienced a disease progression in the last treatment. The combination of Pomalidomide with Cyclophosphamide at metronomic doses (Very low doses) and Dexamethasone is tested in this clinical situation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma
Keywords
Multiple Myeloma, Pomalidomide, Cyclophosphamide, Dexamethasone

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Pomalidomide + Cyclophosphamide + Dexamethasone
Arm Type
Experimental
Arm Description
Treatment Phase: Combination of Pomalidomide, Cyclophosphamide and Dexamethasone, days 1-21 every 4 weeks (28 day cycles), up to a total of 8 cycles: Pomalidomide: Treatment with Pomalidomide 4 mg / day 1-21 days in 28-day cycles is started. Cyclophosphamide: Cyclophosphamide will be administered 15 mg / day, days 1-28 in 28-day cycles. Dexamethasone: Dexamethasone will be administered 40 mg / day, days 1, 8, 15 and 22 in 28-day cycles. Maintenance Phase: Combination of Pomalidomide and Dexamethasone. The last doses prescribed in the previous cycle will be maintained.
Intervention Type
Drug
Intervention Name(s)
Pomalidomide + Cyclophosphamide + Dexamethasone
Intervention Description
Treatment Phase: Combination of Pomalidomide, Cyclophosphamide and Dexamethasone, days 1-21 every 4 weeks (28 day cycles), up to a total of 8 cycles: Pomalidomide: Treatment with Pomalidomide 4 mg / day 1-21 days in 28-day cycles is started. Dose reductions will be made based on the evaluation of hematological and non-hematological toxicity. Cyclophosphamide: Cyclophosphamide will be administered 15 mg / day, days 1-28 in 28-day cycles. Dexamethasone: Dexamethasone will be administered 40 mg / day, days 1, 8, 15 and 22 in 28-day cycles. In patients older than 75 years the dose will be reduced to 20 mg / day in the same previous schedule. Maintenance Phase: Combination of Pomalidomide and Dexamethasone. The last doses prescribed in the previous cycle will be maintained.
Primary Outcome Measure Information:
Title
Best response
Description
Evaluate the best response rate based on the criteria of the International Myeloma Working Group of the following responses at the end of each cycle or during the maintenance period.
Time Frame
Every 28 days (each cycle is 28 days) from randomization until progression or withdrawal of the subject, whichever came first, assessed up to 60 months.
Secondary Outcome Measure Information:
Title
Time to Response
Description
From the entry into the study or the start of treatment until the first evidence of a confirmed response.
Time Frame
Every 28 days (each cycle is 28 days) from randomization until progression or withdrawal of the subject, whichever came first, assessed up to 60 months.
Title
Duration of Response
Description
Time from the first evidence of response to the progression or recurrence of the disease.
Time Frame
Every 28 days (each cycle is 28 days) from randomization until progression or withdrawal of the subject, whichever came first, assessed up to 60 months.
Title
Time to Progression
Description
From the entry into the study or the start of treatment to the progression or recurrence of the disease.
Time Frame
Every 28 days (each cycle is 28 days) from randomization until progression or withdrawal of the subject, whichever came first, assessed up to 60 months.
Title
Global Survival
Description
from the entry into the study or the start of treatment until the date of death of the patient or the last date on which it was known that the patient was alive.
Time Frame
Every 28 days (each cycle is 28 days) from randomization until progression or withdrawal of the subject, whichever came first, assessed up to 60 months.
Title
Progression Free Survival
Description
from the entry into the study or the start of treatment to the progression or recurrence of the disease (includes death from myeloma)
Time Frame
Every 28 days (each cycle is 28 days) from randomization until progression or withdrawal of the subject, whichever came first, assessed up to 60 months.
Title
Tolerability of the study medication
Description
Number of Participants With Treatment-Related Adverse Events as Assessed by CTCAE v4.0.
Time Frame
Every 28 days (each cycle is 28 days) from randomization until progression or withdrawal of the subject, whichever came first, assessed up to 60 months.
Title
Angiogenesis markers of metronomic chemotherapy activity
Description
Evaluations of treatment of Circulating Endothelial Cells by multiparameter flow cytometry.
Time Frame
At baseline and before the beginning of the 2nd, 4th, 6th and 8th treatment cycle (each cycle is 28 days)
Title
Angiogenesis markers of metronomic chemotherapy activity 2
Description
Evaluations of treatment of Circulating Endothelial Cells by serum levels of VEGF, TSP1.
Time Frame
At baseline and before the beginning of the 2nd, 4th, 6th and 8th treatment cycle (each cycle is 28 days)
Title
Immune system evaluation of metronomic chemotherapy activity
Description
Evaluation of the Immune system by the determination of regulatory T populations.
Time Frame
At baseline and before the beginning of the 2nd, 4th, 6th and 8th treatment cycle (each cycle is 28 days)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient over 18 years of age and who meets criteria 2 and / or 3. Patient diagnosed with symptomatic Multiple Myeloma according to standard criteria. Patients with symptomatic multiple myeloma in relapse / refractory after having received treatment with at least two cycles that include Bortezomib and with at least two cycles that include Lenalidomide, whether combined in the same therapeutic scheme or as part of different chemotherapy schemes. Patients with MM with measurable disease, defined as the presence of monoclonal component of at least 0.5 g / dL in serum or at least 0.2 g / d in urine, or in those without measurable disease the presence of altered light chain radius at the time of entry into the study. Patients with good general condition defined as ECOG ≤ 2. The patient must understand the written informed consent and sign it of his own accord. The patient must be able to meet all scheduled visits and other requirements. Laboratory Criteria: Patients must present the following counts:Absolute neutrophils: ≥1000 / μL, Platelet Count: ≥50,000 / μL, Hemoglobin:> 8 gr / dL, Total bilirubin: <2 x upper limit of normal, AST and ALT: <3 x Upper limit of normal, Serum potassium: within the limits of normality. Women of childbearing age should have a negative pregnancy test. The male patient included in the trial must commit to always use a latex condom during any sexual contact with women of childbearing age, even if they have undergone a successful vasectomy. Exclusion Criteria: Any concomitant disease, laboratory alteration or psychiatric disorder that may presuppose the subject's inability to sign the IC. PS> 3 according to the ECOG scale. Previous history of non-hematologic malignancies, unless the patient has been free of the disease for ≥ 5 years. Exceptions include the following: Basal cell carcinoma of the skin, Squamous cell carcinoma of the skin, Carcinoma in situ of the cervix, Carcinoma in situ of the breast. Patients who are unable or unwilling to undergo antithrombotic therapy. Known positive serology for human immunodeficiency virus HIV or active infectious hepatitis, type B, or C. Depressed heart function, or clinically significant heart disease Severe hypercalcemia Major surgical interventions within 15 days prior to inclusion or not having recovered from their side effects. Any serious medical condition, including laboratory alterations that cause the patient to take an unacceptable risk if participating in this study or that may interfere with the interpretation of the study data. Patients treated with any investigational drug in the previous 28 days. Any severe medical condition, abnormality in laboratory tests or any psychiatric illness that prevents the signing of written consent. Pregnant or breastfeeding women. Known hypersensitivity to drugs or compounds of biological or chemical composition similar to those of the study. Plasma Cell Leukemia
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Miguel Ángel Álvarez Rivas, MD
Organizational Affiliation
Hospital Universitario Reina Sofía
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital Universitario Reina Sofía
City
Córdoba
ZIP/Postal Code
14004
Country
Spain

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
The individual participant data will be available. Individual participant data that underlie the results reportes in this article, after deidenttification (text, tables, figures and appendices) The other documents that will be available: study protocol, Statistical Analysis Plan, Informed Consent Form. With whom? Researchers who provide a methodologically sound proposal. For what types of analyses? for individual participant data meta-analysis.
IPD Sharing Time Frame
Open, under previous request.
IPD Sharing Access Criteria
To obtain the data, a proposal must be sent to uicec@imibic.org. To gain access, data requestors will need to sign a data access agreement.

Learn more about this trial

Study of Pomalidomide, Oral Dexamethasone and Very Low-dose Cyclophosphamide in Patients With Refractory Multiple Myeloma Who Have Received Lenalidomide and Bortezomib

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