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Bortezomib in Treating Patients With Newly Diagnosed Multiple Myeloma

Primary Purpose

Stage I Multiple Myeloma, Stage II Multiple Myeloma, Stage III Multiple Myeloma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
bortezomib
laboratory biomarker analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Stage I Multiple Myeloma

Eligibility Criteria

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

Inclusion Criteria: Patients must not have received prior myeloma specific therapy (chemotherapy, radiotherapy, or biologic therapy) other than bisphosphonate therapy Patients may have received radiation of plasmacytoma (for example, solitary plasmacytoma); the last such treatment must have occurred >= 4 weeks prior to registration Patients must be recently diagnosed with symptomatic multiple myeloma confirmed by meeting one or more of the following criteria (obtained =< 30 days prior to registration): NOTE: serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP) and marrow biopsy all must be done at baseline in order to evaluate response Monoclonal protein in the serum >= 1 g/dl (measurable disease), or Monoclonal light chain in the urine protein electrophoresis >= 200 mg/24 hours (measurable disease), or Bone marrow plasmacytosis >= 30% without either of the values in above (evaluable disease) Patients must meet one or more of the following (all tests must be been drawn =< 30 days prior to registration but all results are not required to be available at time of registration as long as at least one of the following criteria has been met; if patient is otherwise eligible, plasma cell labeling index [PCLI] is not required, but is requested): Beta-2 microglobulin >= 5.5 mcg/mL, or PCLI >= 1, or Deletion 13 by cytogenetics Platelet count >= 20,000/mm^3, with or without transfusion support Hemoglobin >= 7.0 g/dL, with or without transfusion support Absolute neutrophil count (ANC) >= 500/mm^3 without growth factor support Direct bilirubin within =< 1.5 x upper normal limits (UNL) Alkaline phosphatase =< 2.5 x UNL Aspartate aminotransferase (AST) =< 2.5 x UNL Calculated or measured creatinine clearance >= 20 mL/minute Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1, or 2; exception: PS = 3 if secondary to acute bone event (fracture) Patients may not receive concurrent chemotherapy, radiotherapy or biologic therapy while on study; the exception for corticosteroids is made for those taking chronic corticosteroids for disorders other than myeloma, such as rheumatoid arthritis, adrenal insufficiency, etc. NOTE: Bisphosphonates are considered to be supportive care rather than therapy, and are thus allowed while on protocol treatment Patients must not have a history of allergic reaction attributable to compounds containing boron or mannitol Patient must not have a peripheral neuropathy > grade 1, as defined by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE version 3.0): Grade 2: Objective sensory (or motor) loss or paresthesia (including tingling), interfering with function, but not interfering with activities of daily living (ADL) Grade 3: Sensory (or motor) loss or paresthesia interfering with ADL Grade 4: Permanent sensory (or motor) loss that interferes with function Patient must be capable of understanding the investigational nature, potential risks and benefits of the study Patient must have adequate cardiac function; patient must not have: History of a myocardial infarction within 6 months of enrollment New York Heart Association (NYHA) class III or IV heart failure Uncontrolled angina or electrocardiographic evidence of acute ischemia Severe uncontrolled ventricular arrhythmias or electrocardiographic evidence of active conduction system abnormalities Cardiac amyloidosis Patient must not have any other serious medical or psychiatric illness that could potentially interfere with the completion of treatment according to this protocol Patient must not have poorly controlled hypertension Women must not be pregnant or breast feeding; all females of childbearing potential must have a blood test or urine study within 7 days prior to registration to rule out pregnancy Women of childbearing potential and sexually active males must be strongly advised to use an accepted and effective method of contraception

Sites / Locations

  • Eastern Cooperative Oncology Group

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (bortezomib)

Arm Description

INDUCTION TREATMENT: Patients receive bortezomib IV on days 1, 4, 8, and 11. Treatment repeats every 3 weeks for up to 8 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE TREATMENT: Patients who complete induction treatment without progressive disease receive bortezomib IV on days 1 and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. REINDUCTION TREATMENT: Patients who progress while on maintenance treatment receive bortezomib IV on days 1, 4, 8, and 11. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Response Rate on Induction
Eastern Cooperative Oncology Group (ECOG) Myeloma Response Criteria that follows the standard European Group for Blood and Bone Marrow Transplant criteria was used to evaluate patient response and progression. Patients who have complete disappearance of an M-protein and no evidence of myeloma in the bone marrow are considered to have complete response. 42 eligible and treated patients were included in the analysis.

Secondary Outcome Measures

Response Rate on Maintenance
ECOG Myeloma Response Criteria that follows the standard European Group for Blood and Bone Marrow Transplant criteria was used to evaluate patient response and progression. Patients who have complete disappearance of an M-protein and no evidence of myeloma in the bone marrow are considered to have complete response. 15 eligible and treated patients were included in the analysis.
Response Rate on Reinduction
ECOG Myeloma Response Criteria that follows the standard European Group for Blood and Bone Marrow Transplant criteria was used to evaluate patient response and progression. Patients who have complete disappearance of an M-protein and no evidence of myeloma in the bone marrow are considered to have complete response. 7 eligible and treated patients were included in the analysis.
1-year Progression Free Survival Probability
Progression-free survival is defined as time from randomization to disease progression or death from any cause, whichever occurred first. Disease progression is defined using the ECOG Myeloma Response Criteria. Kaplan-Meier method is used to estimate the 1-year progression-free survival probability. 42 eligible and treated patients were included in the analysis.

Full Information

First Posted
January 9, 2004
Last Updated
May 29, 2014
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00075881
Brief Title
Bortezomib in Treating Patients With Newly Diagnosed Multiple Myeloma
Official Title
Phase II Study of PS-341 for Patients With High-Risk, Newly Diagnosed Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
March 2014
Overall Recruitment Status
Completed
Study Start Date
January 2004 (undefined)
Primary Completion Date
October 2012 (Actual)
Study Completion Date
October 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase II trial studies how well bortezomib works in treating patients with newly diagnosed multiple myeloma. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
Detailed Description
PRIMARY OBJECTIVES: I. To evaluate the response rate to PS-341 (bortezomib) induction in patients with high risk, newly diagnosed multiple myeloma. SECONDARY OBJECTIVES: I. To evaluate progression free survival. II. To explore the response rate of patients who relapse or progress on maintenance and then return to induction schedule. III. To explore duration of second response. TERTIARY OBJECTIVES: I. To explore a possible differential response to PS-341 with previously described adverse prognostic indicators. II. To explore specific gene expression profiles (GEP) that may predict response to therapy to an agent or combination of agents used in the treatment of newly diagnosed myeloma. III. To explore specific post-treatment gene expression profiles (GEP) in the patients who have received 4 cycles of therapy and achieved a minimal response or better. IV. To develop relevant information about the immune system for multiple myeloma patients treated with PS-341. OUTLINE: INDUCTION TREATMENT: Patients receive bortezomib intravenously (IV) on days 1, 4, 8, and 11. Treatment repeats every 3 weeks for up to 8 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE TREATMENT: Patients who complete induction treatment without progressive disease receive bortezomib IV on days 1 and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. REINDUCTION TREATMENT: Patients who progress while on maintenance treatment receive bortezomib IV on days 1, 4, 8, and 11. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 4 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Stage I Multiple Myeloma, Stage II Multiple Myeloma, Stage III 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
44 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (bortezomib)
Arm Type
Experimental
Arm Description
INDUCTION TREATMENT: Patients receive bortezomib IV on days 1, 4, 8, and 11. Treatment repeats every 3 weeks for up to 8 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE TREATMENT: Patients who complete induction treatment without progressive disease receive bortezomib IV on days 1 and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. REINDUCTION TREATMENT: Patients who progress while on maintenance treatment receive bortezomib IV on days 1, 4, 8, and 11. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
bortezomib
Other Intervention Name(s)
LDP 341, MLN341, VELCADE
Intervention Description
Given IV
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Optional correlative studies
Primary Outcome Measure Information:
Title
Response Rate on Induction
Description
Eastern Cooperative Oncology Group (ECOG) Myeloma Response Criteria that follows the standard European Group for Blood and Bone Marrow Transplant criteria was used to evaluate patient response and progression. Patients who have complete disappearance of an M-protein and no evidence of myeloma in the bone marrow are considered to have complete response. 42 eligible and treated patients were included in the analysis.
Time Frame
participants were evaluated prior to each cycle, up to 8 cycles with a median number of 6 cycles. 1 cycle=21 days
Secondary Outcome Measure Information:
Title
Response Rate on Maintenance
Description
ECOG Myeloma Response Criteria that follows the standard European Group for Blood and Bone Marrow Transplant criteria was used to evaluate patient response and progression. Patients who have complete disappearance of an M-protein and no evidence of myeloma in the bone marrow are considered to have complete response. 15 eligible and treated patients were included in the analysis.
Time Frame
participants were evaluated prior to each cycle, up to 45 cycles with a median number of 9 cycles. 1 cycle=21 days
Title
Response Rate on Reinduction
Description
ECOG Myeloma Response Criteria that follows the standard European Group for Blood and Bone Marrow Transplant criteria was used to evaluate patient response and progression. Patients who have complete disappearance of an M-protein and no evidence of myeloma in the bone marrow are considered to have complete response. 7 eligible and treated patients were included in the analysis.
Time Frame
participants were evaluated prior to each cycle, up to 23 cycles with a median number of 3 cycles. 1 cycle=21 days
Title
1-year Progression Free Survival Probability
Description
Progression-free survival is defined as time from randomization to disease progression or death from any cause, whichever occurred first. Disease progression is defined using the ECOG Myeloma Response Criteria. Kaplan-Meier method is used to estimate the 1-year progression-free survival probability. 42 eligible and treated patients were included in the analysis.
Time Frame
Every 3 months if patient is <2 years from study entry, every 6 months if patient is 2-6 years from study entry, no specific requirment if patient is more than 6 years from study entry

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must not have received prior myeloma specific therapy (chemotherapy, radiotherapy, or biologic therapy) other than bisphosphonate therapy Patients may have received radiation of plasmacytoma (for example, solitary plasmacytoma); the last such treatment must have occurred >= 4 weeks prior to registration Patients must be recently diagnosed with symptomatic multiple myeloma confirmed by meeting one or more of the following criteria (obtained =< 30 days prior to registration): NOTE: serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP) and marrow biopsy all must be done at baseline in order to evaluate response Monoclonal protein in the serum >= 1 g/dl (measurable disease), or Monoclonal light chain in the urine protein electrophoresis >= 200 mg/24 hours (measurable disease), or Bone marrow plasmacytosis >= 30% without either of the values in above (evaluable disease) Patients must meet one or more of the following (all tests must be been drawn =< 30 days prior to registration but all results are not required to be available at time of registration as long as at least one of the following criteria has been met; if patient is otherwise eligible, plasma cell labeling index [PCLI] is not required, but is requested): Beta-2 microglobulin >= 5.5 mcg/mL, or PCLI >= 1, or Deletion 13 by cytogenetics Platelet count >= 20,000/mm^3, with or without transfusion support Hemoglobin >= 7.0 g/dL, with or without transfusion support Absolute neutrophil count (ANC) >= 500/mm^3 without growth factor support Direct bilirubin within =< 1.5 x upper normal limits (UNL) Alkaline phosphatase =< 2.5 x UNL Aspartate aminotransferase (AST) =< 2.5 x UNL Calculated or measured creatinine clearance >= 20 mL/minute Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1, or 2; exception: PS = 3 if secondary to acute bone event (fracture) Patients may not receive concurrent chemotherapy, radiotherapy or biologic therapy while on study; the exception for corticosteroids is made for those taking chronic corticosteroids for disorders other than myeloma, such as rheumatoid arthritis, adrenal insufficiency, etc. NOTE: Bisphosphonates are considered to be supportive care rather than therapy, and are thus allowed while on protocol treatment Patients must not have a history of allergic reaction attributable to compounds containing boron or mannitol Patient must not have a peripheral neuropathy > grade 1, as defined by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE version 3.0): Grade 2: Objective sensory (or motor) loss or paresthesia (including tingling), interfering with function, but not interfering with activities of daily living (ADL) Grade 3: Sensory (or motor) loss or paresthesia interfering with ADL Grade 4: Permanent sensory (or motor) loss that interferes with function Patient must be capable of understanding the investigational nature, potential risks and benefits of the study Patient must have adequate cardiac function; patient must not have: History of a myocardial infarction within 6 months of enrollment New York Heart Association (NYHA) class III or IV heart failure Uncontrolled angina or electrocardiographic evidence of acute ischemia Severe uncontrolled ventricular arrhythmias or electrocardiographic evidence of active conduction system abnormalities Cardiac amyloidosis Patient must not have any other serious medical or psychiatric illness that could potentially interfere with the completion of treatment according to this protocol Patient must not have poorly controlled hypertension Women must not be pregnant or breast feeding; all females of childbearing potential must have a blood test or urine study within 7 days prior to registration to rule out pregnancy Women of childbearing potential and sexually active males must be strongly advised to use an accepted and effective method of contraception
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Angela Dispenzieri
Organizational Affiliation
Eastern Cooperative Oncology Group
Official's Role
Principal Investigator
Facility Information:
Facility Name
Eastern Cooperative Oncology Group
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States

12. IPD Sharing Statement

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Bortezomib in Treating Patients With Newly Diagnosed Multiple Myeloma

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