Back to resultsCyclophosphamide, Carfilzomib, Thalidomide, and Dexamethasone in Treating Patients With Newly Diagnosed Active Multiple Myeloma
Primary Purpose
Multiple Myeloma, Stage I Multiple Myeloma, Stage II Multiple Myeloma
Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
carfilzomib
cyclophosphamide
thalidomide
dexamethasone
Sponsored by
About this trial
This is an interventional treatment trial for Multiple Myeloma
Eligibility Criteria
Inclusion
- Creatinine =< 2 mg/dL
- Calculated Creatinine Clearance >= 30 mL/min
- Total Bilirubin =< 2.0 mg/dL
- Alkaline Phosphatase =< 3 x ULN
- ALT =< 3 x ULN
- Absolute neutrophil count >= 1000/uL
- Platelet >= 75000/uL
- Hemoglobin >= 8.0 g/dL
- Untreated symptomatic myeloma: Prior non-systemic therapy for the treatment of solitary plasmacytoma is permitted, but >= 1 month should have elapsed from the last day of radiation; prior therapy with clarithromycin, DHEA, anakinra, pamidronate or zoledronic acid is permitted; any additional agents not listed must be approved by the Principal Investigator
- Prior high dose corticosteroid therapy for twelve days (480 mg total dose) or less is permitted for emergent complications from newly diagnosed multiple myeloma
- Measurable disease of multiple myeloma, as defined by at least ONE of the following:
- Serum monoclonal protein >= 1.0 g by protein electrophoresis
- OR > 200 mg of monoclonal protein in the urine on 24 hour electrophoresis
- OR serum immunoglobulin free light chain >= 10 mg/dL AND abnormal serum immunoglobulin kappa to lambda free light chain ratio; OR monoclonal bone marrow plasmacytosis >= 30% (evaluable disease)
- ECOG performance status (PS) 0, 1, 2; ECOG PS of 3 will be allowed if secondary to pain in the opinion of the Investigator
- Willingness and able to provide informed written consent
- Negative serum pregnancy test done =< 7 days prior to registration, for women of childbearing potential only
- Willingness to return to Mayo Clinic enrolling institution for follow-up
Exclusion
- MGUS or smoldering myeloma
- Peripheral sensory neuropathy >= Grade 2 as defined by CTEP Active Version of the CTCAE
- Active malignancy with the exception of non melanoma skin cancer or in situ cervical or breast cancer
- Pregnant women or women of reproductive ability who are unwilling to use effective contraception
- Nursing women
- Men who are unwilling to use a condom (even if they have undergone a prior vasectomy) while having intercourse with any woman, while taking the drug and for 4 weeks after stopping treatment
- Known hypersensitivity, allergy or inability to tolerate any of the agents employed
- Active, uncontrolled infection
- Severe cardiac comorbidity
- New York Heart Association Class III or IV Heart Failure
- Recent history of myocardial infarction in the six months prior to registration
- Uncontrolled angina or electrocardiographic evidence of acute ischemia
- Severe uncontrolled ventricular arrhythmias or electrocardiographic evidence of active conduction system abnormalities
- Cardiac amyloidosis with hypotension (systolic BP less than 100 mmHg)
- Other concurrent chemotherapy, radiotherapy, or any ancillary therapy considered investigational; NOTE: Bisphosphonates are considered to be supportive care rather than therapy, and are thus allowed while on protocol treatment
- The following medications are not permitted during the trial: any other investigational treatment; any cytotoxic chemotherapy; any other systemic anti-neoplastic therapy including, but not limited to, immunotherapy, hormonal therapy, or monoclonal antibody therapy
- Palliative radiation therapy is permitted if clinically indicated and not indicative of progressive disease
Sites / Locations
- Mayo Clinic in Arizona
- Mayo Clinic
- Medical University of South Carolina
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Arm I
Arm Description
Patients receive carfilzomib IV on days 1, 2, 8, 9, 15, and 16; oral cyclophosphamide on days 1, 8, and 15; oral dexamethasone on days 1, 8, 15, and 22; and oral thalidomide on days 1-28.
Outcomes
Primary Outcome Measures
Maximum Tolerated Dose (Phase I)
To establish the maximum tolerated dose of carfilzomib given in combination with oral cyclophosphamide and thalidomide and dexamethasone.
For this protocol, dose-limiting toxicity (DLT) will be defined as an adverse event attributed (definitely, probably, possibly) in the first or second cycle for patients enrolled to Dose Levels -1 and 0 and in the first cycle only for patients enrolled to Dose Levels 1 and 2.
We are reporting the number of DLTs
Percentage of Patients Who Have at Least a Confirmed Very Good Partial Response (Phase II)
The proportion of patients who have at least a confirmed very good partial response will be calculated by taking the number of patients with a very good partial response or a complete response divided by the total number of patients.
A complete response is defined as:
Negative immunofixation of the serum and urine
If at on study, only the measurable non-bone marrow parameter was FLC, normalization of FLC ratio
< 5% plasma cells in bone marrow
Disappearance of any soft tissue plasmacytomas
A very good partial response is defined as:
Serum and urine M-component detectable by immunofixation but not on electrophoresis or
If at on study, serum measurable, ≥ 90% or greater reduction in serum Mcomponent
Urine M-component <100 mg per 24 hour
Secondary Outcome Measures
Progression-free Survival (Phase II)
PFS was defined as the time from registration to progression or death due to any cause. Progression was defined as any one or more of the following:
• Increase of 25% from lowest confirmed response in: Serum M-component (absolute increase must be ≥ 0.5 g/dl)c Urine M-component (absolute increase must be ≥ 200 mg/24 hour) If at on study, only the measurable non-bone marrow parameter was FLC, the difference between involved and uninvolved FLC levels (absolute increase must be >10 mg/dl) Bone marrow plasma cell percentage (absolute % must be 10%)d Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas
• Development of hypercalcemia (corrected serum calcium >11.5 mg/dl) that can be attributed solely to the plasma cell proliferative disorder
Time to Treatment Failure
The time from the date of registration to the date at which the patient is removed from treatment due to progression, adverse events, or refusal. If the patient is considered to be a major treatment violation or is taken off study as a non-protocol failure, the patient will be censored on the date they were removed from treatment. The distribution of time to treatment failure will be estimated using the method of Kaplan-Meier
Stem Cell Collection and Engraftment (Phase II)
For patients going on to stem cell collection, the total number of CD34 positive cells collected per collection, days to platelets over 20,000 without transfusion and ANC over 1000 will be recorded. If a patient fails to collect adequate stem cells for transplant, this will be recorded as such. The number of patients with successful stem cell mobilization are reported.
Complete Response (Phase II)
In patients continuing beyond 4 cycles the ability to induce complete response will be evaluated at completion of planned therapy.
Survival Time (Phase II)
Survival time is defined as the time from registration to death due to any cause. The distribution of survival time will be estimated using the method of Kaplan-Meier
Progression Free Survival (12 Month)
Progression-free survival time is defined as the time from registration to the earliest date of documentation of disease progression. If a patient dies without a documentation of disease progression the patient will be considered to have had disease progression at the time of their death. If the patient is declared to be a major treatment violation, the patient will be censored on the date the treatment violation was declared to have occurred. In the case of a patient starting treatment and then never returning for any evaluations, the patient will be censored for progression 1 day post-registration. This is reported as the percentage of patients alive and progression free at the 12 month mark.
Progession Free Survival (24 Month)
Progression-free survival time is defined as the time from registration to the earliest date of documentation of disease progression. If a patient dies without a documentation of disease progression the patient will be considered to have had disease progression at the time of their death. If the patient is declared to be a major treatment violation, the patient will be censored on the date the treatment violation was declared to have occurred. In the case of a patient starting treatment and then never returning for any evaluations, the patient will be censored for progression 1 day post-registration. This is reported as the percentage of patients alive and progression free at the 24 month mark.
Overall Survival (12 Month)
12 Month Overall survival is defined as the proportion of patients to still be alive after 12 months.
Overall Survival (24 Month)
24 Month Overall survival is defined as the proportion of patients to still be alive after 24 months.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT01057225
Brief Title
Cyclophosphamide, Carfilzomib, Thalidomide, and Dexamethasone in Treating Patients With Newly Diagnosed Active Multiple Myeloma
Official Title
A Phase I/II Trial of Cyclophosphamide, Carfilzomib, Thalidomide and Dexamethasone (CYCLONE) in Patients With Newly Diagnosed Active Multiple Myeloma
Study Type
Interventional
2. Study Status
Record Verification Date
November 2017
Overall Recruitment Status
Completed
Study Start Date
March 2010 (undefined)
Primary Completion Date
March 2014 (Actual)
Study Completion Date
September 5, 2017 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Mayo Clinic
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
RATIONALE: Drugs used in chemotherapy, such as cyclophosphamide and dexamethasone, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Carfilzomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Thalidomide may stop the growth of cancer cells by blocking blood flow to the tumor. Giving combination chemotherapy together with carfilzomib and thalidomide may kill more cancer cells.
PURPOSE: This phase I/II trial is studying the side effects and best dose of carfilzomib when given together with cyclophosphamide, thalidomide, and dexamethasone in treating patients with newly diagnosed active multiple myeloma.
Detailed Description
PRIMARY OBJECTIVES:
I. To establish the maximum tolerated dose of carfilzomib given in combination with oral cyclophosphamide and thalidomide and dexamethasone. (Phase I) II. In newly diagnosed myeloma to evaluate the response rate (CR, nCR, and VGPR) to carfilzomib given in combination with oral cyclophosphamide and thalidomide and dexamethasone after four 28 day cycles. (Phase II)
SECONDARY OBJECTIVES:
I. Determine the overall response rate (CR, nCR, PR) after 4, 8, 12 cycles. II. Determine the duration of progression-free and overall survival for patients receiving this regimen.
III. To evaluate the incidence of toxicities for this regimen. IV. To evaluate the ability to successfully collect peripheral blood stem cells following four months of combination therapy.
OUTLINE: This is a phase I, dose escalation study of carfilzomib followed by a phase II study.
Patients receive carfilzomib IV on days 1, 2, 8, 9, 15, and 16; oral cyclophosphamide on days 1, 8, and 15; oral dexamethasone on days 1, 8, 15, and 22; and oral thalidomide on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed at 3 months, then every 3 months for 1 year, and then every 6 months for up to 3 years.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma, Stage I Multiple Myeloma, Stage II Multiple Myeloma, Stage III Multiple Myeloma
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
64 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Arm I
Arm Type
Experimental
Arm Description
Patients receive carfilzomib IV on days 1, 2, 8, 9, 15, and 16; oral cyclophosphamide on days 1, 8, and 15; oral dexamethasone on days 1, 8, 15, and 22; and oral thalidomide on days 1-28.
Intervention Type
Drug
Intervention Name(s)
carfilzomib
Other Intervention Name(s)
PR-171
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
cyclophosphamide
Other Intervention Name(s)
CPM, CTX, Cytoxan, Endoxan, Endoxana, Enduxan
Intervention Description
Given orally
Intervention Type
Drug
Intervention Name(s)
thalidomide
Other Intervention Name(s)
alpha-phthalimidoglutarimide, Contergan, Kevadon, Synovir, THAL, Thalomid
Intervention Description
Given orally
Intervention Type
Drug
Intervention Name(s)
dexamethasone
Other Intervention Name(s)
Aeroseb-Dex, Decaderm, Decadron, Decaspray, DM, DXM
Intervention Description
Given orally
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose (Phase I)
Description
To establish the maximum tolerated dose of carfilzomib given in combination with oral cyclophosphamide and thalidomide and dexamethasone.
For this protocol, dose-limiting toxicity (DLT) will be defined as an adverse event attributed (definitely, probably, possibly) in the first or second cycle for patients enrolled to Dose Levels -1 and 0 and in the first cycle only for patients enrolled to Dose Levels 1 and 2.
We are reporting the number of DLTs
Time Frame
From baseline to end of active treatment, up to 12 28-day cycles.
Title
Percentage of Patients Who Have at Least a Confirmed Very Good Partial Response (Phase II)
Description
The proportion of patients who have at least a confirmed very good partial response will be calculated by taking the number of patients with a very good partial response or a complete response divided by the total number of patients.
A complete response is defined as:
Negative immunofixation of the serum and urine
If at on study, only the measurable non-bone marrow parameter was FLC, normalization of FLC ratio
< 5% plasma cells in bone marrow
Disappearance of any soft tissue plasmacytomas
A very good partial response is defined as:
Serum and urine M-component detectable by immunofixation but not on electrophoresis or
If at on study, serum measurable, ≥ 90% or greater reduction in serum Mcomponent
Urine M-component <100 mg per 24 hour
Time Frame
Following the first 4 cycles of treatment (28 day cycles)
Secondary Outcome Measure Information:
Title
Progression-free Survival (Phase II)
Description
PFS was defined as the time from registration to progression or death due to any cause. Progression was defined as any one or more of the following:
• Increase of 25% from lowest confirmed response in: Serum M-component (absolute increase must be ≥ 0.5 g/dl)c Urine M-component (absolute increase must be ≥ 200 mg/24 hour) If at on study, only the measurable non-bone marrow parameter was FLC, the difference between involved and uninvolved FLC levels (absolute increase must be >10 mg/dl) Bone marrow plasma cell percentage (absolute % must be 10%)d Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas
• Development of hypercalcemia (corrected serum calcium >11.5 mg/dl) that can be attributed solely to the plasma cell proliferative disorder
Time Frame
From baseline to progression or death up to 3 years
Title
Time to Treatment Failure
Description
The time from the date of registration to the date at which the patient is removed from treatment due to progression, adverse events, or refusal. If the patient is considered to be a major treatment violation or is taken off study as a non-protocol failure, the patient will be censored on the date they were removed from treatment. The distribution of time to treatment failure will be estimated using the method of Kaplan-Meier
Time Frame
From baseline to end of active treatment
Title
Stem Cell Collection and Engraftment (Phase II)
Description
For patients going on to stem cell collection, the total number of CD34 positive cells collected per collection, days to platelets over 20,000 without transfusion and ANC over 1000 will be recorded. If a patient fails to collect adequate stem cells for transplant, this will be recorded as such. The number of patients with successful stem cell mobilization are reported.
Time Frame
Following the first 4 courses of treatment
Title
Complete Response (Phase II)
Description
In patients continuing beyond 4 cycles the ability to induce complete response will be evaluated at completion of planned therapy.
Time Frame
Following the first 4 courses of treatment
Title
Survival Time (Phase II)
Description
Survival time is defined as the time from registration to death due to any cause. The distribution of survival time will be estimated using the method of Kaplan-Meier
Time Frame
From baseline to death
Title
Progression Free Survival (12 Month)
Description
Progression-free survival time is defined as the time from registration to the earliest date of documentation of disease progression. If a patient dies without a documentation of disease progression the patient will be considered to have had disease progression at the time of their death. If the patient is declared to be a major treatment violation, the patient will be censored on the date the treatment violation was declared to have occurred. In the case of a patient starting treatment and then never returning for any evaluations, the patient will be censored for progression 1 day post-registration. This is reported as the percentage of patients alive and progression free at the 12 month mark.
Time Frame
12 months
Title
Progession Free Survival (24 Month)
Description
Progression-free survival time is defined as the time from registration to the earliest date of documentation of disease progression. If a patient dies without a documentation of disease progression the patient will be considered to have had disease progression at the time of their death. If the patient is declared to be a major treatment violation, the patient will be censored on the date the treatment violation was declared to have occurred. In the case of a patient starting treatment and then never returning for any evaluations, the patient will be censored for progression 1 day post-registration. This is reported as the percentage of patients alive and progression free at the 24 month mark.
Time Frame
24 months
Title
Overall Survival (12 Month)
Description
12 Month Overall survival is defined as the proportion of patients to still be alive after 12 months.
Time Frame
From baseline to death
Title
Overall Survival (24 Month)
Description
24 Month Overall survival is defined as the proportion of patients to still be alive after 24 months.
Time Frame
From baseline to death
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion
Creatinine =< 2 mg/dL
Calculated Creatinine Clearance >= 30 mL/min
Total Bilirubin =< 2.0 mg/dL
Alkaline Phosphatase =< 3 x ULN
ALT =< 3 x ULN
Absolute neutrophil count >= 1000/uL
Platelet >= 75000/uL
Hemoglobin >= 8.0 g/dL
Untreated symptomatic myeloma: Prior non-systemic therapy for the treatment of solitary plasmacytoma is permitted, but >= 1 month should have elapsed from the last day of radiation; prior therapy with clarithromycin, DHEA, anakinra, pamidronate or zoledronic acid is permitted; any additional agents not listed must be approved by the Principal Investigator
Prior high dose corticosteroid therapy for twelve days (480 mg total dose) or less is permitted for emergent complications from newly diagnosed multiple myeloma
Measurable disease of multiple myeloma, as defined by at least ONE of the following:
Serum monoclonal protein >= 1.0 g by protein electrophoresis
OR > 200 mg of monoclonal protein in the urine on 24 hour electrophoresis
OR serum immunoglobulin free light chain >= 10 mg/dL AND abnormal serum immunoglobulin kappa to lambda free light chain ratio; OR monoclonal bone marrow plasmacytosis >= 30% (evaluable disease)
ECOG performance status (PS) 0, 1, 2; ECOG PS of 3 will be allowed if secondary to pain in the opinion of the Investigator
Willingness and able to provide informed written consent
Negative serum pregnancy test done =< 7 days prior to registration, for women of childbearing potential only
Willingness to return to Mayo Clinic enrolling institution for follow-up
Exclusion
MGUS or smoldering myeloma
Peripheral sensory neuropathy >= Grade 2 as defined by CTEP Active Version of the CTCAE
Active malignancy with the exception of non melanoma skin cancer or in situ cervical or breast cancer
Pregnant women or women of reproductive ability who are unwilling to use effective contraception
Nursing women
Men who are unwilling to use a condom (even if they have undergone a prior vasectomy) while having intercourse with any woman, while taking the drug and for 4 weeks after stopping treatment
Known hypersensitivity, allergy or inability to tolerate any of the agents employed
Active, uncontrolled infection
Severe cardiac comorbidity
New York Heart Association Class III or IV Heart Failure
Recent history of myocardial infarction in the six months prior to registration
Uncontrolled angina or electrocardiographic evidence of acute ischemia
Severe uncontrolled ventricular arrhythmias or electrocardiographic evidence of active conduction system abnormalities
Cardiac amyloidosis with hypotension (systolic BP less than 100 mmHg)
Other concurrent chemotherapy, radiotherapy, or any ancillary therapy considered investigational; NOTE: Bisphosphonates are considered to be supportive care rather than therapy, and are thus allowed while on protocol treatment
The following medications are not permitted during the trial: any other investigational treatment; any cytotoxic chemotherapy; any other systemic anti-neoplastic therapy including, but not limited to, immunotherapy, hormonal therapy, or monoclonal antibody therapy
Palliative radiation therapy is permitted if clinically indicated and not indicative of progressive disease
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joseph R. Mikhael, M.D.
Organizational Affiliation
Mayo Clinic
Official's Role
Study Chair
Facility Information:
Facility Name
Mayo Clinic in Arizona
City
Scottsdale
State/Province
Arizona
ZIP/Postal Code
85259
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Medical University of South Carolina
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425-6350
Country
United States
12. IPD Sharing Statement
Learn more about this trial
Cyclophosphamide, Carfilzomib, Thalidomide, and Dexamethasone in Treating Patients With Newly Diagnosed Active Multiple Myeloma
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