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Samarium Sm 153 Lexidronam Pentasodium and Bortezomib in Treating Patients With Relapsed or Refractory Multiple Myeloma

Primary Purpose

Multiple Myeloma and Plasma Cell Neoplasm

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
bortezomib
immunologic technique
samarium Sm 153 lexidronam pentasodium
Sponsored by
Mayo Clinic
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma and Plasma Cell Neoplasm focused on measuring stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, refractory multiple myeloma

Eligibility Criteria

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

DISEASE CHARACTERISTICS:

  • Diagnosis of multiple myeloma

    • Relapsed or refractory disease
  • Measurable or evaluable disease as defined by at least 1 of the following:

    • Serum monoclonal protein ≥ 1.0 g by protein electrophoresis
    • Monoclonal protein ≥ 200 mg by 24-hour urine electrophoresis
    • Serum immunoglobulin free light chain ≥ 10 mg/dL AND abnormal serum immunoglobulin kappa to lambda free light chain ratio
    • Monoclonal bone marrow plasmacytosis ≥ 30% (evaluable disease)
  • Previously treated disease

    • No limit to prior therapy provided there is adequate residual organ function
  • Must have undergone hematopoietic stem cell collection (for transplant candidates) OR not considered to be a hematopoietic stem cell transplant candidate

PATIENT CHARACTERISTICS:

  • ECOG performance status (PS) 0-2 (ECOG PS of 3 allowed if secondary only to pain)
  • Platelet count ≥ 75,000/mm^3
  • Hemoglobin ≥ 8.0 g/dL (transfusion allowed)
  • ANC ≥ 1,000/mm^3
  • Creatinine ≤ 3 mg/dL
  • Calcium ≤ 15 mg/dL
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 4 weeks after completion of study therapy
  • No impending long bone fracture
  • No other active malignancy except nonmelanoma skin cancer, carcinoma in situ of the cervix, or breast cancer
  • No uncontrolled infection
  • No known hypersensitivity to any of the components of study drugs
  • No other co-morbidity that would preclude study participation

PRIOR CONCURRENT THERAPY:

  • Recovered from prior surgery, radiotherapy, or other antineoplastic therapy
  • No prior samarium Sm 153 lexidronam pentasodium or strontium chloride Sr 89
  • At least 3 weeks since prior myelosuppressive agents
  • At least 2 weeks since prior nonmyelosuppressive agents (e.g., thalidomide)
  • At least 2 weeks since prior and no concurrent high-dose corticosteroids

    • Chronic steroids (maximum dose of 20 mg/day prednisone or equivalent) allowed for disorders other than myeloma (i.e., adrenal insufficiency or rheumatoid arthritis)
  • At least 30 days since prior and no other concurrent investigational therapy
  • No concurrent external beam radiotherapy
  • No concurrent cytotoxic chemotherapy
  • No other concurrent systemic antineoplastic therapy including, but not limited to, any of the following:

    • Immunotherapy
    • Hormonal therapy
    • Monoclonal antibody therapy

Sites / Locations

  • Mayo Clinic Scottsdale
  • Mayo Clinic - Jacksonville
  • Mayo Clinic Cancer Center

Outcomes

Primary Outcome Measures

Toxicity (Phase I)
Confirmed clinical response (complete response, very good partial response, partial response, or minimal response) (Phase II)

Secondary Outcome Measures

Immunoglobulin free light chain response
Changes in complete blood cell count and micronucleated reticulocyte count

Full Information

First Posted
May 23, 2007
Last Updated
May 10, 2011
Sponsor
Mayo Clinic
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00478075
Brief Title
Samarium Sm 153 Lexidronam Pentasodium and Bortezomib in Treating Patients With Relapsed or Refractory Multiple Myeloma
Official Title
A Phase I/II Study of 153 Sm EDTMP (Quadramet™) and PS-341 (Velcade®) in Patients With Relapsed or Refractory Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
May 2011
Overall Recruitment Status
Completed
Study Start Date
September 2005 (undefined)
Primary Completion Date
November 2007 (Actual)
Study Completion Date
June 2009 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Mayo Clinic
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Radioactive drugs, such as samarium Sm 153 lexidronam pentasodium, may carry radiation directly to cancer cells and not harm normal cells. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the cancer. Bortezomib may also make cancer cells more sensitive to radiation therapy. Giving samarium Sm 153 lexidronam pentasodium together with bortezomib may kill more cancer cells. PURPOSE: This phase I/II trial is studying the side effects and best dose of bortezomib when given together with samarium Sm 153 lexidronam pentasodium and to see how well they work in treating patients with relapsed or refractory multiple myeloma.
Detailed Description
OBJECTIVES: Primary Determine the maximum tolerated dose of bortezomib when given together with samarium Sm 153 lexidronam pentasodium in patients with recurrent or refractory multiple myeloma. (Phase I) Determine the safety and tolerability of this regimen in these patients. (Phase II) Determine the hematologic response rate in patients treated with this regimen. (Phase II) Secondary Determine the rate of serum immunoglobulin light chain reduction in patients treated with this regimen. Assess the in vivo toxicity of this regimen to the progenitor cells by measuring complete blood cell count and micronucleated reticulocyte count in these patients. OUTLINE: This is a phase I, pilot, open-label, dose-escalation study of bortezomib followed by a phase II study. Phase I: Patients receive samarium Sm 153 lexidronam pentasodium IV over 1 minute on day 1 and bortezomib IV over 3-5 seconds on days 2 and 5. Cohorts of 3-6 patients receive escalating doses of bortezomib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose limiting toxicity. Phase II: Patients receive samarium Sm 153 lexidronam pentasodium as in phase I and bortezomib at the MTD determined in phase I . Patients undergo blood sample collection at baseline and then on days 1-6 for correlative studies. Samples are analyzed for micronucleated reticulocyte count and immunoglobulin free light chain ratio to determine the early effects of treatment. After completion of study treatment, patients are followed weekly for 7 weeks, monthly for 3 months and then every 3 months for a total of 3 years. PROJECTED ACCRUAL: A total of 50 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma and Plasma Cell Neoplasm
Keywords
stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, refractory multiple myeloma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Masking
None (Open Label)
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
bortezomib
Intervention Type
Other
Intervention Name(s)
immunologic technique
Intervention Type
Radiation
Intervention Name(s)
samarium Sm 153 lexidronam pentasodium
Primary Outcome Measure Information:
Title
Toxicity (Phase I)
Title
Confirmed clinical response (complete response, very good partial response, partial response, or minimal response) (Phase II)
Secondary Outcome Measure Information:
Title
Immunoglobulin free light chain response
Title
Changes in complete blood cell count and micronucleated reticulocyte count

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of multiple myeloma Relapsed or refractory disease Measurable or evaluable disease as defined by at least 1 of the following: Serum monoclonal protein ≥ 1.0 g by protein electrophoresis Monoclonal protein ≥ 200 mg by 24-hour urine electrophoresis Serum immunoglobulin free light chain ≥ 10 mg/dL AND abnormal serum immunoglobulin kappa to lambda free light chain ratio Monoclonal bone marrow plasmacytosis ≥ 30% (evaluable disease) Previously treated disease No limit to prior therapy provided there is adequate residual organ function Must have undergone hematopoietic stem cell collection (for transplant candidates) OR not considered to be a hematopoietic stem cell transplant candidate PATIENT CHARACTERISTICS: ECOG performance status (PS) 0-2 (ECOG PS of 3 allowed if secondary only to pain) Platelet count ≥ 75,000/mm^3 Hemoglobin ≥ 8.0 g/dL (transfusion allowed) ANC ≥ 1,000/mm^3 Creatinine ≤ 3 mg/dL Calcium ≤ 15 mg/dL Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 4 weeks after completion of study therapy No impending long bone fracture No other active malignancy except nonmelanoma skin cancer, carcinoma in situ of the cervix, or breast cancer No uncontrolled infection No known hypersensitivity to any of the components of study drugs No other co-morbidity that would preclude study participation PRIOR CONCURRENT THERAPY: Recovered from prior surgery, radiotherapy, or other antineoplastic therapy No prior samarium Sm 153 lexidronam pentasodium or strontium chloride Sr 89 At least 3 weeks since prior myelosuppressive agents At least 2 weeks since prior nonmyelosuppressive agents (e.g., thalidomide) At least 2 weeks since prior and no concurrent high-dose corticosteroids Chronic steroids (maximum dose of 20 mg/day prednisone or equivalent) allowed for disorders other than myeloma (i.e., adrenal insufficiency or rheumatoid arthritis) At least 30 days since prior and no other concurrent investigational therapy No concurrent external beam radiotherapy No concurrent cytotoxic chemotherapy No other concurrent systemic antineoplastic therapy including, but not limited to, any of the following: Immunotherapy Hormonal therapy Monoclonal antibody therapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Angela Dispenzieri, MD
Organizational Affiliation
Mayo Clinic
Official's Role
Study Chair
Facility Information:
Facility Name
Mayo Clinic Scottsdale
City
Scottsdale
State/Province
Arizona
ZIP/Postal Code
85259-5499
Country
United States
Facility Name
Mayo Clinic - Jacksonville
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32224
Country
United States
Facility Name
Mayo Clinic Cancer Center
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States

12. IPD Sharing Statement

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Samarium Sm 153 Lexidronam Pentasodium and Bortezomib in Treating Patients With Relapsed or Refractory Multiple Myeloma

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