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Vorinostat and Lenalidomide After Autologous Stem Cell Transplant in Treating Patients With Multiple Myeloma

Primary Purpose

Multiple Myeloma, Plasma Cell Neoplasm

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
lenalidomide
vorinostat
Sponsored by
Ohio State University Comprehensive Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma 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
  • Has undergone melphalan-conditioned autologous peripheral blood stem cell transplant myeloma.

PATIENT CHARACTERISTICS:

  • ECOG/WHO performance status 0-2
  • ANC ≥ 1,000/mm³
  • Platelet count ≥ 75,000/mm³
  • Total bilirubin ≤ 2 times upper limit of normal (ULN)
  • AST and ALT ≤ 2 times ULN
  • Serum creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 50 mL/min
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 90 days after completion of study treatment
  • No blood, sperm, or ova donation during and for ≥ 4 weeks after completion of study treatment
  • Able to obtain commercially available lenalidomide via Celegene's RevAssist® program

    • Registered in the RevAssist® program
    • Willing and able to comply with the requirements of RevAssist®
  • Able to swallow capsules
  • No severe or uncontrolled systemic illness
  • No "currently active" second malignancy, other than nonmelanoma skin cancer or carcinoma in situ of the cervix

    • Patients are not considered to have a "currently active" malignancy if they completed therapy for the malignancy, are disease free from the malignancy for > 5 years, and are considered by their physician to be at < 30% risk of relapse
  • No congenital long QT syndrome
  • No drug or alcohol abuse within the past 12 months
  • No history of allergic reactions (including erythema nodosum) attributed to compounds of similar chemical or biologic composition to lenalidomide, thalidomide, or vorinostat
  • No other medical condition, including mental illness or substance abuse, deemed by the investigator(s) to likely interfere with a patient's ability to sign informed consent, cooperate and participate in the study, or interfere with the interpretation of the study results

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • More than 4 weeks since prior class Ia, Ib, or Ic antiarrhythmic medication
  • No prior HDAC inhibitor-like compounds (e.g., valproic acid) as anticancer therapy
  • More than 30 days since prior HDAC inhibitor-like compounds for other indications (e.g., valproic acid for epilepsy)
  • No prior gastrointestinal surgery or other procedure that may, in the opinion of the investigator, interfere with the absorption or swallowing of the study drugs
  • No concurrent corticosteroids other than for physiologic maintenance treatment
  • No concurrent radiotherapy, unless for local control of bone pain

    • Irradiated area should be as small as possible
    • Lesions within the irradiated field cannot be used for response assessment
  • No concurrent use of complementary or alternative medicines that would confound the interpretation of toxicities and anticancer activity of the study drugs
  • No other concurrent anticancer therapy, including chemotherapy or biologic therapy
  • No other concurrent HDAC inhibitors (e.g., valproic acid)

Sites / Locations

  • Ohio State University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Lenalidomide + Vorinostat

Arm Description

Maintenance post autologous transplant

Outcomes

Primary Outcome Measures

Safety of patients receiving SAHA and lenalidomide following autologous PBSCT
Patients will be assessed for Adverse events using the NCI CTCAE version 4.0 criteria

Secondary Outcome Measures

Duration of response
The time from progression to death
Time to progression (TTP)
Patients will be assessed for TTP from the start of treatment until the date of progression.
Progression-free survival (PFS)
PFS is the time from the first dose a patient receives until disease progression or death at trial closure.
Time to response
From the first dose of study therapy until measurement criteria are first met progressive response (PR), complete response (CR) or stable disease (SD). The patients best response is recorded.
Duration of overall response
The duration computed for subjects whose best response is either PR or CR or SD and is measured when first met for complete or partial response(whichever comes first) until first date of progressive disease or death
Overall survival
The survival time defined as the time from start of treatment to the date of death.
Response rate
Tumor response defined as the total number of patients whose best response is PR or CR or SD, divided by the number of patients

Full Information

First Posted
August 6, 2008
Last Updated
May 14, 2020
Sponsor
Ohio State University Comprehensive Cancer Center
Collaborators
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT00729118
Brief Title
Vorinostat and Lenalidomide After Autologous Stem Cell Transplant in Treating Patients With Multiple Myeloma
Official Title
Vorinostat (SAHA) and Lenalidomide After Autologous Transplant for Patients With Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
May 2020
Overall Recruitment Status
Completed
Study Start Date
September 26, 2008 (Actual)
Primary Completion Date
December 26, 2019 (Actual)
Study Completion Date
May 4, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ohio State University Comprehensive Cancer Center
Collaborators
Merck Sharp & Dohme LLC

4. Oversight

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

5. Study Description

Brief Summary
RATIONALE: Vorinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Lenalidomide may stop the growth of multiple myeloma by blocking blood flow to the cancer. Giving vorinostat together with lenalidomide may kill more cancer cells. PURPOSE: This phase I trial is studying the side effects and best dose of vorinostat when given together with lenalidomide after autologous stem cell transplant in treating patients with multiple myeloma.
Detailed Description
OBJECTIVES: Primary To assess the dose-limiting toxicities and safety of vorinostat and lenalidomide after autologous peripheral blood stem cell transplantation in patients with multiple myeloma. To evaluate the overall response rate to the combination of Vorinostat (SAHA) and lenalidomide. Secondary To evaluate the effect of this treatment regimen on natural killer cell activity and regulatory T cells in the post-transplant period. To determine preliminary clinical activity of this treatment regimen by assessing overall survival and progression-free survival of these patients. To obtain pilot data regarding an association between this treatment regimen and patient quality of life and circulating inflammatory cytokines. OUTLINE: This is a dose-escalation study of vorinostat. Patients receive oral vorinostat alone once daily on days 1-21 in course 1. For the second and subsequent courses, patients receive oral vorinostat in combination with oral lenalidomide once daily on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection periodically for correlative laboratory studies. Studies include functional immune assays (T-cell and natural killer cell activity and regulatory T-cell recovery) by fluorescence activated cell sorting (FACS) or ELISPOT; analysis of inflammatory markers (cytokines and catecholamines); and analysis of global H3 and H4 acetylation by immunohistochemistry. Quality of life is assessed periodically using the Brief Pain Inventory (Short Form), The Center for Epidemiologic Studies Depression Scale (CES-D-10), a 9-item Brief Fatigue Inventory, and the FACT-G questionnaires. After completion of study treatment, patients are followed for at least 30 days.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma, 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
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
19 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Lenalidomide + Vorinostat
Arm Type
Experimental
Arm Description
Maintenance post autologous transplant
Intervention Type
Drug
Intervention Name(s)
lenalidomide
Other Intervention Name(s)
Revlimid, CC-5013
Intervention Description
combined with Vorinostat (SAHA) days 1-21 of a 28-day cycle until progression or clinically significant toxicity.
Intervention Type
Drug
Intervention Name(s)
vorinostat
Other Intervention Name(s)
SAHA, Suberoylanilide hydroxamic acid
Intervention Description
Vorinostat (SAHA) will be administered orally beginning at dose level 1 starting day +90 ±6 days after HSCT for days 1 and 15-21 of a 28-day cycle combined with lenalidomide days 1-21 of a 28-day cycle until progression or clinically significant toxicity.
Primary Outcome Measure Information:
Title
Safety of patients receiving SAHA and lenalidomide following autologous PBSCT
Description
Patients will be assessed for Adverse events using the NCI CTCAE version 4.0 criteria
Time Frame
up to 3 years
Secondary Outcome Measure Information:
Title
Duration of response
Description
The time from progression to death
Time Frame
up to 3 years
Title
Time to progression (TTP)
Description
Patients will be assessed for TTP from the start of treatment until the date of progression.
Time Frame
up to 3 years
Title
Progression-free survival (PFS)
Description
PFS is the time from the first dose a patient receives until disease progression or death at trial closure.
Time Frame
up to 3 years
Title
Time to response
Description
From the first dose of study therapy until measurement criteria are first met progressive response (PR), complete response (CR) or stable disease (SD). The patients best response is recorded.
Time Frame
up to 3 years
Title
Duration of overall response
Description
The duration computed for subjects whose best response is either PR or CR or SD and is measured when first met for complete or partial response(whichever comes first) until first date of progressive disease or death
Time Frame
up to 3 years
Title
Overall survival
Description
The survival time defined as the time from start of treatment to the date of death.
Time Frame
up to 3 years
Title
Response rate
Description
Tumor response defined as the total number of patients whose best response is PR or CR or SD, divided by the number of patients
Time Frame
up to 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of multiple myeloma Has undergone melphalan-conditioned autologous peripheral blood stem cell transplant myeloma. PATIENT CHARACTERISTICS: ECOG/WHO performance status 0-2 ANC ≥ 1,000/mm³ Platelet count ≥ 75,000/mm³ Total bilirubin ≤ 2 times upper limit of normal (ULN) AST and ALT ≤ 2 times ULN Serum creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 50 mL/min Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 90 days after completion of study treatment No blood, sperm, or ova donation during and for ≥ 4 weeks after completion of study treatment Able to obtain commercially available lenalidomide via Celegene's RevAssist® program Registered in the RevAssist® program Willing and able to comply with the requirements of RevAssist® Able to swallow capsules No severe or uncontrolled systemic illness No "currently active" second malignancy, other than nonmelanoma skin cancer or carcinoma in situ of the cervix Patients are not considered to have a "currently active" malignancy if they completed therapy for the malignancy, are disease free from the malignancy for > 5 years, and are considered by their physician to be at < 30% risk of relapse No congenital long QT syndrome No drug or alcohol abuse within the past 12 months No history of allergic reactions (including erythema nodosum) attributed to compounds of similar chemical or biologic composition to lenalidomide, thalidomide, or vorinostat No other medical condition, including mental illness or substance abuse, deemed by the investigator(s) to likely interfere with a patient's ability to sign informed consent, cooperate and participate in the study, or interfere with the interpretation of the study results PRIOR CONCURRENT THERAPY: See Disease Characteristics More than 4 weeks since prior class Ia, Ib, or Ic antiarrhythmic medication No prior HDAC inhibitor-like compounds (e.g., valproic acid) as anticancer therapy More than 30 days since prior HDAC inhibitor-like compounds for other indications (e.g., valproic acid for epilepsy) No prior gastrointestinal surgery or other procedure that may, in the opinion of the investigator, interfere with the absorption or swallowing of the study drugs No concurrent corticosteroids other than for physiologic maintenance treatment No concurrent radiotherapy, unless for local control of bone pain Irradiated area should be as small as possible Lesions within the irradiated field cannot be used for response assessment No concurrent use of complementary or alternative medicines that would confound the interpretation of toxicities and anticancer activity of the study drugs No other concurrent anticancer therapy, including chemotherapy or biologic therapy No other concurrent HDAC inhibitors (e.g., valproic acid)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yvonne C. Efebera, MD
Organizational Affiliation
Ohio State University Comprehensive Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
26058589
Citation
Sborov DW, Benson DM, Williams N, Huang Y, Bowers MA, Humphries K, Efebera Y, Devine S, Hofmeister CC. Lenalidomide and vorinostat maintenance after autologous transplant in multiple myeloma. Br J Haematol. 2015 Oct;171(1):74-83. doi: 10.1111/bjh.13527. Epub 2015 Jun 8.
Results Reference
derived
Links:
URL
http://cancer.osu.edu
Description
Jamesline

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Vorinostat and Lenalidomide After Autologous Stem Cell Transplant in Treating Patients With Multiple Myeloma

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