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A Study of the Combination Vorinostat With Lenalidomide, Bortezomib and Dexamethasone for Patients With Newly Diagnosed Multiple Myeloma

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborators:
Merck Sharp & Dohme Corp.
Celgene Corporation
Information provided by (Responsible Party):
Jonathan Kaufman, Emory University
ClinicalTrials.gov Identifier:
NCT01038388
First received: July 7, 2009
Last updated: February 10, 2014
Last verified: February 2014
  Purpose

The purpose of the study is to evaluate the clinical effectiveness and side effects of the vorinostat, bortezomib, lenalidomide, and dexamethasone investigational combination.


Condition Intervention Phase
Multiple Myeloma
Drug: Vorinostat, Lenalidomide, Bortezomib, Dexamethasone
Phase 1

Study Type: Interventional
Study Design: Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I Trial Evaluating the Safety and Efficacy of Vorinostat (Zolinza ®) + RVD (Lenalidomide {Revlimid ®} + Bortezomib {Velcade ®} + Dexamethasone) for Patients With Newly Diagnosed Multiple Myeloma

Resource links provided by NLM:


Further study details as provided by Emory University:

Primary Outcome Measures:
  • To determine the maximum tolerated dose (MTD) and recommended phase II doses (RP2D) of vorinostat in combination with lenalidomide, bortezomib, and dexamethasone. [ Time Frame: Every 3 weeks ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Efficacy by standard myeloma measurements (SPEP, UPEP, bone marrow) [ Time Frame: Every 3 weeks ] [ Designated as safety issue: No ]

Estimated Enrollment: 35
Study Start Date: January 2010
Estimated Study Completion Date: December 2014
Estimated Primary Completion Date: March 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 3 potential cohorts
The three cohorts are different only by the dose of Vorinostat.
Drug: Vorinostat, Lenalidomide, Bortezomib, Dexamethasone

Level 1

  • 25mg lenalidomide daily on days 1-14
  • 1.3mg/m2 bortezomib daily on days 1, 4, 8, and 11
  • 20 mg dexamethasone daily on days 1, 2, 4, 5, 8, 9, 11, 12
  • 100mg vorinostat daily on days 1-14

Level 2

  • 25mg lenalidomide daily on days 1-14
  • 1.3mg/m2 bortezomib daily on days 1, 4, 8, and 11
  • 20mg dexamethasone daily on days 1, 2, 4, 5, 8, 9, 11, 12
  • 200mg vorinostat daily on days 1-14

Level 3

  • 25mg lenalidomide daily on days 1-14
  • 1.3mg/m2 bortezomib daily on days 1, 4, 8, and 11
  • 20mg dexamethasone daily on days 1, 2, 4, 5, 8, 9, 11, 12
  • 300mg vorinostat daily on days 1-14
Other Names:
  • Zolizna
  • Revlimid
  • Velcade
  • Dexamethasone

Detailed Description:

The purpose of the study is to evaluate the clinical effectiveness and side effects of the vorinostat, bortezomib, lenalidomide, and dexamethasone investigational combination.

All of these drugs - vorinostat, bortezomib, lenalidomide and dexamethasone, are approved by the FDA (U.S. Food and Drug Administration). They have not been approved in this combination for use in your type of cancer or any other type of cancer. Vorinostat is approved for treatment of patients with a different type of cancer (Cutaneous T-Cell Lymphoma). Bortezomib is currently approved for the treatment of multiple myeloma. Lenalidomide is currently approved for the treatment of certain types of myelodysplastic syndrome (another form of cancer affecting the blood) and for use with dexamethasone for patients with multiple myeloma who have received at least one prior therapy. Dexamethasone is commonly used, either alone, or in combination with other drugs, to treat multiple myeloma.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Multiple Myeloma Diagnosis: Subject was previously diagnosed with multiple myeloma based on standard diagnostic criteria or by the new International Myeloma Foundation 2003 Diagnostic Criteria:

Standard Criteria

Major criteria:

  1. Plasmacytomas on tissue biopsy.
  2. Bone marrow plasmacytosis (>30% plasma cells). 3 Monoclonal immunoglobulin spike on serum electrophoresis immunoglobulin G (IgG) >3.5 g/dL or immunoglobulin A (IgA) >2.0 g/dL; kappa or lambda light chain excretion >1 g/day on 24 hour urine protein electrophoresis.

Minor criteria:

  1. Bone marrow plasmacytosis (10 to 30% plasma cells)
  2. Monoclonal immunoglobulin present but of lesser magnitude than given under major criteria
  3. Lytic bone lesions
  4. Normal IgM <50 mg/dL, IgA <100 mg/dL or IgG <600 mg/dL.

Any of the following sets of criteria will confirm the diagnosis of multiple myeloma:

  • Any two of the major criteria.
  • Major criterion 1 plus minor criterion b, c or d.
  • Major criterion 3 plus minor criterion a or c.
  • Minor criteria a, b and c or a, b and d.
  • Patient must not have been previously treated with any prior systemic therapy for the treatment of multiple myeloma.

    • Prior treatment of hypercalcemia or spinal cord compression with corticosteroids does not disqualify the patient (the dose should not exceed the equivalent of 160 mg of dexamethasone in a 2 week period).
    • Bisphosphonates are permitted
  • Patients treated with local radiotherapy with or without concomitant exposure to steroids, for pain control or management of cord/nerve root compression, are eligible. One week must have lapsed since last date of radiotherapy, which is recommended to be a limited field. Patients who require concurrent radiotherapy should have entry to the protocol deferred until the radiotherapy is completed and one week have passed since the last date of therapy.
  • Voluntary written informed consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care.
  • Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL 10 - 14 days prior to therapy and repeated again within 24 hours of prescribing lenalidomide and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure. See Appendix IX: Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods,.
  • Age ≥ 18 years at the time of signing Informed Consent.
  • All necessary baseline studies for determining eligibility must be obtained within 21 days prior to enrollment.
  • Subject has a Karnofsky performance status of ≥ 60. (Appendix II, Section 8.2)
  • Subject must be able to adhere to the study visit schedule and other protocol requirements.
  • All study participants must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®.
  • Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (patients intolerant to ASA may use warfarin or low molecular weight heparin).

Exclusion Criteria:

A female of childbearing potential is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).

  • Patient has ≥ Grade 2 peripheral neuropathy on clinical examination within 14 days before enrollment.
  • Renal insufficiency (serum creatinine levels > 2.5 mg/dL).
  • Subjects with evidence of mucosal or internal bleeding and/or platelet refractory (i.e., unable to maintain a platelet count ≥ 50,000 cells/mm3).
  • Subjects with an absolute neutrophil count (ANC) < 1000 cells/mm3. Growth factors may not be used to meet ANC eligibility criteria.
  • Subjects with a hemoglobin < 8.0 g/dL.
  • AST (SGOT and ALT (SGPT) > 2 x ULN
  • Concomitant therapy medications that include corticosteroids (except as indicated in inclusion criteria).
  • Myocardial infarction within 6 months prior to enrollment or has New York Heart Association (NYHA) Class III or IV heart failure (see section 8.4), uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Prior to study entry, any ECG abnormality at screening has to be documented by the investigator as not medically relevant.
  • Clinically relevant active infection requiring intravenous antibiotics
  • Serious co-morbid medical conditions such as chronic obstructive or chronic restrictive pulmonary disease, and cirrhosis.
  • Any condition, including laboratory abnormalities, that in the opinion of the Investigator places the subject at unacceptable risk if he/she were to participate in the study.
  • Prior malignancy (within the last 3 years) except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, in situ breast cancer, in situ prostate cancer or if the expected survival from other malignancy is greater than 90% at 5 years
  • Female subject is pregnant or breast-feeding.
  • Serious medical or psychiatric illness likely to interfere with participation in this clinical study.
  • Uncontrolled diabetes mellitus (Fasting Blood Sugar > 400 despite medical treatment)
  • Hypersensitivity to acyclovir or similar anti-viral drug
  • Known history of POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein (M-protein) and skin changes).
  • Known HIV infection
  • Known active hepatitis B or C viral infection
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01038388

Locations
United States, Georgia
Emory University Winship Cancer Institute
Atlanta, Georgia, United States, 30322
Sponsors and Collaborators
Emory University
Merck Sharp & Dohme Corp.
Celgene Corporation
Investigators
Principal Investigator: Jonathan Kaufman, MD Emory University
  More Information

No publications provided

Responsible Party: Jonathan Kaufman, MD, Emory University
ClinicalTrials.gov Identifier: NCT01038388     History of Changes
Other Study ID Numbers: IRB00017528, 1591
Study First Received: July 7, 2009
Last Updated: February 10, 2014
Health Authority: United States: Institutional Review Board
United States: Food and Drug Administration

Keywords provided by Emory University:
Multiple Myeloma

Additional relevant MeSH terms:
Multiple Myeloma
Neoplasms, Plasma Cell
Blood Protein Disorders
Cardiovascular Diseases
Hematologic Diseases
Hemorrhagic Disorders
Hemostatic Disorders
Immune System Diseases
Immunoproliferative Disorders
Lymphoproliferative Disorders
Neoplasms
Neoplasms by Histologic Type
Paraproteinemias
Vascular Diseases
BB 1101
Bortezomib
Dexamethasone
Dexamethasone 21-phosphate
Dexamethasone acetate
Lenalidomide
Thalidomide
Vorinostat
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Anti-Bacterial Agents
Anti-Infective Agents
Anti-Inflammatory Agents
Antiemetics
Antineoplastic Agents
Antineoplastic Agents, Hormonal

ClinicalTrials.gov processed this record on November 24, 2014