Bortezomib and Pegylated Liposomal Doxorubicin in Treating Patients With Multiple Myeloma

• CR+nCR+PR rate [ Time Frame: 126 days ] [ Designated as safety issue: No ]
  Evaluated using the criteria of Blade et al. with the additional category or near-CR as defined by Richardson et al. Estimated with an exact 90% confidence interval.
• Toxicity rates using the CTCAE version 3.0 [ Time Frame: Up to 7 years ] [ Designated as safety issue: Yes ]
  Tabulated by type and grade.
• Progression-free survival [ Time Frame: From onstudy date to the date of progression or death, whichever comes first, assessed up to 7 years ] [ Designated as safety issue: No ]
  Estimated using the Kaplan-Meier method.
• Overall survival [ Time Frame: From onstudy date to the date of death, assessed up to 7 years ] [ Designated as safety issue: No ]
  Estimated using the Kaplan-Meier method.

This phase II trial is studying how well giving bortezomib together with liposomal doxorubicin works in treating patients with multiple myeloma. Bortezomib may stop the growth of cancer cells by blocking the enzymes necessary for their growth. Drugs used in chemotherapy, such as liposomal doxorubicin, work in different ways to stop cancer cells from dividing so they stop growing or die. Combining bortezomib with liposomal doxorubicin may kill more cancer cells.

PRIMARY OBJECTIVES:

I. To evaluate the complete response (CR) + near-complete response (nCR) rate of the bortezomib /pegylated liposomal doxorubicin regimen in patients with previously untreated, symptomatic multiple myeloma.

II. To evaluate the toxicity of the bortezomib/pegylated liposomal doxorubicin regimen in patients with previously untreated, symptomatic multiple myeloma.

SECONDARY OBJECTIVES:

I. To evaluate the overall response rate, including patients with CR, nCR, and partial response (PR), of the bortezomib/pegylated liposomal doxorubicin regimen in patients with previously untreated, symptomatic multiple myeloma. Data for minor responses (MR) and stable disease (SD), as well as progressive disease (PD) will be collected as well.

II. To evaluate the impact of therapy with the bortezomib/pegylated liposomal doxorubicin regimen on the ability to collect peripheral blood stem cells in those patients going on to subsequent autologous stem cell transplantation. Data will also be collected about the engraftment characteristics of those patients who undergo transplantation, including the number of days to achieve an ANC of 500, a platelet count of 100,000, and packed red blood cell and platelet transfusion independence.

III. To evaluate the time to progression (TTP) in all patients receiving bortezomib/pegylated liposomal doxorubicin therapy, both those who go on to autologous stem cell transplantation and those who do not go on to transplantation.

IV. To evaluate the value of early changes in levels of serum interleukin 6 (IL-6) and macrophage inflammatory protein 1 alpha (MIP-1α) as predictors of response to bortezomib/pegylated liposomal doxorubicin.

V. To correlate pre-treatment clinical and biological characteristics with response to therapy and toxicity.

OUTLINE:

Patients receive bortezomib IV over 3-5 seconds on days 1, 4, 8, and 11 and pegylated doxorubicin HCl liposome IV over 1 hour on day 4. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity.

Patients are followed every 6 weeks for 2 years and then every 6 months for up to 5 years.

• Extramedullary Plasmacytoma
• Isolated Plasmacytoma of Bone
• Stage I Multiple Myeloma
• Stage II Multiple Myeloma
• Stage III Multiple Myeloma

• Drug: bortezomib
  Given IV
  Other Names:

  • LDP 341
  • MLN341
  • VELCADE
• Drug: pegylated liposomal doxorubicin hydrochloride
  Given IV
  Other Names:

  • CAELYX
  • Dox-SL
  • DOXIL
  • doxorubicin hydrochloride liposome
  • LipoDox
• Other: laboratory biomarker analysis
  Correlative studies

Inclusion Criteria:

• Patients must have a histologically confirmed diagnosis of symptomatic multiple myeloma with evaluable disease parameters

• Patients may not have undergone any prior therapy, with the following exceptions:

  • Prior plasmapheresis with plasma exchange (PLEX) for a hyperviscosity syndrome is allowed, providing the patient has no current evidence of hyperviscosity and has not required PLEX for at least one week prior to initiation of therapy
  • Prior radiation therapy to areas of spinal cord compression by plasmacytomas, painful lesions due to bony involvement, or other myeloma related indications, is allowed provided that radiation will have been completed 3 weeks before initiation of therapy
  • Prior surgical intervention, such as for bony fractures or other myeloma related complications, is allowed provided that this will have been completed 3 weeks before the initiation of therapy, and patients have recovered from surgery
  • Prior therapy with corticosteroids for indications other than multiple myeloma is allowed, provided such therapy has been discontinued at least two weeks prior to study entry, and at least two weeks before their baseline disease evaluation
  • Prior supportive therapy with bisphosphonates or erythropoietin is allowed

• Non-pregnant and Non-nursing

  • Inclusion of females of childbearing potential requires a negative pregnancy test
• ECOG Performance Status =< 2
• Patients may not have a prior history of a hypersensitivity reaction to pegylated liposomal doxorubicin or doxorubicin, bortezomib or other boronic acid-based compounds; patients with a history of reactions to liposomal drug formulations other than Pegylated liposomal doxorubicin will be evaluated individually, and if their reactions were felt to have been due to the liposomal component itself, as opposed to the encapsulated agent, they will be excluded at the discretion of the investigators
• Patients who are known to be HIV-seropositive and are taking anti-retrovirals may not participate in this study because of potential interactions between these medications and the investigational agent; patients who are HIV seropositive and not on anti-retroviral therapy, and who otherwise meet the organ function criteria, will be eligible for the study
• Patients who are known to have active hepatitis A, B, or C viral infection may not participate in this study; active disease is defined as patients with a known viral hepatitis whose liver function tests are elevated beyond the criteria indicated
• No EKG evidence of acute ischemia
• No EKG evidence of medically significant conduction system abnormalities
• No history of myocardial infarction within the last 6 months
• Left ventricular ejection fraction (LVEF) must be >= 45% by either echocardiography or radionuclide-based multiple gated acquisition (RNV or MUGA)
• No Class 3 or Class 4 New York Heart Association Congestive Heart Failure
• Creatinine < 2.5 mg/dL
• ALT (SGPT) and AST (SGOT) =< 2.5 times the upper limit of the institutional normal value
• Total bilirubin =< 1.2 times the upper limit of the institutional normal value
• ANC >= 1,000/ul
• Platelets >= 100,000/ul
• Hemoglobin >= 8 g/dl (transfusion- and/or growth factor-dependent patients are not excluded if the above parameters can be achieved with such support)
• For those patients receiving warfarin (Coumadin), unfractionated Heparin, or low-molecular weight Heparin therapy, the applicable coagulation parameter that is being monitored must be within the accepted therapeutic ranges for those indications