Vaccine Therapy With or Without Cyclophosphamide in Treating Patients With Recurrent or Refractory Multiple Myeloma

• ClinicalTrials.gov Identifier: NCT00450814
• Recruitment Status: Completed
• First Posted: March 22, 2007
• Results First Posted: December 16, 2019
• Last Update Posted: December 16, 2019
• Sponsor: Mayo Clinic
• Collaborator: National Cancer Institute (NCI)
• Information provided by (Responsible Party): Mayo Clinic

Study Description

Brief Summary:

This phase I/II trial studies the side effects and best dose of vaccine therapy when given with or without cyclophosphamide and to see how well they work in treating patients with multiple myeloma that has come back (recurrent) or has not responded to previous treatment (refractory). Vaccines made from a gene-modified virus may help the body build an effective immune response to kill cancer cells. Drugs used in chemotherapy, such as cyclophosphamide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving vaccine therapy together with cyclophosphamide may be a better treatment for multiple myeloma.

Condition or disease	Intervention/treatment	Phase
Recurrent Plasma Cell Myeloma; Refractory Plasma Cell Myeloma	Drug: Cyclophosphamide; Other: Laboratory Biomarker Analysis; Biological: Oncolytic Measles Virus Encoding Thyroidal Sodium Iodide Symporter; Other: Pharmacological Study	Phase 1; Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To determine the maximum tolerated dose (MTD) of oncolytic measles virus encoding thyroidal sodium iodide symporter (MV-NIS) when administered with or without cyclophosphamide in patients with relapsed or refractory multiple myeloma. (Phase I) II. To evaluate the confirmed response rate of MV-NIS alone in patients with relapsed or refractory multiple myeloma who have exhausted all therapeutic options. (Phase II, Cohort A) III. To evaluate the confirmed response rate of MV-NIS alone in patients who are relapsing from very good partial response (VGPR) or complete response (CR) and have not received myeloma directed therapy for at least 12 weeks. (Phase II, Cohort B)

SECONDARY OBJECTIVES:

I. To determine the safety and toxicity of the intravenous administration of an Edmonston vaccine strain measles virus engineered to express the thyroidal sodium iodide symporter (MV-NIS) when administered with or without cyclophosphamide in patients with relapsed or refractory multiple myeloma. (Phase I) II. To evaluate the confirmed response rate of MV-NIS in patients with relapsed or refractory multiple myeloma. (Phase I) III. To further evaluate the adverse event profile of MV-NIS in patients with relapsed or refractory multiple myeloma. (Phase II) IV. To evaluate overall survival, failure-free survival and progression-free survival. (Phase II)

TERTIARY OBJECTIVES:

I. To determine the time course of viral gene expression and virus elimination, and the biodistribution of virally infected cells at various times points after infection with MV-NIS (when administered with or without cyclophosphamide) using 99m-technetium (Tc) gamma camera imaging. (Phase I and II) II. To assess virus replication, viremia, viral shedding in urine and respiratory secretions, and virus persistence after systemic administration of MV-NIS (when administered with or without cyclophosphamide). (Phase I and II) III. To monitor humoral responses to the injected virus. (Phase I and II) IV. To explore the anti-myeloma efficacy (i.e. clinical response rate, time to progression, progression free survival, duration of response) of the virus using standard myeloma response criteria as well as immunoglobulin free light chain measurements. (Phase I and II)

OUTLINE: This is a phase I, dose-escalation study of MV-NIS followed by a phase II study. Patients are assigned to 1 of 2 treatment arms (Stage 1 or Stage 2) in phase I and assigned to Stage 1 in phase II.

STAGE 1 (MV-NIS ALONE, closed to accrual on 12/17/2009 and reopened 10/13/2011): Patients receive MV-NIS intravenously (IV) over 1 hour on day 1.

STAGE 2 (MV-NIS AND CYCLOPHOSPHAMIDE, temporarily closed to accrual on 10/13/11): Patients receive cyclophosphamide IV over 30 minutes and then MV-NIS IV over 1 hour 2 days later.

After completion of study treatment, patients are followed up at 6 weeks, 12 weeks, and then every 3 months for 1 year.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 48 participants
• Allocation: Non-Randomized
• Intervention Model: Sequential Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase I/II Trial of Systemic Administration of Edmonston Strain of Measles Virus, Genetically Engineered to Express NIS, With or Without Cyclophosphamide, in Patients With Recurrent or Refractory Multiple Myeloma
• Actual Study Start Date: November 30, 2006
• Actual Primary Completion Date: July 10, 2018
• Actual Study Completion Date: November 20, 2019

Arms and Interventions

Arm	Intervention/treatment
Experimental: Stage 1 (MV-NIS alone); Patients receive MV-NIS IV over 1 hour on day 1. (Closed to accrual on 12/17/2009 and reopened 10/13/2011)	Other: Laboratory Biomarker Analysis; Correlative studies; Biological: Oncolytic Measles Virus Encoding Thyroidal Sodium Iodide Symporter; Given IV; Other Name: MV-NIS; Other: Pharmacological Study; Correlative studies
Experimental: Stage 2 (MV-NIS and cyclophosphamide); Patients receive cyclophosphamide IV over 30 minutes and then MV-NIS IV over 1 hour 2 days later. (Temporarily closed to accrual on 10/13/11)	Drug: Cyclophosphamide; Given IV; Other Names: (-)-Cyclophosphamide; 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate; Carloxan; Ciclofosfamida; Ciclofosfamide; Cicloxal; Clafen; Claphene; CP monohydrate; CTX; CYCLO-cell; Cycloblastin; Cycloblastine; Cyclophospham; Cyclophosphamid monohydrate; Cyclophosphamidum; Cyclophosphan; Cyclophosphane; Cyclophosphanum; Cyclostin; Cyclostine; Cytophosphan; Cytophosphane; Cytoxan; Fosfaseron; Genoxal; Genuxal; Ledoxina; Mitoxan; Neosar; Revimmune; Syklofosfamid; WR- 138719; Other: Laboratory Biomarker Analysis; Correlative studies; Biological: Oncolytic Measles Virus Encoding Thyroidal Sodium Iodide Symporter; Given IV; Other Name: MV-NIS; Other: Pharmacological Study; Correlative studies

Outcome Measures

Primary Outcome Measures :

1. Number of Phase I Participants With Dose-Limiting Toxicity Events (Phase I) [ Time Frame: 6 weeks ]
   The Maximum Tolerated Dose (MTD) is defined as the dose level below the lowest dose that induces dose-limiting toxicity (DLT) in at least one-third of patients graded according to NCI Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Dose-limiting toxicities include non-hematologic events graded 3 or higher and deemed at least possibly related to treatment. A total of 6 patients treated at the MTD will be sufficient to identify common toxicities at the MTD. The number of patients reporting a dose-limiting event are reported.
2. Maximum Tolerated Dose (MTD) (Phase I) [ Time Frame: 6 weeks ]
   The Maximum Tolerated Dose (MTD) is defined as the dose level below the lowest dose that induces dose-limiting toxicity (DLT) in at least one-third of patients graded according to NCI Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Dose-limiting toxicities include non-hematologic events graded 3 or higher and deemed at least possibly related to treatment. A total of 6 patients treated at the MTD will be sufficient to identify common toxicities at the MTD. The MTD is reported below.
3. Proportion of Confirmed Response, Defined as a Partial Response (PR) or Better (Phase II) [ Time Frame: Up to 1 year ]
   Confirmed response will be evaluated using all cycles. The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR

Secondary Outcome Measures :

1. Overall Toxicity Rate, Assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events Version 3.0 (NCI CTCAE v3.0) (Phase I) [ Time Frame: Up to 1 year ]
   The overall toxicity rates (percentages) for grade 3 or higher adverse events considered at least possibly related to treatment are reported below by stage for Phase I patients.
2. Number of Patients With Clinical Responses (Phase I) [ Time Frame: Up to 1 year ]
   The number of patients with clinical responses (CR, VGPR, PR, or minimal response [MR]) will be summarized by stage.
3. Overall Survival (Phase II) [ Time Frame: Time from registration to death due to any cause, assessed up to 1 year ]
   Time from registration to death due to any cause, assessed up to 1 year. The distribution of survival time will be estimated using the method of Kaplan-Meier.
4. Time to Progression (TTP) (Phase II) [ Time Frame: Time from registration to the earliest date with documentation of disease progression, assessed up to 1 year ]
   Time from registration to the earliest date with documentation of disease progression, assessed up to 1 year. The distribution of time to progression will be estimated using the method of Kaplan-Meier.
5. Progression-free Survival (Phase II) [ Time Frame: At 1 year ]
   1-year progression-free survival (PFS1). Evidence of local recurrence, distant metastasis, or death from any cause within 1 year counted as events in the time-to-event Kaplan-Meier analysis of progression-free survival. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions
6. Progression-free Survival (Phase II) [ Time Frame: At 2 years ]
   2-year progression-free survival (PFS2). Evidence of local recurrence, distant metastasis, or death from any cause within 2 years counted as events in the time-to-event Kaplan-Meier analysis of progression-free survival. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions
7. Progression-free Survival (Phase II) [ Time Frame: Up to 5 years ]
   Progression free survival (PFS) is defined as the time from the date of randomization to the date of disease progression or death resulting from any cause, whichever comes first. Progression is defined according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. The median and 95% confidence intervals are estimated using the Kaplan-Meier estimator. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions
8. Failure-free Survival (Phase II) [ Time Frame: Time from registration to the earliest of progressive disease, alternative treatment for myeloma, or death due to any cause, assessed up to 1 year ]
   Time from registration to the earliest of progressive disease, alternative treatment for myeloma, or death due to any cause, assessed up to 1 year. The distribution of failure-free survival will be estimated using the method of Kaplan-Meier.
9. Overall Toxicity Rate, Assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events Version 3.0 (NCI CTCAE v3.0) (Phase II) [ Time Frame: Up to 1 year ]
   The overall toxicity rates (percentages) for grade 3 or higher adverse events considered at least possibly related to treatment are reported below for Phase II patients.

Other Outcome Measures:

1. Time Until Any Treatment Related Toxicity (Phase I) [ Time Frame: Up to 1 year ]
   Tolerability will be explored in an ancillary manner through time-related variables, including time until any treatment related toxicity. Simple summary statistics will be supplemented with Kaplan-Meier survival estimates and related confidence intervals. The effect of dose and ancillary dichotomized covariates such as age will be explored using log-rank testing involving one covariate at a time.
2. Time Until Hematologic Nadirs (White Blood Cells, ANC, Platelets) (Phase I) [ Time Frame: Up to 1 year ]
   Tolerability will be explored in an ancillary manner through time-related variables, including time until hematologic nadirs. Simple summary statistics will be supplemented with Kaplan-Meier survival estimates and related confidence intervals. The effect of dose and ancillary dichotomized covariates such as age will be explored using log-rank testing involving one covariate at a time.
3. Time Until Treatment Related Grade 3+ Toxicity (Phase I) [ Time Frame: Up to 1 year ]
   Tolerability will be explored in an ancillary manner through time-related variables, including time until treatment related grade 3+ toxicity. Simple summary statistics will be supplemented with Kaplan-Meier survival estimates and related confidence intervals. The effect of dose and ancillary dichotomized covariates such as age will be explored using log-rank testing involving one covariate at a time.
4. Biodistribution and Kinetics of Virus Spread [ Time Frame: Up to 6 weeks ]
   Will be correlated with tumor distribution. Descriptive statistics and scatterplots will form the basis of presentation of these variables. Correlations between the laboratory values and other outcome measures will be carried out by standard parametric and non-parametric tests (e.g. Pearson's and Spearman's rho).
5. NIS Gene Expression in Vivo [ Time Frame: Up to 6 weeks ]
   Will be correlated with tumor distribution. Descriptive statistics and scatterplots will form the basis of presentation of these variables. Correlations between the laboratory values and other outcome measures will be carried out by standard parametric and non-parametric tests (e.g. Pearson's and Spearman's rho).
6. Radiation Dose [ Time Frame: Up to 6 weeks ]
   The radiation dose that could be delivered to the bone marrow as well as critical organs such as the liver, lungs and kidneys if iodine-131 were to be administered using MIRDOSE 3 program will be estimated. Where patterns of correlation are indicated, ordinary and partial correlation coefficients (controlling for dose levels) will be calculated. Inferential testing for significant shifts in the correlative laboratory data results across dose levels will be carried out only as a hypothesis generating exercise.
7. Viral Replication [ Time Frame: Up to 6 weeks ]
   Descriptive statistics and scatterplots will form the basis of presentation of these variables. Correlations between the laboratory values and other outcome measures will be carried out by standard parametric and non-parametric tests (e.g. Pearson's and Spearman's rho).
8. Viral Shedding [ Time Frame: Up to 6 weeks ]
   Descriptive statistics and scatterplots will form the basis of presentation of these variables. Correlations between the laboratory values and other outcome measures will be carried out by standard parametric and non-parametric tests (e.g. Pearson's and Spearman's rho).

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Myeloma relapsing from partial response or better

  • Patients relapsing > 18 months from transplant if not on maintenance, or
  • If off maintenance, discontinued at least 6 months ago, or
  • If relapsing on maintenance, at least 3 years from transplant, or
  • Off prior myeloma therapy at least 6 months ago

  • Sufficient tumor burden that is assessable for response

    • Serum M-spike >= 0.5 g/dL, or
    • If immunoglobulin A (IgA) myeloma, IgA > 1000 mg/dL, or
    • Difference between involved and uninvolved free light chain (dFLC) > 10 mg/dL, or
    • Urine M-spike >= 200 mg/24 hours, or
    • Bone marrow plasmacytosis >= 10%, or
    • Plasmacytoma >= 2 cm in diameter
• Absolute neutrophil count (ANC) >= 1000/uL
• Platelets (PLT) >= 50,000/uL
• Hemoglobin >= 8.5 g/dl
• Aspartate aminotransferase (AST) =< 2 times upper limit of normal
• Creatinine < 2 times upper limit of normal
• Total bilirubin =< 1.5 x upper limit of normal
• International normalized ratio (INR) =< 1.4 x ULN at the time of registration
• Ability to provide informed consent
• Willingness to return to Mayo Clinic Rochester for follow-up
• Life expectancy >= 12 weeks
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1, or 2
• Willingness to provide all biological specimens as required by the protocol
• Negative serum pregnancy test done =< 7 days prior to registration for women of childbearing potential only
• Measles antibody titer on the BioRad Multiplex assay less than or equal to 1.0

Exclusion Criteria:

• Uncontrolled infection
• Active tuberculosis
• Any myeloma directed therapy within 12 weeks of registration including plasmapheresis or transfusion
• New York Heart Association classification III or IV, known symptomatic coronary artery disease, or symptoms of coronary artery disease on systems review
• Active central nervous system (CNS) disorder or seizure disorder
• Human immunodeficiency virus (HIV) positive test result
• Other concurrent chemotherapy, immunotherapy, radiotherapy, or any ancillary therapy considered investigational (used for a non-Food and Drug Administration [FDA] approved indication and in the context of a research investigation)
• Previous exposure to heat inactivated measles virus vaccine (this vaccine was given to some individuals between the years of 1963-1967)

• Any of the following:

  • 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
• Evidence of chronic or acute graft versus host disease or on-going treatment for graft versus host disease from prior allogeneic stem cell transplantation
• Exposure to household contacts =< 15 months old or household contact with known immunodeficiency

Contacts and Locations

Locations

United States, Minnesota

Mayo Clinic

Rochester, Minnesota, United States, 55905

Sponsors and Collaborators

Mayo Clinic

National Cancer Institute (NCI)

Investigators

• Principal Investigator: Angela Dispenzieri; Mayo Clinic

  Study Documents (Full-Text)

Documents provided by Mayo Clinic:

Study Protocol and Statistical Analysis Plan  [PDF] January 20, 2017

More Information

• Responsible Party: Mayo Clinic
• ClinicalTrials.gov Identifier: NCT00450814
• Other Study ID Numbers: MC038C; NCI-2009-01194 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ); MC038C ( Other Identifier: Mayo Clinic ); P30CA015083 ( U.S. NIH Grant/Contract ); R01CA125614 ( U.S. NIH Grant/Contract ); R01CA168719 ( U.S. NIH Grant/Contract )
• First Posted: March 22, 2007
• Results First Posted: December 16, 2019
• Last Update Posted: December 16, 2019
• Last Verified: January 2019

Additional relevant MeSH terms:

Multiple Myeloma; Neoplasms, Plasma Cell; Recurrence; Disease Attributes; Pathologic Processes; Neoplasms by Histologic Type; Neoplasms; Hemostatic Disorders; Vascular Diseases; Cardiovascular Diseases; Paraproteinemias; Blood Protein Disorders; Hematologic Diseases; Hemorrhagic Disorders; Lymphoproliferative Disorders; Immunoproliferative Disorders; Immune System Diseases; Cyclophosphamide; Immunosuppressive Agents; Immunologic Factors; Physiological Effects of Drugs; Antirheumatic Agents; Antineoplastic Agents, Alkylating; Alkylating Agents; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Myeloablative Agonists