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Daratumumab, Thalidomide and Dexamethasone in Relapse and/or Refractory Myeloma

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ClinicalTrials.gov Identifier: NCT03143036
Recruitment Status : Recruiting
First Posted : May 8, 2017
Last Update Posted : June 7, 2018
Sponsor:
Collaborators:
Janssen, LP
International Myeloma Foundation
Information provided by (Responsible Party):
National University Hospital, Singapore

Brief Summary:

Myeloma patients who relapse after prior treatment with bortezomib and lenalidomide have survival of less than 1 year. A number of new drugs have been approved for the treatment of relapse myeloma in the last couple of years, including, Elotuzumab, Panobinostat, Ixazomib, carfilzomib and Pomalidomide. However, most of these drugs either do not have good single agent activity or still belongs to the category of immunomodulatory drugs or proteasome inhibitors. Daratumumab is a monoclonal antibody against CD38 that is highly expressed on myeloma plasma cells. In phase ½ studies, it has impressive single agent activity in relapse and refractory myeloma with a very acceptable toxicity profile. This set the stage for combinations with daratumumab to increase efficacy and improve outcome of patients with myeloma. The use of immunomodulatory drugs, such as thalidomide and lenalidomide, has been shown to augment NK cell activity. NK cells are important mediator of antibody dependent cellular cytotoxicity. We therefore hypothesize that the combination of Daratumumab with thalidomide may therefore improve the efficacy of the treatment.

In this study, we will plan to perform a phase II trial using the Daratumumab, Thalidomide, Dexamethasone combination in 100 myeloma patients with relapse myeloma in Asia.


Condition or disease Intervention/treatment Phase
Relapse and / or Refractory Myeloma Drug: Daratumumab, thalidomide and dexamethasone Phase 2

Detailed Description:

Daratumumab is a humanized antibody against CD38 which is expressed on myeloma cells. Daratumumab exhibited single agent activity in myeloma and is a promising new treatment. Recently, 2 phase 1 / 2 studies establishes the dosing regimen for Daratumumab and impressive single agent activity of about 30% response rates in patients who relapse after prior lenalidomide and bortezomib. Daratumumab also appear to be well tolerated. The most common toxicity is infusion-related and almost all confined to the first cycle. On the whole these are manageable with early intervention, concurrent corticosteroids and anti-histamines as well as slowing infusion rate. More recently, early results from 2 randomise study comparing Daratumumab plus lenalidomide and dexamethasone compared to lenalidomide and dexamethasone, and Daratumumab plus bortezomib and dexamethasone compared to bortezomib and dexamethasone, showed that the addition of Daratumumab significantly improved response and progression free survival, including a high minimal residual disease (MRD) negative rate of more than 20% in the relapse myeloma populations.

In addition, the use of immunomodulatory drugs, such as thalidomide and lenalidomide, has been shown to augment NK cell activity. NK cells are important mediator of antibody dependent cellular cytotoxicity, which is an important mechanism of action for Daratumumab. Furthermore, in the studies using another antibody target SLAMF7, Elotuzumab, the addition of dexamethasone greatly improve efficacy. Furthermore, thalidomide plus dexamethasone combination have a long history in myeloma and is relatively well tolerated and cost-effective. We therefore propose to add Daratumumab to thalidomide and dexamethasone, as this combination will be relatively easy to deliver in the Asian population because of availability and there is good rationale that such a combination will be synergistic and well-tolerated

Patients will be assessed every 28 days (+/-10 days). Patients shall receive the treatment until disease progression, unacceptable toxicity as determined by treating physician, withdrawal of consent or mortality (whichever occurs first). After disease progression, the treating physician should provide long-term follow-up data on disease status and survival. For patients who discontinued treatment before disease progression occurred, disease assessment measurements shall be performed once every 28 days (+/- 10 days) until disease progression. After patients have documented progression of disease, they will be followed for survival every 3 months (+/-10 days) until study closure or until patients withdraws consent, is lost to follow-up or until death, whichever comes first. For any patient who is lost to follow-up, the study site shall attempt to ascertain survival information via public database search.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 100 participants
Intervention Model: Single Group Assignment
Intervention Model Description: This is a phase 2 study of the combination of Daratumumab, thalidomide and dexamethasone in 100 Asian patients with relapse or refractory multiple myeloma.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 2 Study of Daratumumab in Combination With Thalidomide and Dexamethasone in Relapse and / or Refractory Myeloma
Actual Study Start Date : May 1, 2018
Estimated Primary Completion Date : July 1, 2019
Estimated Study Completion Date : July 1, 2022


Arm Intervention/treatment
Experimental: Daratumumab, thalidomide and dexamethasone Drug: Daratumumab, thalidomide and dexamethasone

Patients will be treated with with the following schedule. IV daratumumab 16mg/kg body weight weekly for weeks 1-8 followed by daratumumab 16mg/kg body weight once every 2 weeks from weeks 9 to 24 and then daratumumab 16mg/kg once every 4 weeks from weeks 25 onwards until disease progression; PO thalidomide 100mg daily for 1 year and PO Dexamethasone 40mg (starting dose of dexamethasone is 20mg once weekly for patients >75 years old) once weekly for 1 year (13 cycles, each cycle is 4 weeks). After 1 year, patient only continue on daratumumab until progression

Patients will be assessed every 28 days (+/-10 days).





Primary Outcome Measures :
  1. Progression free survival (PFS) [ Time Frame: Time from commencement of treatment to disease progression or death, whichever occurs first, assessed up to 100 months ]
    To assess the progression free survival (PFS) for daratumumab in combination with thalidomide and dexamethasone in Asian patients with relapsed myeloma.


Secondary Outcome Measures :
  1. Overall Response Rate (ORR) [ Time Frame: anytime from commencement of treatment with daratumumab, thalidomide and dexamethasone to the end of studyaseline until disease progression, unmanageable adverse event or death, whichever occurs first, approximately up to 3 years ]
    percentage of patients enrolled that achieve a complete response (CR), or stringent complete response (sCR), or very good partial response (VGPR), or partial response (PR) based on the International Myeloma Working Group criteria

  2. Overall survival (OS) [ Time Frame: Up to approximately 5 years (anticipated) after the last participant is enrolled ]
    Time from commencement of treatment with daratumumab, thalidomide and dexamethasone to the date of death.

  3. Duration of response (DOR) [ Time Frame: the time from first evidence of PR or VGPR, or CR, or sCR to confirmation of disease progression or death due to any cause, assessed up to 100 months ]
    the time from first evidence of PR or VGPR, or CR, or sCR to confirmation of disease progression or death due to any cause.

  4. Number of Participants affected by Adverse Events [ Time Frame: from the time of enrolment into study till 3 years from the date of the last patient randomized ]
    assessed on the basis of the frequency and severity of adverse events



Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years to 99 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Multiple myeloma, diagnosed according to standard criteria, with relapsing and refractory disease at study entry
  2. Patients must have evaluable multiple myeloma with at least one of the following (within 21 days of starting treatment)

    1. Serum M-protein ≥ 0.5g/dL, or
    2. In subjects without detectable serum M-protein, Urine M-protein ≥ 200mg/24 hour, or serum free light chai (sFLC) > 100mg/L (involved light chain) and an abnormal kappa/Lambda ratio
  3. Must receive at least 1 line of prior treatment. (Induction therapy followed by stem cell transplantation and consolidation/maintenance therapy will be considered as one line of treatment)
  4. Must have relapsed disease and/or be refractory to prior treatment except for thalidomide or lenalidomide. Refractoriness is defined as disease progression on treatment or progression within 6 months after the last dose of a given therapy. Relapse is defined according to the criteria of IMWG
  5. Males and females ≥ 18 years of age or > country's legal age for adult consent
  6. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 2
  7. Patients must meet the following clinical laboratory criteria with 21 days of starting treatment:

    1. Absolute neutrophil count (ANC) ≥ 1,000/mm3 and platelet ≥ 50,000/mm3 (≥ 30,000/mm3 if myeloma involvement in the bone marrow is >50%)
    2. Total bilirubin ≤ 1.5 x the upper limit of the normal range (ULN). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 x ULN.
    3. Calculated creatinine clearance ≥ 30mL/min.
  8. Written informed consent in accordance with federal, local and institutional guidelines

Exclusion Criteria:

  1. Female patients who are lactating or pregnant
  2. Multiple Myeloma of IgM subtype
  3. Glucocorticoid therapy (prednisolone > 30mg/day or equivalent) within 14 days prior to informed consent obtained
  4. POEMS syndrome
  5. Plasma cell leukemia or circulating plasma cells ≥ 2 x 109/L
  6. Waldenstrom's Macroglobulinaemia
  7. Existing peripheral neuropathy of grade 2 or higher or presence of neuropathic pain
  8. Patients with known amyloidosis
  9. Chemotherapy with approved or investigation anticancer therapeutics within 21 days prior to starting Dara-TD treatment
  10. Focal radiation therapy within 7 days prior to start of Dara-TD. Radiation therapy to an extended field involving a significant volume of bone marrow within 21 days prior to start of pomalidomide
  11. Immunotherapy (excluding steroids) 21 days prior to start of Dara-TD
  12. Major surgery (excluding kyphoplasty) within 28 days prior to start of Dara-TD
  13. Active congestive heart failure (New York Heart Association [NYHA] Class III or IV), symptomatic ischaemia, or conduction abnormalities uncontrolled by conventional intervention. Myocardial infarction within 4 months prior to informed consent obtained
  14. Known HIV seropositive, hepatitis C infection, and/or hepatitis B (except for patients with hepatitis B surface antigen or core antibody receiving and responding to antiviral therapy directed at hepatitis B: these patients are allowed)
  15. Patients with known cirrhosis
  16. Patients with creatinine clearance <30m/min
  17. Second malignancy within the past 3 years except:

    1. Adequately treated basal cell or squamous cell skin cancer
    2. Carcinoma in situ of the cervix
    3. Breast carcinoma in situ with full surgical resection
  18. Patients with myelodysplastic syndrome
  19. Patients with steroid or thalidomide hypersensitivity
  20. Patients previously treated with daratumumab or other anti-CD38 antibodies.
  21. Ongoing graft-versus-host disease
  22. Patients with pleural effusions requiring thoracentesis or ascites requiring paracentesis within 14 days prior to starting Dara-TD treatment
  23. Disease refractory to thalidomide or lenalidomide
  24. Contraindication to any of the required concomitant drugs or supportive treatments
  25. Any clinically significant medical disease or psychiatric condition that, in the investigator's opinion, may interfere with protocol adherence or a patient's ability to give informed consent.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03143036


Contacts
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Contact: Wee Joo Chng 6779 5555 mdccwj@nus.edu.sg
Contact: Adeline Lin 6779 5555 adeline_hf_lin@nuhs.edu.sg

Locations
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Hong Kong
Queen Mary Hospital Not yet recruiting
Hong Kong, Hong Kong
Korea, Republic of
Samsung Medical Center Not yet recruiting
South Korea, Korea, Republic of
Singapore
National University Hospital Recruiting
Singapore, Singapore
Singapore General Hospital Recruiting
Singapore, Singapore
Taiwan
National Taiwan University Not yet recruiting
Taipei, Taiwan
Sponsors and Collaborators
National University Hospital, Singapore
Janssen, LP
International Myeloma Foundation
Investigators
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Principal Investigator: Wee Joo Chng National University Hospital, Singapore

Publications:
3. Palumbo A, Chanan-Khan A, Weisel K, et al. Phase III randomized controlled study of daratumumab, bortezomib and dexamethasone (DVd) versus bortezomib and dexamethasone (Vd) in patients with relapsed or refractory multiple myeloma (RRMM): CASTOR study. J Clin Oncol 2016; 34 (Suppl abstr LBA4)
4. Dimopoulos MA, Oriol A, Nahi H, et al. An open-label, randomised phase 3 study of daratumumab, lenalidomide, dexamethasone (DRD) versus lenalidomide and dexamethasone (RD) in relapsed or refractory multiple myeloma (RRMM): POLLUX. EHA 2016 Abstract LB2238

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Responsible Party: National University Hospital, Singapore
ClinicalTrials.gov Identifier: NCT03143036     History of Changes
Other Study ID Numbers: AMN004
First Posted: May 8, 2017    Key Record Dates
Last Update Posted: June 7, 2018
Last Verified: May 2018

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National University Hospital, Singapore:
daratumumab
Additional relevant MeSH terms:
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Multiple Myeloma
Daratumumab
Neoplasms, Plasma Cell
Recurrence
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
Disease Attributes
Pathologic Processes
Thalidomide
Dexamethasone
Dexamethasone acetate
BB 1101
Antibodies, Monoclonal
Anti-Inflammatory Agents
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Glucocorticoids