Retrospective Viability Study of the PETHEMA-POMCIDEX Clinical Practice Guidelines for the Treatment of Patients With Relapsed and Refractory Multiple Myeloma (RRMM)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT03477643|
Recruitment Status : Recruiting
First Posted : March 26, 2018
Last Update Posted : May 15, 2019
Multiple myeloma (MM) is a plasma cell neoplasm representing the second most common type of hematologic tumor after lymphomas. The incorporation of novel agents such as bortezomib, lenalidomide, or thalidomide into first-line treatment as well as in relapse settings has led to a significant improvement in survival rates for MM patients, which have doubled in the last 5-7 years (1,2). However, except for a small percentage of patients (10-30%)(3) that may achieve a cure after first-line treatment, in the majority of cases, MM behaves as an incurable disease whose clinical course is characterized by repeated relapses, shorter and shorter periods of remission, and by becoming refractory to succesive treatments (bortezomib or lenalidomide). In this situation, survival is generally less than 9 months, which underscores the need to develop new drugs for MM patients Pomalidomide, a third-generation immunomodulatory drug (IMiD), has demonstrated efficacy in patients with relapsed and refractory MM, with an overall response rate that fluctuates between 30-60% depending on whether it is administered in combination with low-dose dexamethasone or in association with treatment with a cytostatic agent such as cyclophosphamide.
In clinical trial CC-4047-MM-003, treatment with pomalidomide and low-dose dexamethasone in patients with relapsed and refractory MM or those intolerant to bortezomib or lenalidomide was a successful rescue treatment in 30% of patients with a median progression-free survival of 4 months. The association of cyclophosphamide at dose of 400mg/day on days 1, 8, and 15 of each cycle is able to increase the overall response rate from 39% for combination pomalidomide-dexamethasone to up to 65% for the triple regimen (pomalidomide, cyclophosphamide, dexamethasone - POMCIDEX), as well as the median PFS from 4.4 mo. to 9.2 mo. respectively. As well, the tolerance and safety profiles of the triple combination pomalidomide, cyclophosphamide, and dexamethasone were acceptable.
The association of bortezomib with pomalidomide-dexamethasone also increases the overall response rate (85%) and prolongs PFS (10.7 months).
The BiRD study (lenalidomide, dexamethasone, and clarithromycin) suggests that clarithromycin intensifies the effect of corticosteroids, increasing their anti-myeloma effect . A study evaluating the combination of clarithromycin with pomalidomide and low-dose dexamethasone in RRMM patients showed an overall response rate of 57% and clinical benefit rate (considered equal or superior to minor response) of 66%.
Since July 2014, pomalidomide (Imnovid®) in combination with dexamethasone has been approved for the treatment of adult patients with relapsed and refractory MM who have received at least two prior lines of therapy (including bortezomib and lenalidomide) and who have shown progressive disease to the last line of treatment.
In Spain in January of 2015, and in the Spanish Myeloma Group (GEM) context, we implemented clinical practice guidelines for the treatment of RRMM patients who are candidates for pomalidomide treatment with a triple therapy combination pomalidomide + cyclophosphamide + low-dose dexamethasone (POMCIDEX) (Appendix 1). The goal of the clinical practice guidelines was to increase the overall response rate, quality of response, and progression-free survival in patients treated with POMCIDEX. In patients with suboptimal response (defined as stable disease in the first 3 cycles, or inferior to partial response after six cycles according to International Myeloma Working Group Uniform Response Criteria ), clarithromycin can be added to their treatment at a dose of 500mg/12hrs on days 1-28 of each cycle. Treatment can be administered until disease progression, unacceptable toxicity, or based on patient decision.
Keeping in mind the time that has passed since the approval of pomalidomide for use in Spain and the publication of the clinical practice guidelines, we believe it is now time for a retrospective evaluation of the results of the therapeutic guidelines for Spanish MM patients and to review the viability of the recommendations contained in the guidelines with respect to compliance with the same, and effectiveness of the planned course of treatment. Once the viability of the proposed therapy regimen has been evaluated, other analyses for the purpose of studying the clinical results of treatment can be carried out as a separate analysis.
The therapeutic paradigm for MM is rapidly changing due to the availability of new drugs for the treatment of patients with refractory or relapsed disease, making clinical decisions more challenging. For this reason, the availability of data obtained from real-life settings, outside of clinical trials, is essential in order to choose the appropriate treatment for each patient
|Condition or disease|
|Relapsed and Refractory Multiple Myeloma|
This is a national, multicentre, observational, retrospective, open-label, non-randomized, non-interventional study to evaluate the degree of compliance at PETHEMA centres in Spain with the clinical practice guidelines proposed by the Spanish Myeloma Group for the treatment of relapsed and refractory MM with POMCIDEX.
In this study, all patients will be included retrospectively who met the inclusion criteria for the GEM clinical practice guidelines and who were treated with POMCIDEX. The period of retrospective data collection will be from 01/01/2015 to 01/04/2018.
The period of data collection for the study includes a maximum period of three months to allow each centre to collect the necessary clinical and demographic data for each patient in order to fulfill the different study objectives. Patient data will be anonymized and recorded in the electronic Case Report Form (eCRF) using the RedCap platform. Afterward, data cleansing and verification will be carried out on all data recorded by the study investigators. This procedure will be carried out in the six months after database lock.
Once the process of recording and verification of patient data is complete, extraction and statistical analysis of the data will be carried out.
|Study Type :||Observational|
|Estimated Enrollment :||100 participants|
|Official Title:||Retrospective Viability Study of the PETHEMA-POMCIDEX Clinical Practice Guidelines for the Treatment of Patients With Relapsed and Refractory Multiple Myeloma (RRMM)|
|Actual Study Start Date :||April 27, 2018|
|Estimated Primary Completion Date :||December 13, 2019|
|Estimated Study Completion Date :||December 13, 2019|
Refractory Multiple Myeloma
Patients with relapsed and refractory multiple myeloma who have received treatment with pomalidomide, cyclophosphamide, and dexamethasone following the GEM-PETHEMA clinical practice guidelines between 01/01/2015 to 01/04/2018
- Level of compliance at PETHEMA centres in Spain with the clinical practice guidelines proposed by the Spanish Myeloma Group for the treatment of relapsed and refractory MM with POMCIDEX. [ Time Frame: 3 months ]To evaluate the viability of the therapeutic guidelines, measured in terms of compliance and the effectiveness of the treatment planned.
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): NCT03477643
|Hospital de Sant Joan de Déu||Recruiting|
|Contact: Cristina Motllo, Dr + 34 932 53 21 00 email@example.com|
|Hospital Donostia-Donostia Ospitalea||Recruiting|
|Contact: Mailen Sirvent, Dr + 34 943 00 70 00 MAIALEN.SIRVENTAUZMENDI@osakidetza.eus|
|Hospital Universitario Virgen de Las Nieves||Not yet recruiting|
|Contact: Rafael Rios, Dr + 34 958 02 00 00 firstname.lastname@example.org|
|Hospital General San Jorge - Huesca||Recruiting|
|Contact: Ilda Maria Murillo, Dr + 34 974 24 70 00 email@example.com|
|Hospital de Jaén||Not yet recruiting|
|Contact: M Magdalena Anguita, Dr + 34 953 008 000 firstname.lastname@example.org|
|Hospital Lucus Augusti||Recruiting|
|Contact: Esperanza la Villa, Dr + 34 982 29 60 00 email@example.com|
|Hospital Clínico San Carlos||Not yet recruiting|
|Contact: Belen Iñigo, Dr + 34 913 30 30 01 firstname.lastname@example.org|
|Hospital Del Tajo||Not yet recruiting|
|Contact: Ana Lafuente, Dr + 34 918 01 41 00 email@example.com|
|Hospital General Universitario Gregorio Marañón||Recruiting|
|Contact: Cristina Encinas, Dr + 34 915 86 80 00 firstname.lastname@example.org|
|Hospital Ramón Y Cajal||Recruiting|
|Contact: Mª Jesus Blanchard, Dr + 34 913 36 80 00 email@example.com|
|Hospital Universitario 12 de Octubre||Recruiting|
|Contact: Juan José Lahuerta, Dr + 34 913 90 80 00 firstname.lastname@example.org|
|Hospital Universitario de La Princesa||Not yet recruiting|
|Contact: Adrián Alegre, Dr + 34 915202200 email@example.com|
|Hospital Universitario Infanta Leonor||Not yet recruiting|
|Contact: José Angel Hernández Rivas, Dr firstname.lastname@example.org|
|Hospital Universitario Virgen de La Arrixaca||Not yet recruiting|
|Contact: Valentin Cabañas, Dr + 34 968 36 95 00 email@example.com|
|Complejo Hospitalario de Especialidades Virgen de La Victoria||Not yet recruiting|
|Contact: Ricarda García, Dr + 34 951 03 20 00 firstname.lastname@example.org|
|Hospital Central de Asturias||Recruiting|
|Contact: Ana Pilar Gonzalez, Dr + 34 985 10 80 00 email@example.com|
|Hospital Universitari Son Espases||Recruiting|
|Palma De Mallorca, Spain|
|Contact: Antonia Sampol, Dr + 34 871 20 50 00 firstname.lastname@example.org|
|Complejo Hospitalario de Navarra||Not yet recruiting|
|Contact: Jose María Arguiñano Pérez, Dr 948 25 54 00 email@example.com|
|Hospital El Bierzo||Recruiting|
|Contact: Erik de Cabo, Dr + 34 987 45 52 00 firstname.lastname@example.org|
|Hospital Universitario de Salamanca||Recruiting|
|Contact: María Victoria Mateos, Dr + 34 983 42 00 00 email@example.com|
|Hospital Mutua Terrassa||Recruiting|
|Contact: Josep Mª Tutusaus, Dr + 34 93 736 50 50 firstname.lastname@example.org|
|Complejo Hospitalario de Toledo||Recruiting|
|Contact: Luis Casado Montero, Dr + 34 925 26 92 00 email@example.com|
|Hospital Universitario Dr. Peset Aleixandre||Not yet recruiting|
|Contact: Paz Ribas + 34 961622300 firstname.lastname@example.org|
|Hospital Arnau de Vilanova||Not yet recruiting|
|Contact: Aurelio Lopez, dr + 34 973 705 246 ... email@example.com|
|Hospital Universitario La Fe||Not yet recruiting|
|Contact: Mario Arnao, Dr +34 961 244 350 firstname.lastname@example.org|
|HOSPITAL CLíNICO UNIVERSITARIO DE VALLADOLID||Recruiting|
|Contact: Alfonso García de Coca, Dr +34 983 42 00 00 email@example.com|
|Contact: Ernesto Pérez, Dr + 34 945007000 firstname.lastname@example.org|