Phase I/II Study of Sorafenib, Lenalidomide, and Dexamethasone in Relapsed/Refractory Multiple Myeloma
OBJECTIVES:
Primary
- To determine the maximum tolerated dose of sorafenib tosylate and lenalidomide in
combination with dexamethasone in patients with relapsed or refractory multiple
myeloma. (phase I)
- To describe the toxicity of this regimen in these patients. (phase I)
- To evaluate the confirmed response in patients treated with this regimen. (phase II)
Secondary
- To correlate clinical effects (adverse events and/or tumor response or activity) with
pharmacologic parameters (pharmacokinetics or pharmacodynamics) and/or biologic results
(correlative laboratory). (phase II)
- To assess overall survival and time to disease progression in patients treated with
this regimen. (phase II)
OUTLINE: This is a phase I, dose-escalation study of sorafenib tosylate in combination with
lenalidomide followed by a phase II study.
Patients receive oral sorafenib tosylate once to twice daily on days 1-28, oral lenalidomide
once daily on days 1-21, and oral dexamethasone on days 1, 8, 15, and 22. Treatment repeats
every 28 days in the absence of disease progression or unacceptable toxicity.
Patients undergo blood and bone marrow sample collection periodically during study for
laboratory correlative studies. Bone marrow plasma samples (i.e., fresh marrow aspirates)
are assessed for marrow angiogenesis (microvessel density) by IHC; angiogenic capability
(tubular network formation) by in vitro angiogenesis assay; tumor cell proliferation by
bromo-2-deoxyuridine uptake; tumor cell apoptosis by three-color flow cytometry (CD38, CD45
or CD138, and 7AAD); and expression of VEGF and soluble VEGF receptors on plasma cells by
enzyme-linked immunosorbent assay. Bone marrow biopsies are assessed for various
phosphoproteins by IHC; phosphorylation status of ERK1/2 by immunoblotting; and for
pharmacodynamic markers (e.g., P70 S6K) by immunoblotting. Blood samples are assessed for
surface markers of circulating endothelial cells (CD105, CD34, and CD146) by flow cytometry
and for circulating endothelial cell progenitors by late colony formation in mononuclear
cells. The endothelial lineage is confirmed by phenotyping of surface markers for
endothelial cells.
After completion of study therapy, patients are followed periodically for up to 3 years.
PROJECTED ACCRUAL: A total of 39 patients will be accrued for phase I and 44 for phase II of
this study.
Interventional
Allocation: Non-Randomized, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Number of Participants With a Grade 3 and 4 Adverse Event (Phase I)
Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 3. Description of Grades: Grade 1: Mild Grade 2: Moderate Grade 3: Severe Grade 4: Life-threatening Grade 5: Death
up to 3 years
Yes
Shaji K. Kumar, M.D.
Study Chair
Mayo Clinic
United States: Food and Drug Administration
CDR0000597065
NCT00687674
August 2008
November 2011
Name | Location |
---|---|
Mayo Clinic | Rochester, Minnesota 55905 |