A Multicenter Randomized Open Label Phase II Study of Pomalidomide and Dexamethasone in Relapse and Refractory Multiple Myeloma Patients Who Are Progressive and Did Not Achieve at Least a Partial Response to Bortezomib and Lenalidomide
Multiple myeloma (MM) is an incurable disease that is characterized by the accumulation of
clonal plasma cells in the bone marrow. The median overall survival for patients with MM is
approximately 4-5 years. Despite front line treatment approaches, the disease eventually
relapses. The recent US Food and Drug Administration (FDA) approvals of bortezomib (2003)
and combination lenalidomide plus dexamethasone (2006) therapies for the treatment of
previously treated MM has provided effective therapeutic options that give patients with
relapsed or refractory MM the prospect for a prolongation of overall and progression-free
survival times. However, MM remains an incurable disease. A clear unmet medical need still
exists for additional novel therapeutic options for the treatment of previously treated MM.
Pomalidomide belongs to the IMiDs class of compounds which thalidomide is the parent
compound and lenalidomide the most recently approved agent. It is derived from thalidomide
and shares a number of the beneficial pharmacologic properties with thalidomide. The
efficacy of thalidomide has been limited by adverse effects. This toxicity profile seems
dose and duration-related, spurring the development of IMiDs, which have the potential of
improved potency and reduced toxicity. By modifying the thalidomide structure through the
addition of an amino group at the 4 position of the phthaloyl ring to generate pomalidomide,
a compound that is up to 50000 times more potent at inhibiting TNF-alpha than thalidomide
was formed.
Recently, preliminary efficacy and safety data from an ongoing phase 2 study, led by Martha
Lacy, et al, at Mayo Clinic, were presented at the XII International Myeloma Workshop in
Washington DC (01 March 2009). The study highlighted a 63 % objective response and a 5%
complete response in patients taking pomalidomide (2 mg daily on days 1-28 of a 28-day
cycle) plus dexamethasone (40 mg daily on days 1, 8, 15, 22 of each cycle) including
patients with lenalidomide resistant refractory multiple myeloma. The results also showed
that the treatment was well tolerated. Based on the encouraging data of this study, a phase
1/2b multi-center, randomized, open-label, dose escalation study (dose level from 2 mg to 5
mg daily on days 1-21 of a 28-day cycle)is conducted to determine the MTD of pomalidomide.
This ongoing study will evaluate the safety and efficacy of oral pomalidomide alone, and in
combination with dexamethasone, in patients with relapsed and refractory MM. The first
results obtained in this study demonstrated that the maximum tolerated dose of pomalidomide
was 4 mg once per day and highlighted that pomalidomide has significant efficacy in MM and
can be safely administered to myeloma patients. Moreover, there are an increasing number of
patients who are refractory or did not respond significantly or experienced significant
toxicity to either bortezomib or lenalidomide.
Based on these studies, we hypothesized that these patients might benefit from the
combination of pomalidomide and dexamethasone. We have therefore designed a multicenter
phase 2 randomized open labelled study to determine response to pomalidomide and
dexamethasone in relapse and refractory MM patients who are progressive and did not achieve
at least a partial response to bortezomib and lenalidomide. This study will determine the
efficacy and toxicity profile of 2 modalities of pomalidomide in patients with advanced
myeloma, previously heavily treated characterized with adverse prognostic and that are in
desperate need of novel therapeutics. This study will be conducted in accordance with "good
clinical practice" (GCP) and all applicable regulatory requirements, including, where
applicable, the 2008 version of the Declaration of Helsinki.
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
To determine Response rate to pomalidomide and dexamethasone in MM patients who are progressive and did not achieve at least a partial response to bortezomib and lenalidomide
30 months
Yes
Bruno ROYER, MD PhD
Principal Investigator
CHRU-Hôpital Sud d'Amiens-AMIENS
France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)
2009-013319-36
NCT01053949
October 2009
August 2013
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