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A MULTICENTER, OPEN LABEL STUDY OF WEEKLY CARFILZOMIB, CYCLOPHOSPHAMIDE AND DEXAMETHASONE (wCCyd) IN NEWLY DIAGNOSED MULTIPLE MYELOMA (MM) PATIENTS


Phase 1/Phase 2
65 Years
N/A
Open (Enrolling)
Both
Multiple Myeloma

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Trial Information

A MULTICENTER, OPEN LABEL STUDY OF WEEKLY CARFILZOMIB, CYCLOPHOSPHAMIDE AND DEXAMETHASONE (wCCyd) IN NEWLY DIAGNOSED MULTIPLE MYELOMA (MM) PATIENTS


TREATMENT PERIOD Patients will start the induction treatment with wCCyd, as soon as the
screening visits of the pre-treatment period have been terminated.

Each cycle will be repeated every 28 days for a total of 9 courses.

Treatment schedule for 9 cycles of induction:

Phase I:

In the phase I part of the study, the following dose levels of carfilzomib will be studied
with constant doses of dexamethasone and cyclophosphamide to define the maximum tolerated
dose (MTD):

Level -1

1. Cyclophosphamide given orally at the dose of 300 mg/m2 on days 1, 8, 15.

2. Dexamethasone given orally at the dose of 40 mg on days 1, 8, 15, 22 or 20 mg on days
1-2, 8-9,15-16, 22-23.

3. Carfilzomib given 20 mg/m2 IV once daily on Day 1 of Cycle 1 only followed by 36 mg/m2
on days 8, 15 of Cycle 1, then for all subsequent doses 36 mg/m2 IV once daily on days
1, 8, 15, followed by 14-day rest period (day 16 through 28).

Level 0 (starting dose)

1. Cyclophosphamide given orally at the dose of 300 mg/m2 on days 1, 8, 15.

2. Dexamethasone given orally at the dose of 40 mg on days 1, 8, 15, 22 or 20 mg on days
1-2, 8-9,15-16, 22-23.

3. Carfilzomib given 20 mg/m2 IV once daily on Day 1 of Cycle 1 only followed by 45 mg/m2
on days 8, 15 of Cycle 1, then for all subsequent doses 45 mg/m2 IV once daily on days
1, 8, 15, followed by 14-day rest period (day 16 through 28).

Level +1

1. Cyclophosphamide given orally at the dose of 300 mg/m2 on days 1, 8, 15.

2. Dexamethasone given orally at the dose of 40 mg on days 1, 8, 15, 22 or 20 mg on days
1-2, 8-9,15-16, 22-23.

3. Carfilzomib given 20 mg/m2 IV once daily on Day 1 of Cycle 1 only followed by 56 mg/m2
on days 8, 15 of Cycle 1, then for all subsequent doses 56 mg/m2 IV once daily on days
1, 8, 15, followed by 14-day rest period (day 16 through 28).

Level +2

1. Cyclophosphamide given orally at the dose of 300 mg/m2 on days 1, 8, 15.

2. Dexamethasone given orally at the dose of 40 mg on days 1, 8, 15, 22 or 20 mg on days
1-2, 8-9,15-16, 22-23.

3. Carfilzomib given 20 mg/m2 IV once daily on Day 1 of Cycle 1 only followed by 70 mg/m2
on days 8, 15 of Cycle 1, then for all subsequent doses 70 mg/m2 IV once daily on days
1, 8, 15, followed by 14-day rest period (day 16 through 28).

Patients will be observed during the first cycle of therapy for the assessment of side
effects and observation of DLTs. Dose escalation will proceed as follows:

- 3 patients will be entered at dose level 0.

- If 0/3 patients experience DLT, dose escalation will continue.

- If 1/3 patients experience DLT, 3 additional patients will be added to this cohort (max
6).

- If no further patients experience DLT (1/6) dose escalation will continue.

- If 2/6 patients experience DLT, the MTD will have been exceeded and the MTD will be the
previous dose at which < 2/6 experienced DLT.

- If 2/3 patients experience a DLT at any given dose, the MTD will have been exceeded and
the MTD will be the preceding dose at which < 2/6 (or 1/3) patients experienced a DLT.

Phase II:

The dose used to treat patients in the phase II will be the MTD defined in the phase I of
the study.

MAINTENANCE PERIOD At the end of the induction phase, patients will start the maintenance
phase with Carfilzomib at the MTD defined by the phase I study IV once daily on days 1, 8,
15 until progression or intolerance.

Treatment schedule for maintenance until progression or intolerance:

Carfilzomib at the MTD defined by phase I study IV once daily on days 1, 8, 15.


Inclusion Criteria:



Disease-related

1. Patient is a newly diagnosed MM patient.

2. Patient is age ≥ 65 year of age or who are ineligible for autologous stem cell
transplantation.

3. Patient has measurable disease, defined as follows: any quantifiable serum monoclonal
protein value (generally, but not necessarily, ≥ 0.5 g/dL of M-protein) and, where
applicable, urine light-chain excretion of > 200 mg/24 hours. For patients with
oligo- or non-secretory MM, it is required that they have measurable plasmacytoma > 2
cm as determined by clinical examination or applicable radiographs (i.e. MRI,
CT-Scan) or an abnormal free light chain ratio (n.v.: 0.26-1.65). We anticipate that
less than 10% of patients admitted to this study will be oligo- or non-secretory MM
with free light chains only in order to maximize interpretation of benefit results.

Demographic:

4. Age ≥ 18 years.

5. Life expectancy ≥ 3 months.

6. Eastern Cooperative Oncology Group (ECOG) performance status 0-2 (Appendix F).

Laboratory:

7. Adequate hepatic function, with serum ALT ≤ 3.5 times the upper limit of normal and
serum direct bilirubin ≤ 2 mg/dL (34 µmol/L) within 14 days prior to randomization.

8. Absolute neutrophil count (ANC) ≥ 1.0 × 109/L within 14 days prior to randomization.

9. Corrected serum calcium ≤ 14 mg/dL (3.5 mmol/L).

10. Alanine transaminase (ALT): ≤ 3 x the ULN.

11. Hemoglobin ≥ 8 g/dL (80 g/L) within 14 days prior to randomization (subjects may be
receiving red blood cell [RBC] transfusions in accordance with institutional
guidelines).

12. Platelet count ≥ 50 × 109/L (≥ 30 × 109/L if myeloma involvement in the bone marrow
is > 50%) within 14 days prior to randomization.

13. Creatinine clearance (CrCl) ≥ 15 mL/minute within 7 days prior to randomization,
either measured or calculated using a standard formula (eg, Cockcroft and Gault).

Ethical/Other:

14. Written informed consent in accordance with federal, local, and institutional
guidelines.

15. Females of childbearing potential (FCBP) must agree to ongoing pregnancy testing and
to practice contraception.

16. Male subjects must agree to practice contraception.

Exclusion Criteria:

Disease-related:

1. Previous treatment with anti-myeloma therapy (does not include radiotherapy,
bisphosphonates, or a single short course of steroid; ≤ to the equivalent of
dexamethasone 40 mg/day for 4 days)

2. Patient with relapsed or refractory multiple myeloma.

3. Patients with non-secretory MM unless serum free light chains are present and the
ratio is abnormal.

Concurrent Conditions:

4. Pregnant or lactating females (Appendix I).

5. Major surgery within 21 days prior to randomization.

6. Acute active infection requiring treatment (systemic antibiotics, antivirals, or
antifungals) within 14 days prior to randomization.

7. Known human immunodeficiency virus infection.

8. Active hepatitis B or C infection.

9. Unstable angina or myocardial infarction within 4 months prior to randomization, NYHA
Class III or IV heart failure, uncontrolled angina, history of severe coronary artery
disease, severe uncontrolled ventricular arrhythmias, sick sinus syndrome, or
electrocardiographic evidence of acute ischemia or Grade 3 conduction system
abnormalities unless subject has a pacemaker.

10. Uncontrolled hypertension, uncontrolled congestive heart failure (CHF) or
uncontrolled diabetes within 14 days prior to randomization.

11. Non-hematologic malignancy within the past 3 years with the exception of a)
adequately treated basal cell carcinoma, squamous cell skin cancer, or thyroid
cancer; b) carcinoma in situ of the cervix or breast; c) prostate cancer of Gleason
Grade 6 or less with stable prostate-specific antigen levels; or d) cancer considered
cured by surgical resection or unlikely to impact survival during the duration of the
study, such as localized transitional cell carcinoma of the bladder or benign tumors
of the adrenal or pancreas.

12. Significant neuropathy (Grades 3-4, or Grade 2 with pain) within 14 days prior to
randomization.

13. Known history of allergy to Captisol® (a cyclodextrin derivative used to solubilize
carfilzomib).

14. Contraindication to any of the required concomitant drugs or supportive treatments,
including hypersensitivity to all anticoagulation and antiplatelet options, antiviral
drugs, or intolerance to hydration due to preexisting pulmonary or cardiac
impairment.

15. Subjects with pleural effusions requiring thoracentesis or ascites requiring
paracentesis within 14 days prior to randomization.

16. Any other clinically significant medical disease or condition that, in the
Investigator's opinion, may interfere with protocol adherence or a subject's ability
to give informed consent.

Type of Study:

Interventional

Study Design:

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Identification of Dose-limiting toxicity (DLT)

Outcome Description:

Non-hematologic: Grade2 neuropathy with pain any Grade 3 toxicity (excluding nausea, vomiting, diarrhea) Grade3 nausea, vomiting, or diarrhea despite maximal antiemetic/antidiarrheal therapy Grade4 fatigue lasting for ≥7days Any non-hematologic toxicity requiring a dose reduction within Cycle1 Inability to receive Day 1 dose of Cycle2 due to drug related toxicity persisting from Cycle1 or drug related toxicity newly encountered on Day1 of Cycle2. Hematologic: Grade 4 neutropenia (ANC<0.5x109/L) lasting for ≥7days Febrile neutropenia (ANC<1.0x109/L with a fever ≥38.3ºC) Grade 4 thrombocytopenia (platelets<25.0x109/L) lasting ≥7 days despite dose delay Grade 3-4 thrombocytopenia associated with bleeding Any hematologic toxicity requiring a dose reduction within Cycle1 Inability to receive Day1 dose of Cycle2 due to drug related toxicity persisting from Cycle1 or drug related toxicity newly encountered on Day1 of Cycle2.

Outcome Time Frame:

1 year

Safety Issue:

Yes

Authority:

Italy: Ministry of Health

Study ID:

IST-CAR-561

NCT ID:

NCT01857115

Start Date:

April 2013

Completion Date:

April 2016

Related Keywords:

  • Multiple Myeloma
  • Multiple myeloma
  • Diagnosis
  • Weekly
  • CCyd
  • Multiple Myeloma
  • Neoplasms, Plasma Cell

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