Ixazomib, Pomalidomide, and Dexamethasone for the Treatment of Recurrent or Refractory Multiple Myeloma
- Previously diagnosed with multiple myeloma (MM) based on standard International Myeloma Working Group (IMWG) criteria and currently requires treatment
- Patient has given voluntary written informed consent before performance of any study-related procedures not part of normal medical care, with the understanding that consent may be withdrawn by the patient at any time without prejudice to their future medical care
- Patient has received at least two previous therapies who now demonstrate progression OR who have received an immunomodulatory imide drug (IMiD) plus a proteasome inhibitor as their first line of therapy and has demonstrated disease progression on or within 60 days of completion of the last therapy
- Patient has measurable disease defined as at least one of the following according to Standard Diagnostic Criteria: * Serum IgG, IgA, or IgM M-protein >= 0.5 g/dL, or * Serum IgD M-protein >= 0.05 g/dL, or * Urine M protein >= 200 mg/24 hours or * Serum free light chain (FLC) assay: Involved FLC assay >= 10 mg/dL (>= 100 mg/L) and an abnormal serum FLC ratio (< 0.26 or > 1.65)
- Absolute neutrophil count (ANC) >= 1,000 cells/dL (1.0 x 10^9/L) (Growth factors cannot be used more recently than 14 days prior to initiation of therapy)
- Platelet count >= 75,000 cells/dL (75 x 10^9/L) (without transfusions required during the 14 days prior to initiation of therapy)
- Hemoglobin >= 8.0 g/dl (red blood cell [RBC] transfusions are permitted)
- Total bilirubin =< 1.5 X upper limit of normal (ULN) (except subjects with Gilbert syndrome, who can have total bilirubin < 3.0 mg/dL)
- Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3.0 x ULN
- Calculated creatinine clearance >= 45 mL/min
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
- All study participants must be registered into the mandatory pomalidomide (POMALYST) Risk Evaluation and Mitigation Strategy (REMS) program, and be willing and able to comply with the requirements of the POMALYST REMS program
- Females of reproductive potential must adhere to the scheduled pregnancy testing as required in the POMALYST REMS program
- Ability to understand and the willingness to sign a written informed consent document
- Prior exposure to ixazomib OR is refractory to pomalidomide * Patients that have previously been treated with ixazomib, or participated in a study with ixazomib, whether treated with the agent or not, are also excluded
- Participation in other clinical trials, including those with other investigational agents not included in this trial, within 30 days of the start of this trial and throughout the duration of this trial • Participants on prior clinical trials with agents that are already Food and Drug Administration (FDA) approved for use in multiple myeloma need only have a washout appropriate for the drug(s) class as outlined • Investigational agents for indications other than for their disease under study may be approved after review and approval by the overall principal investigator (PI)
- Diagnosed or treated for another malignancy within 3 years prior to enrollment, with the exception of complete resection of basal cell carcinoma or squamous cell carcinoma of the skin, an in situ malignancy, or low risk prostate cancer after curative therapy
- Known gastrointestinal (GI) disease or is in need of, or has had a previous GI procedure that could interfere with the oral absorption or tolerance of ixazomib or pomalidomide including difficulty swallowing
- Known central nervous system involvement
- Systemic treatment, within 14 days before the first dose of treatment, with strong CYP3A or inducers (rifampin, rifapentine, rifabutin, carbamazepine, phenytoin, phenobarbital), or use of St. John’s wort OR systemic treatment within 14 days of the first dose of treatment with a strong inhibitor of CYP1A2 (ciprofloxacin, fluvoxamine, cimetidine, enoxacin, ethynyl estradiol, mexiletine)
- Any medical or psychiatric illness/social situation that in the Investigator’s opinion, would impose excessive risk to the patient, would adversely affect his/her participating in this study or would limit compliance with study requirements
- Any active, or uncontrolled cardiovascular conditions, including but not limited to uncontrolled hypertension, uncontrolled cardiac arrhythmias, symptomatic congestive heart failure, unstable angina, grade 3 thromboembolic event or myocardial infarction within the past 6 months
- The following therapies within the stated time frames prior to initiation of therapy: * Previous cytotoxic therapies, including cytotoxic investigational agents, for multiple myeloma within 21 days (42 days for nitrosoureas) * The use of live vaccines within 30 days * ImiDs or proteasome inhibitors within 14 days * Other investigational therapies and/or monoclonal antibodies within 4 weeks * Prior peripheral stem cell transplant within 12 weeks * Prior allogeneic stem cell transplantation with active graft-versus-host-disease
- Currently active graft versus host disease of any stage or grade after allogeneic stem cell transplantation
- Prior major surgical procedure or radiation therapy within 14 days of initiation of therapy * Those who require a limited course of radiation for management of bone pain more than 14 days out from initiation of therapy are not excluded * If the involved field is small, 7 days will be considered a sufficient interval between radiotherapy and administration of the ixazomib
- Daily requirement for corticosteroids (equivalent to > 10 mg/day prednisone, though > 10 mg/day is acceptable if physiological levels require, so long as the dose is stable for at least 7 days prior to initiation of therapy. Inhalation corticosteroids are exempt from this criterion * Lower amounts of corticosteroids that are not part of a daily requirement within 14 days prior to initiating therapy
- Concurrent symptomatic amyloidosis or plasma cell leukemia
- POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes)
- Infection requiring systemic antibiotic therapy or other serious infection within 14 days of starting therapy * Those who are on prophylactic antibiotics only, or on antibiotics and have confirmation of resolution of active infection are eligible
- Known seropositive for active viral infection with human immunodeficiency virus (HIV) hepatitis B (hepatitis B virus [HBV]) or hepatitis C viral (HCV). Those who are seropositive because of hepatitis B vaccine are eligible. Patients who are positive for HBV core antibody or HBV surface antigen must have a negative polymerase chain reaction (PCR) result prior to enrollment. Those who are PCR positive will be excluded
- Female patients who are lactating or have a positive serum pregnancy test during the screening period
- Participants who are receiving any other investigational agents for any indication
- History of erythema multiforme or severe hypersensitivity to prior IMiD’s or those who have a known allergy to any of the study medications, their analogues, or excipients in the various formulations of any agent
- Inability to tolerate thromboprophylaxis
- Failure to have fully recovered (=< grade 1 according to Common Terminology Criteria for Adverse Events [CTCAE] version [v] 5) from the reversible effects of prior chemotherapy * Peripheral neuropathy must have resolved to =< grade 1 toxicity or peripheral neuropathy grade 2 with no pain to be eligible * Alopecia of any grade is eligible
I. To determine the maximum tolerated dose of this combination in the dose escalation Phase I portion.
II. To determine the overall response rate and clinical benefit rate in the Phase II portion of the study.
III. To evaluate the safety of this combination in patients with multiple myeloma.
I. To assess time to progression.
II. To assess the progression free survival.
III. To assess duration of response.
IV. To assess overall survival.
V. To determine minimal residual disease (MRD) rate in those who achieve complete response (CR) by International Myeloma Working Group (IMWG) criteria at any time during treatment.
CORRELATIVE STUDY OBJECTIVES:
I. To characterize somatic aberrations present in cell free deoxyribonucleic acid (DNA) (cfDNA) and circulating tumor cells (CTCs) as biomarkers of response/ resistance to ixazomib citrate (ixazomib)/pomalidomide (pom)/dexamethasone (dex).
II. To define markers of the permissive bone marrow microenvironment that characterize risks of progression in multiple myeloma (MM).
III. To define the immune-oncogenomic landscape of MM in response to therapy.
OUTLINE: This is a phase I, dose-escalation study of ixazomib citrate and pomalidomide followed by a phase II study.
Patients receive ixazomib citrate orally (PO) on days 1, 4, 8, and 11, pomalidomide PO once daily (QD) on days 1-14, and dexamethasone PO on days 1, 2, 4, 5, 8, 9, 11, and 12. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, all patients are followed up at 4 weeks. Patients without disease progression after completion of study treatment are followed every month until disease progression, then every 3 months for up to 24 months total. Patients with disease progression after completion of study treatment are followed every 3 months for up to 24 months.
Trial Phase Phase I/II
Trial Type Treatment
Dana-Farber Harvard Cancer Center
- Primary ID 19-291
- Secondary IDs NCI-2019-07333
- Clinicaltrials.gov ID NCT04094961