Vactosertib and Pomalidomide in Treating Patients with Relapsed or Relapsed and Refractory Multiple Myeloma

Inclusion Criteria

• 18 years of age or older
• Patient has given voluntary written informed consent before performance of any study-related procedures not part of standard (non-investigational) medical care
• Patient has been previously diagnosed with multiple myeloma (MM) based on standard International Myeloma Working Group (IMWG) criteria
• Patient must have relapsed or refractory disease according to international uniform response criteria and must have previously received therapy with a proteasome inhibitor and an immunomodulatory imide drug (IMiD)
• All subjects must have documented disease progression during or after their last antimyeloma therapy
• Patient has an Eastern Cooperative Oncology Group (ECOG) performance status score =< 2
• Patient has measurable disease defined as having at least one of the following: * Serum M protein >= 0.5 /dL (>= 5 g/L) * Urine M protein >= 200 mg/24 hours * 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) >= 1000 cells/ul (growth factor cannot be used within the previous 5 days) (obtained within 14 days [or as stipulated] prior to study drug [treatment] administration)
• Platelet count >= 50,000/ul (without platelet transfusion in the previous 5 days) (obtained within 14 days [or as stipulated] prior to study drug [treatment] administration)
• Aspartate aminotransferase / serum glutamic-oxaloacetic transaminase (AST/SGOT) and alanine aminotransferase / serum glutamate pyruvate transaminase(ALT/SGPT) < 3.0 x upper limit of normal (ULN) (obtained within 14 days [or as stipulated] prior to study drug [treatment] administration)
• Total bilirubin =< 2.0 mg/dL or > 3.0 x ULN for subjects with hereditary benign hyperbilirubinemia (obtained within 14 days [or as stipulated] prior to study drug [treatment] administration)
• Creatinine clearance >= 30 ml/min (calculated by the Cockcroft-Gault Equation or per 24-hour urine collection) (obtained within 14 days [or as stipulated] prior to study drug [treatment] administration)
• Serum calcium (corrected for albumin) level at or below the ULN range (treatment of hypercalcemia is allowed and subject may enroll if hypercalcemia returns to normal range with standard treatment) (obtained within 14 days [or as stipulated] prior to study drug [treatment] administration)
• Females of childbearing potential (FCBP)* must have a negative serum or urine pregnancy test prior to initiation of the study treatment with vactosertib /POM; the test must have a sensitivity of at least 50 mIU/mL; study participants who are FCBP must either commit to continued abstinence from heterosexual intercourse or begin two acceptable methods of birth control, one highly effective method and one additional effective method at the same time, at least 28 days before she starts taking POM through 30 days after the last dose of POM and 60 days after the last dose of vactosertib; FCBP must also agree to ongoing pregnancy testing during the entire duration of treatment; all patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure; all patients enrolled into this trial, must agree to be registered in and must comply with all requirements of the POM Risk Evaluation and Mitigation Strategy (REMS) program * A female of childbearing potential (FCBP) is a sexually mature female who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
• Male subjects must agree to use a latex or synthetic condom during sexual contact with a FCBP even if they have had a vasectomy from the time of signing the informed consent form through 60 days after the last dose of POM or vactosertib; male subjects must not donate sperm; all patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure; all patients enrolled into this trial, must agree to be registered in and must comply with all requirements of the POM REMS program

Exclusion Criteria

• Prior therapy with vactosertib or received any investigational drug within the prior 28 days
• Plasma cell leukemia
• Patients with solitary plasmacytoma
• Patients who are primarily eligible for autologous stem cell transplant
• Prior anti-cancer therapy (chemotherapy, targeted agents, radiotherapy, and immunotherapy) within the prior 21 days except for alkylating agents (e.g. melphalan) within the prior 28 days
• Prior treatment with pomalidomide
• Subjects with active malignancy and/or cancer history that may confound the assessment of the study endpoints; patients with a past cancer history (within 2 years of entry) with substantial potential for recurrence and/or ongoing active malignancy must be discussed with the principal investigator (PI) before study entry; this exclusion criterion does not apply to: non-melanoma skin cancer, carcinoma in situ (including superficial bladder cancer), cervical intraepithelial neoplasia, and organ-confined prostate cancer with no evidence of progressive disease
• Any > grade 1 (according to the National Cancer Institute [NCI] Common Terminology Criteria for Adverse Events [CTCAE] version [v.]4.03) adverse reaction unresolved from previous treatments or not readily managed and controlled with supportive care; the presence of alopecia of any grade and peripheral neuropathy =< grade 2 without pain is allowed
• Has received high-dose melphalan and autologous stem cell transplant (HDM-ASCT) within 12 weeks before the first infusion or are planning for HDM-ASCT
• Previous allogeneic stem cell transplantation with active graft versus host disease (GVHD), or treatment with immunosuppressive therapy (excluding corticosteroids) in the 2 months prior to study entry
• Use of any oral corticosteroids 3 days before initiating combinations vactosertib/POM; inhaled corticosteroids are permitted
• Patient is known to be human immunodeficiency virus (HIV) positive, or have chronic or active hepatitis B (core- or surface antigen-positive) or active hepatitis C infection
• Clinically significant cardiovascular disease (e.g., uncontrolled or any New York Heart Association [NYHA] class 3 or 4, congestive heart failure, uncontrolled or unstable angina, history of myocardial infarction or stroke within 6 months prior to study entry, or clinically significant arrhythmias not controlled by medication)
• Major abnormalities identified by electrocardiogram (ECG) or echocardiogram (ECHO), at the investigator’s discretion
• Presence of aneurysms of the ascending aorta or aortic stress
• Hypertension that is not controlled by standard medication (to 150/90 mmHg or below)
• Uncontrolled, clinically significant pulmonary disease (e.g., chronic obstructive pulmonary disease [COPD], pulmonary hypertension) that in the opinion of the investigator would put the patient at significant risk for pulmonary complications during the study
• Uncontrolled intercurrent illness including, but not limited to, uncontrolled infection, disseminated intravascular coagulation (DIC), or psychiatric illness/social situations that would limit compliance with study requirements
• History of erythema multiforme or severe hypersensitivity to prior IMiD’s such as thalidomide and lenalidomide
• Patients requiring hemodialysis
• The patient is receiving medications that are: * Drugs which are exclusively or primarily eliminated by cytochrome P-450 isozyme 3A4 (CYP3A4) * Drugs which are exclusively or primarily eliminated by UDP-glucuronyl transferase 1A1 (UGT1A1) * Drugs which are substrates for the drug transporter multidrug resistance protein 1 (MDR1) have a narrow therapeutic window; or which are strong inhibitors of drug transporter MDR1 ** Patients should have discontinued strong CYP1A2 inhibitors (e.g. ciprofloxacin and fluvoxamine) at least five half-lives before beginning study treatment
• Inability to tolerate thromboprophylaxis