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MUK Nine b: OPTIMUM Treatment Protocol (MUKnineb)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03188172
Recruitment Status : Active, not recruiting
First Posted : June 15, 2017
Last Update Posted : May 25, 2022
Sponsor:
Collaborators:
Myeloma UK
Celgene
Janssen, LP
Information provided by (Responsible Party):
University of Leeds

Study Description
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Brief Summary:
To determine whether a combination of four novel agents bortezomib(Velcade), lenalidomide (Revlimid), Daratumumab (Darzalex) & dexamethasone in combination with low-dose cyclophosphamide is sufficiently active in a high risk population of myeloma patients, to take forward into a phase III trial compared to standard treatment.

Condition or disease Intervention/treatment Phase
Multiple Myeloma Drug: Cyclophosphamide Drug: Bortezomib Drug: Lenalidomide Drug: Daratumumab Drug: Dexamethasone Drug: Melphalan Drug: Filgrastim Phase 2

Detailed Description:

Multiple myeloma (MM) is a plasma cell tumour with an annual incidence in the UK of approximately 40 -50 per million i.e. 4500 new cases per annum. Approximately 20% of the patients diagnosed with multiple myeloma have a significantly worse prognosis at 3 years than other multiple myeloma patients and these are characterised as having high risk (HR) disease defined by genetic lesions and gene expression profiles (GEP). There have been no significant improvements in outcome over the last decade for patients with HR disease. Therefore, it is important to identify more effective treatment options for this group of patients especially given that the number of novel agents are potentially available and which can be given as part of intensive therapy regimen.

Intensive treatment in HR patients has been used outside the UK with promising results but access to drugs in the UK has been challenging with constraints in the NHS treatment pathway. This is the first time in the UK that newly diagnosed multiple myeloma patients may be entered into a clinical trial prospectively according to their genetic risk profile. It provides a unique opportunity to improve outcomes and provide evidence for high cost novel treatment strategies in this restricted population of poor prognosis patients.

The MUKnine trial is designed to evaluate the novel treatment strategies for multiple myeloma patients with HR disease and incorporate a genetic screening component. Patients identified as having HR disease are then invited to take part in the phase II single arm, multi centre trial that investigates the intensive treatment schedule comprising four novel agents bortezomib (Velcade), lenalidomide (Revlimid), daratumumab (Daralex), dexamethasone with cyclophosphamide. The trial will determine if this treatment strategy is sufficiently active to take forward in to further testing in this population. Patients identified as not having HR disease will receive standard local treatment and will be followed up in a cohort study to assess response, progression free survival and overall survival.

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 95 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: The trial is designed as a single arm phase II trial with interim assessments for futility, using a Bayesian strategy for monitoring multiple outcomes.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: MUK Nine b: OPTIMUM. A Phase II Study Evaluating Optimised Combination of Biological Therapy in Newly Diagnosed High Risk Multiple Myeloma and Plasma Cell Leukaemia.
Actual Study Start Date : September 28, 2017
Estimated Primary Completion Date : December 31, 2022
Estimated Study Completion Date : June 30, 2023

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Multiple Myeloma

Arms and Interventions
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Arm Intervention/treatment
Experimental: Trial Treatment

Induction:

Cyclophosphamide 500mg, days 1, 8 Bortezomib 1.3mg/m2, days 1, 4, 8, 11 Lenalidomide 25mg, days 1-14 Daratumumab 16mg/kg, days 1, 8, 15 (cycles 1& 2), day 1 only from cycle 3 Dexamethasone 20-40mg, days 1, 4, 8, 11

ASCT stem cell harvest:

with Bortezomib 1.3mg/m2, (12 hours post melphalan) Bortezomib 1.3mg/m2, day +5, +14, weekly

Consolidation part 1:

Bortezomib 1.3mg/m2 days 1, 8, 15, 22 Lenalidomide 25mg days 1-21 Daratumumab 16mg/kg day 1 Dexamethasone 20-40mg days 1, 8, 15, 22

Consolidation part 2:

Bortezomib 1.3mg/m2 days 1, 8, 15 Lenalidomide 25mg days 1-21 Daratumumab 16mg/kg day 1

Maintenance:

Lenalidomide 10mg days 1-21 Daratumumab 16mg/kg day 1

 Drug: Cyclophosphamide
Chemotherapy

Drug: Bortezomib
Chemotherapy
Other Name: Velcade

Drug: Lenalidomide
Chemotherapy
Other Name: Revlamid

Drug: Daratumumab
Chemotherapy
Other Name: Daralex

Drug: Dexamethasone
Chemotherapy

Drug: Melphalan
Chemotherapy

Drug: Filgrastim
Haematopoietic agent for the stem cell harvest


Outcome Measures
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Primary Outcome Measures :
  1. Progression free survival [ Time Frame: At 18 months post registration ]
    Defined as the time from registration until first documented evidence of progressive disease or death. Participants not progressed at analysis will be censored at the last date known to be alive and progression free.


Secondary Outcome Measures :
  1. Occurrence of Serious Adverse Events(SAE) and Suspected, Unexpected Serious Adverse Reactions (SUSAR) [ Time Frame: At 120 days post autologous stem cell transplant (ASCT) ]
    Will be reported based on occurrence of SAE & SUSARs with details of causality and expectedness.

  2. Progression free survival at 100 days post autologous stem cell transplant [ Time Frame: At 100 days post ASCT ]
    Determine whether the treatment schedule should be dropped for futility

  3. Minimal residual disease (MRD) negative disease [ Time Frame: At 100 days post ASCT ]
    Defined as absence of aberrant phenotype plasma cells

  4. Overall survival [ Time Frame: At 12 months, 24 months & 36 months post registration ]
    Median overall survival estimates

  5. Maximum response [ Time Frame: From registration to end of induction therapy, 100 days post ASCT, post consolidation part 2 ]
    Proportion of participants achieving each response category. Time from registration until the participant achieves a maximum response.

  6. Overall response [ Time Frame: At end of induction therapy, 100 days post ASCT, post consolidation part 2 ]
    Proportion of participants receiving at least a partial response

  7. Second progression free survival [ Time Frame: From registration until second disease progression, 3 years ]
    Time from registration to second disease progression or death.

  8. Overall treatment benefit [ Time Frame: At the end of induction therapy and 100 days post autologous stem cell transplant ]
    Clinician assessment of treatment benefit will be obtained

  9. Quality of Life [ Time Frame: From registration until second disease progression, 3 years ]
    Based on EQ-5D outcome measure combined with EORTC QLQ-C30 and MY20 responses


Other Outcome Measures:
  1. Progression free survival (comparison with Myeloma XI/XI+ data) [ Time Frame: From registration until second disease progression, 3 years ]
    Matched comparison of progression free survival

  2. Impact of minimal residual disease on progression free survival [ Time Frame: From registration until second disease progression, 3 years ]
    Analysis will include any participant with a MRD assessment

  3. Genomic instability [ Time Frame: From registration until second disease progression, 3 years ]
    To be investigated in an exploratory manner and will include analysis of new genetic abnormalities


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 100 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Confirmation of High Risk status from Institute of Cancer Research (ICR) following bone marrow and blood sample processed through the MUKnine a screening protocol.
  2. Previously untreated participants, although participants may have received up to 2 cycles of cyclophosphamide, thalidomide, dexamethasone (CTD), cyclophosphamide, velcade, dexamethasone (CVD), cyclophosphamide, lenalidomide, dexamethasone (CRD) or velcade, thalidomide, dexamethasone (VTD) pre-trial induction chemotherapy while awaiting the results of the laboratory analysis from the MUKnine a Screening Protocol. (In addition, non-systemic therapy such as therapeutic plasma exchange, dexamethasone up to a maximum of 160mg or radiotherapy sufficient to alleviate or control pain or local invasion is permitted).

  3. Measurable disease with at least one of the following or willing to undergo further bone marrows for assessment:

    - Paraprotein ≥ 5g/L or ≥ 0.5 g/L for IgD subtypes.

    - Serum free kappa or lambda light chains ≥ 100 mg/L with abnormal ratio (for light chain only myeloma).

    - Urinary Bence Jones protein ≥ 200 mg/L.

  4. Non measurable participants providing they accept a 3 monthly bone marrow during induction and a 6 monthly bone marrow assessment during consolidation and maintenance.
  5. Aged 18 years or over.
  6. Fit for intensive chemotherapy and autologous stem cell transplant (at clinician's discretion).
  7. Eastern Cooperative Oncology Group (ECOG) Performance Status ≤2.

  8. The Celgene Pregnancy Prevention Plan must be followed and participants must agree to comply with this:

    • Females of childbearing potential (FCBP) must agree to utilise two reliable forms of contraception simultaneously or practice complete abstinence for at least for 28 days prior to starting trial treatment, during the trial and for at least 28 days after trial treatment discontinuation, and even in case of dose interruption, and must agree to regular pregnancy testing during this timeframe.
    • Males must agree to use a latex condom during any sexual contact with FCBP during the trial, including during dose interruptions and for 28 days following discontinuation from this trial even if he has undergone a successful vasectomy o Males must also agree to refrain from donating semen or sperm while on trial treatment including during any dose interruptions and for at least 6 months after discontinuation from this trial
    • All participants must agree to refrain from donating blood while on trial drug including during dose interruptions and for 28 days after discontinuation from this trial.
  9. Calculated creatinine clearance ≥ 30mL/min (using Cockcroft-Gault formula).
  10. Alanine transaminase (ALT) and/or Aspartate transaminase (AST) ≤ 2.5 times upper limit of normal (ULN).
  11. Bilirubin ≤ 2.0 x ULN, except in participants with congenital bilirubinemia, such as Gilbert syndrome (direct bilirubin ≤2.0 times ULN
  12. Platelet count ≥ 75 x 109/L. (≥ 50 x 109/L if myeloma involvement in the bone marrow is >50%). Platelet support is permitted.
  13. Absolute neutrophil count (ANC) ≥ 1.0 x 109/L. Growth factor support is permitted.
  14. Haemoglobin ≥ 80 g/L. (Participants may be receiving red blood cell (RBC) transfusions in accordance with institutional guidelines.
  15. Corrected serum calcium ≤ 3.5 mmol/L.

Exclusion Criteria:

  1. Solitary bone/solitary extramedullary plasmacytoma.
  2. Primary diagnosis of amyloidosis, monoclonal gammopathy of undetermined significance or smoldering multiple myeloma or Waldenstrom's Disease.

  3. Prior or concurrent invasive malignancies except the following:

    • Adequately treated basal cell or squamous cell skin cancer.
    • Incidental finding of low grade (Gleason 3+3 or less) prostate cancer.
    • Any cancer from which the subject has been disease free for at least 3 years.
  4. Known/underlying medical conditions that, in the investigator's opinion, would make the administration of the study drug hazardous (e.g. uncontrolled diabetes or uncontrolled coronary artery disease).

  5. Any clinically significant cardiac disease, including:

    - myocardial infarction within 1 year before randomization, or an unstable or uncontrolled disease/condition related to or affecting cardiac function (e.g., unstable angina, congestive heart failure, New York Heart Association Class III-IV.

    - Uncontrolled cardiac arrhythmia (National Cancer Institute Common Terminology Criteria for Adverse Events [NCI CTCAE] Version 4 Grade ≥2) or clinically significant ECG abnormalities.

    - screening 12-lead ECG showing a baseline QT interval as corrected by Fridericia's formula (QTcF) >470 msec. · Known chronic obstructive pulmonary disease (COPD) (defined as a forced expiratory volume [FEV] in 1 second <60% of predicted normal), persistent asthma, or a history of asthma within the last 2 years (intermittent asthma is allowed). Participants with known or suspected COPD or asthma must have a FEV1 test during screening.

  6. Known to be seropositive for history of human immunodeficiency virus (HIV) or known to have active hepatitis B or hepatitis C.
  7. Any known allergies, hypersensitivity, or intolerance to corticosteroids, monoclonal antibodies or human proteins, or their excipients (refer to respective package inserts), or known sensitivity to mammalian-derived products.
  8. Clinically significant allergies or intolerance to cyclophosphamide, lenalidomide, velcade, daratumumab or dexamethasone. · Previous treatment with daratumumab or any other anti-CD38 therapies.
  9. Participants with contraindication to thromboprophylaxis.
  10. Grade 2 or greater peripheral neuropathy (per NCI-CTCAEv4.0).
  11. Participants with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes).
  12. Any concurrent medical or psychiatric condition or disease (e.g., active systemic infection, uncontrolled diabetes, acute diffuse infiltrative pulmonary disease) that is likely to interfere with the study procedures or results, or that in the opinion of the investigator, would constitute a hazard for participating in this study.
  13. Known or suspected of not being able to comply with the study protocol (e.g., because of alcoholism, drug dependency, or psychological disorder). Participant has any condition for which, in the opinion of the investigator, participation would not be in the best interest of the subject (e.g., compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments.
  14. Participant is a woman who is pregnant, or breast-feeding, or planning to become pregnant while enrolled in this trial or within at least 6 months after the last dose of trial treatment. Or, participant is a man who plans to father a child while taking part in this trial or within at least 6 months after the last dose of trial treatment.
  15. Major surgery within 2 weeks before treatment protocol registration or has not fully recovered from surgery, or has surgery planned during the time the participant is expected to participate in the study. Kyphoplasty or vertebroplasty is not considered major surgery.
  16. Received an investigational drug (including investigational vaccines) or used an invasive investigational medical device within 4 weeks before treatment protocol registration or is currently enrolled in an interventional investigational study.

Inclusion Criteria for ASCT

  1. Minimum stem cell harvest of 2 x 106 CD34+ cells/kg body weight.
  2. Received a minimum of 4, unless a complete response (CR) has been achieved with a lesser number, or a maximum of 6 Induction (CVRDd) cycles.
  3. Achieved a response of stable disease (SD) or better.

Exclusion Criteria for ASCT 1. Participants that have progressive disease.

Inclusion Criteria for Consolidation Part 1 (VRDd)

  1. Undergone autologous transplant with high dose melphalan-velcade (HDM-V) conditioning (Participants must have received a minimum of 100 mg/m2 Melphalan in order to proceed with consolidation).
  2. Neutrophils ≥ 1.0 x 109/L. Growth factor support is permitted.
  3. Platelet count ≥ 75 x 109/L. Platelet support is permitted.

Exclusion Criteria for Consolidation Part 1 (VRDd)

1. Participants that have progressive disease.

Inclusion Criteria for Consolidation Part 2 (VRD)

  1. Received 6 cycles of Consolidation Part 1 (VRDd) or 1 cycle of VRd pre-harvest plus 5 cycles of Consolidation Part 1 (VRDd).
  2. Neutrophils ≥ 1.0 x 109/L. Growth factor support is permitted.
  3. Platelet count ≥ 75 x 109/L. Platelet support is permitted.

Exclusion Criteria for Consolidation Part 2 (VRD)

1. Participants that have progressive disease.

Inclusion Criteria for Maintenance (RD)

  1. Received 12 cycles of Consolidation Part 2 (VRD).
  2. Neutrophils ≥ 1.0 x 109/L. Growth factor support is permitted.
  3. Platelet count ≥ 75 x 109/L. Platelet support is permitted.

Exclusion Criteria for Maintenance (RD)

1. Participants that have progressive disease.

Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03188172


Locations
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Sponsors and Collaborators
University of Leeds
Myeloma UK
Celgene
Janssen, LP
Investigators
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Principal Investigator: Martin Kaiser University of Leeds
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: University of Leeds
ClinicalTrials.gov Identifier: NCT03188172    
Other Study ID Numbers: HM16/235
First Posted: June 15, 2017    Key Record Dates
Last Update Posted: May 25, 2022
Last Verified: May 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Multiple Myeloma
Neoplasms, Plasma Cell
Neoplasms by Histologic Type
Neoplasms
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Paraproteinemias
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Lymphoproliferative Disorders
Immunoproliferative Disorders
Immune System Diseases
Dexamethasone
 Cyclophosphamide
Melphalan
Lenalidomide
Bortezomib
Daratumumab
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Anti-Inflammatory Agents