Aggressive Smoldering Curative Approach Evaluating Novel Therapies and Transplant

Running, not enrolling · Phase 2

Conditions studied: Smoldering Multiple Myeloma

In brief

This study evaluates the use of carfilzomib, lenalidomide, daratumumab, and dexamethasone in subjects with high-risk smoldering multiple myeloma (SMM). Subjects will receive treatment in 3 phases - induction (6 cycles), consolidation (6 cycles), and maintenance (12 cycles). Each cycle is 28 days.

Key facts

Study ID

NCT03289299

Run by

International Myeloma Foundation

People needed

87

Starts

2018-05-25

Expected to finish

2031-11-15

Last updated by the study team

2023-12-12

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Age 18 years and ≤ 80 years
• High risk smoldering myeloma, which is untreated, as defined by either of the two following criteria:
• Presence of any two of the following: Serum M spike > 2 gm/dL OR an involved to uninvolved free light chain (FLC) ratio > 20 OR bone marrow PC% > 20%
• Total score of 9 or above using the following scoring system:
• FLC Ratio >10-25 = 2 >25-40 = 3 > 40 = 5
• Serum M Protein (g/dL) >1.5-3 = 3 >3 = 4
• BMPC% >15-20 = 2 >20-30 = 3 >30-40 = 5 >40 = 6
• FISH abnormality (t(4,14), t(14,16), 1q gain, or del13q = 2
• The following laboratory values obtained 14 days prior to registration.
• Calculated creatinine clearance (using Cockcroft-Gault equation below)* ≥ 30 mL/min
• Absolute neutrophil count (ANC) ≥ 1000/mm3 (without the use of growth factors)
• Platelet count ≥ 75000/mm3
• Hemoglobin ≥8.0 g/dL
• Total bilirubin ≤ 1.5 x upper limit of normal (ULN)
• alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 x ULN
• left ventricular ejection fraction (LVEF) ≥ 40%
• LVEF ≥ 40%
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1 (Appendix VII)
• Previously untreated.
• Provide informed written consent.
• Negative pregnancy test done ≤14 days prior to cycle 1 day 1, for women of childbearing potential only.
• All study participants must be registered into the mandatory Revlimid Risk Evaluation and Mitigation Strategy (REMS®) program and be willing and able to comply with the requirements of the REMS® program.
• Females of reproductive potential must adhere to the scheduled pregnancy testing as required in the Revlimid REMS® program.
• Willing to follow strict birth control measures as outlined in the protocol.
• Female subjects: If they are of childbearing potential, agree to one of the following:

You may not qualify if…

• monoclonal gammopathy of undetermined significance (MGUS), standard risk smoldering myeloma, active myeloma by current IMWG definition, light chain amyloidosis with organ involvement or patients with extramedullary disease.
• Diagnosed or treated for another malignancy ≤ 2 years before trial enrollment or previously diagnosed with another malignancy and have any evidence of residual disease. NOTE: Subjects with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection.
• If any of the following exist at screening, subject will not be eligible for trial because this trial involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:
• Pregnant women
• Nursing women
• Men or women of childbearing potential who are unwilling to employ adequate contraception (per protocol)
• Other co-morbidity which would interfere with subject's ability to participate in trial, e.g. uncontrolled infection, uncompensated heart or lung disease.
• Other concurrent chemotherapy, or any ancillary therapy considered investigational. NOTE: Bisphosphonates are considered to be supportive care rather than therapy, and are thus allowed while on protocol treatment.
• Peripheral neuropathy ≥ Grade 3 on clinical examination or grade 2 with pain within 30 days prior to C1D1.
• Major surgery ≤14 days prior to C1D1.
• Evidence of current uncontrolled cardiovascular conditions, including hypertension, cardiac arrhythmias, congestive heart failure, unstable angina, or myocardial infarction within the past 6 months. Note: Prior to trial entry, any ECG abnormality at screening must be documented by the investigator as not medically relevant.
• New York Heart Association (NYHA) II, III, IV heart failure
• Known human immunodeficiency virus (HIV) positive.
• Seropositive for hepatitis B (defined by a positive test for hepatitis B surface antigen [HBsAg]). Subjects with resolved infection (ie., subjects who are HBsAg negative but positive for antibodies to hepatitis B core antigen [anti-HBc] and/or antibodies to hepatitis B surface antigen [anti-HBs]) must be screened using real-time polymerase chain reaction (PCR) measurement of hepatitis B virus (HBV) DNA levels. Those who are PCR positive will be excluded. EXCEPTION: subjects with serologic findings suggestive of HBV vaccination (anti-HBs positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA by PCR.
• Known or suspected active hepatitis C infection.
• Any medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol.
• Prior radiation therapy for bony lesions or plasmacytomas
• Known allergies, hypersensitivity, or intolerance to corticosteroids, monoclonal antibodies or human proteins, or their excipients (refer to respective package inserts or Investigator's Brochure), or known sensitivity to mammalian-derived products. Known allergies, hypersensitivity, or intolerance to trial drugs.
• Inability to comply with protocol/procedures.

Where it is running

• Moffitt Cancer Center — Tampa, Florida, United States
• University of Chicago Medical Center — Chicago, Illinois, United States
• Indiana University Simon Cancer Center — Indianapolis, Indiana, United States
• University of Kansas Cancer Center — Westwood, Kansas, United States
• University of Maryland Medical Center — Baltimore, Maryland, United States
• Mayo Clinic — Rochester, Minnesota, United States
• Weill Cornell Medicine — New York, New York, United States
• Levine Cancer Institute — Charlotte, North Carolina, United States
• Swedish Cancer Institute — Seattle, Washington, United States
• Medical College of Wisconsin — Milwaukee, Wisconsin, United States

Full record on ClinicalTrials.gov

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