Radioimmunotherapy (111Indium/225Actinium-DOTA-daratumumab) for the Treatment of Relapsed/Refractory Multiple Myeloma

Recruiting now · Phase 1

Conditions studied: Recurrent Plasma Cell Myeloma, Refractory Plasma Cell Myeloma

In brief

This phase I trial tests the safety, side effects, and best dose of actinium Ac 225-DOTA-daratumumab (225Ac-DOTA-daratumumab) in combination with daratumumab and indium In 111-DOTA-daratumumab (111In-DOTA-daratumumab) in treating patients with multiple myeloma that does not respond to treatment (refractory) or that has come back (recurrent). Daratumumab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. 111In-DOTA-daratumumab and 225Ac-DOTA-daratumumab are forms of radioimmunotherapy in which a monoclonal antibody, daratumumab, has been linked to a radiotracer to allow for targeted delivery of the treatment to cancer cells. Giving all three together may kill more cancer cells.

Key facts

Study ID: NCT05363111
Run by: City of Hope Medical Center
People needed: 15
Starts: 2022-11-22
Expected to finish: 2027-03-23
Last updated by the study team: 2025-10-29

Who can join

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

You may qualify if…

Documented informed consent of the participant and/or legally authorized representative
Assent, when appropriate, will be obtained per institutional guidelines
Age >= 18 years
Karnofsky performance status (KPS) > 60%
Multiple myeloma according to International Myeloma Working Group (IMWG) criteria with measurable disease defined as one of the following:
Serum monoclonal protein >= 1.0 g/dL (or 0.5 g/dL in patients with immunoglobulin A [IgA] multiple myeloma [MM])
24 hour urine monoclonal protein >= 200 mg/24 hour
Serum free light chain (FLC) of > 10 mg/dL and an abnormal kappa:lambda ratio
Minimum of two prior lines of therapy
Previously received treatment with all of the following: a proteasome inhibitor, an immunomodulatory drug, and an anti-CD38 monoclonal antibody. Refractory (defined per IMWG Consensus Criteria) to daratumumab
CD38 expression on multiple myeloma (MM) cells from bone marrow aspirate or biopsy as demonstrated by flow cytometry or immunohistochemistry
Refractory (defined per IMWG Consensus Criteria) or intolerant to most recent therapy
Fully recovered from the acute toxic effects (except alopecia) to =< grade 1 to prior anti-cancer therapy
Prior antitumor therapy must have been completed prior to enrollment as follows:
>= 21 days for investigational agents, cytotoxic chemotherapy
>= 21 days for radiation therapy. Note: Patients must have measurable disease that has been untreated/unaffected by local radiation therapy
>= 3 months for prior anti-CD38-targeted therapy, adoptive cell therapy
>=14 days for proteasome inhibitor therapy
>= 7 days for immunomodulatory agents
Absolute neutrophil count (ANC) >= 1,000/mm\^3 (within 14 days prior to day 1 of protocol therapy)
NOTE: Growth factor is not permitted within 7 days of ANC assessment unless cytopenia is secondary to disease involvement
Platelets >= 75,000/mm\^3 (>= 50,000/mm\^3 if >= 50% marrow involvement) (within 14 days prior to day 1 of protocol therapy)
NOTE: Platelet transfusions are not permitted within 14 days of platelet assessment unless cytopenia is secondary to disease involvement
Total bilirubin =< 1.5 x upper limit of normal (ULN) (unless has Gilbert's disease) (within 14 days prior to day 1 of protocol therapy)
Aspartate aminotransferase (AST) =< 3 x ULN (within 14 days prior to day 1 of protocol therapy)

You may not qualify if…

Daratumumab or other anti CD38 antibody treatment < 3 months prior to study enrollment
Prior radiopharmaceutical therapy
Detectable antibodies directed against daratumumab
Subject has received previous radiation to > 25% of their bone marrow
Female patients who are lactating or have a positive pregnancy test during the screening period
Major surgery within 14 days prior to start of study treatment
Subject is receiving concurrent chemotherapy, radiation, or biologic for cancer treatment. Subject is receiving bone marrow stimulatory factors (e.g., granulocyte-macrophage colony-stimulating factor [GM-CSF]). Note: Hormonal therapy for someone with a history of cancer treated with curative intent is permitted if subject has been on hormonal therapy > 1 year
Vaccination with live attenuated vaccines within 4 weeks of study agent administration
A diagnosis of primary amyloidosis, plasma cell leukemia, Waldenstrom macroglobulinemia, or POEMS
Severe persistent asthma (forced expiratory volume in 1 second [FEV1] < 60% and/or daily symptoms) or severe chronic obstructive pulmonary disease (COPD) defined clinically or by historical pulmonary function tests with an FEV1 < 50% predicted
Subject has known allergies, hypersensitivity, or intolerance to monoclonal antibodies or human proteins, or their excipients (refer to respective package inserts or investigator's brochure). Patients with a history of infusion reactions to daratumumab with prior treatment that resolved with supportive measures and in whom daratumumab therapy was not previously discontinued because of infusion reactions are permitted
Subject has uncontrolled human immunodeficiency virus (HIV-1), chronic or active hepatitis B, or active hepatitis A or C
Patients with HIV are eligible unless their CD4+ T-cell counts are < 350 cells/mcL or they have a history of acquired immunodeficiency syndrome (AIDS)-defining opportunistic infection within the 12 months prior to registration. Concurrent treatment with effective antiretroviral therapy (ART) according to Department of Health and Human Services (DHHS) treatment guidelines is recommended
Subject has any one of the following:
Clinically significant abnormal electrocardiogram (ECG) finding at screening
Congestive heart failure (New York Heart Association class III or IV)
Myocardial infarction within 12 months prior to starting study treatment
Unstable or poorly controlled angina pectoris, including Prinzmetal variant angina pectoris
Subject has presence of other active malignancy [see exceptions below] (However, research participants with history of prior malignancy treated with curative intent and in complete remission are eligible). The following malignancies are exceptions to the active malignancy statement:
Basal cell carcinoma of the skin
Squamous cell carcinoma of the skin
Non-muscle invasive bladder cancer
Carcinoma in situ of the cervix
Carcinoma in situ of the breast
Incidental histologic finding of prostate cancer (T1a or T1b using the TNM clinical staging system) or prostate cancer that is curative

Where it is running

City of Hope Medical Center — Duarte, California, United States (enrolling)

Full record on ClinicalTrials.gov

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