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Arsenic Trioxide Plus Vitamin C in Treating Patients With Recurrent or Refractory Multiple Myeloma

Phase I/II Trial of Arsenic Trioxide (As2O3) With Ascorbic Acid in the Treatment of Relapsed/Refractory Multiple Myeloma

Status
Completed
Phases
Phase 1Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00006021
Enrollment
22
Registered
2003-01-27
Start date
2000-06-30
Completion date
2007-03-31
Last updated
2016-12-15

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Multiple Myeloma and Plasma Cell Neoplasm

Keywords

refractory multiple myeloma, stage II multiple myeloma, stage III multiple myeloma

Brief summary

RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Vitamin C may increase the effectiveness of arsenic trioxide by making cancer cells more sensitive to the drug. PURPOSE: Phase I/II trial to determine the effectiveness of arsenic trioxide plus vitamin C in treating patients who have recurrent or refractory multiple myeloma.

Detailed description

OBJECTIVES: * Determine the maximum tolerated dose of arsenic trioxide when administered with ascorbic acid in patients with recurrent or refractory multiple myeloma. * Determine the therapeutic efficacy of this treatment combination in these patients. * Determine the expression of MDR and Bcl-xL genes and the intracellular levels of GSH in these patients before and after this treatment regimen and assess whether these measures have prognostic value. OUTLINE: This is a multicenter, dose-escalation study of arsenic trioxide. * Phase I: Patients receive arsenic trioxide IV over 1-4 hours and ascorbic acid IV over 5-10 minutes on days 1-5 weekly for 5 weeks. Treatment continues every 7 weeks for up to 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of arsenic trioxide until the maximum tolerated dose (MTD) is reached. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. * Phase II: Patients receive the MTD of arsenic trioxide with ascorbic acid as outlined above. Patients are followed monthly for up to 5 years. PROJECTED ACCRUAL: A total of 31-43 patients (6-18 for phase I and 16-25 for phase II) will be accrued for this study within 2.5 years.

Interventions

DIETARY_SUPPLEMENTascorbic acid
DRUGarsenic trioxide

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
University of Miami
Lead SponsorOTHER

Study design

Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 120 Years
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically confirmed multiple myeloma * M-protein by serum protein electrophoresis or urine protein electrophoresis * Quantitative determination of immunoglobulin * Bone marrow biopsy and aspirate with a plasma cell count greater than 10% * Refractory or chemoresistant disease defined as failure to respond (less than 50% reduction in M protein level) or progression within 2 months after receiving at least 2 chemotherapy regimens including: * Alkylating based regimen (melphalan) in combination with steroids (prednisone) or other chemotherapy regimens (e.g., vincristine, bleomycin, melphalan, cyclophosphamide, and prednisone or vincristine, carmustine, doxorubicin, and prednisone) * Vincristine, doxorubicin, and dexamethasone (VAD) regimen * Pulse therapy with high dose steroids alone * High dose alkylating agent and autologous stem cell transplantation * Allogeneic bone marrow transplantation * Plateau phase defined as M protein in the serum or urine for more than 6 weeks despite response to prior therapy * Must have received at least 2 of the chemotherapy regimens listed above or equivalent regimens * Recurrent disease defined as progression more than 2 months after initial therapy and failure to respond (less than 50% reduction or progression in M protein levels) to 1 chemotherapy regimen listed above or other salvage regimens (e.g., high-dose cyclophosphamide or topotecan) * Must have received VAD or other equivalent chemotherapy regimen * Should be considered for autologous or allogenic transplantation * Prior local radiotherapy allowed PATIENT CHARACTERISTICS: Age: * Over 18 Performance status: * Karnofsky 60-100% Life expectancy: * Not specified Hematopoietic: * WBC at least 2,000/mm\^3\* * Platelet count at least 50,000/mm\^3\* NOTE: \*Unless attributable to bone marrow infiltration by multiple myeloma Hepatic: * Bilirubin less than 3 mg/dL * Transaminases less than 2.5 times upper limit of normal (ULN) Renal: * Creatinine less than 1.5 times ULN OR * Creatinine clearance at least 60 mL/min Cardiovascular: * No cardiac arrhythmias including recurrent supraventricular arrhythmia, any type of sustained ventricular arrhythmia, or conduction block (atrioventricular block grade II or III, left bundle branch block) * Ejection fraction at least 30% * No uncontrolled ischemic heart disease Other: * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective barrier contraception during and for 4 months after study * HIV negative * No grade 3 or higher neurological disorder, including seizure disorders * No underlying medical condition that would preclude study * No other active malignancy except adequately treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix PRIOR CONCURRENT THERAPY: Biologic therapy: * See Disease Characteristics Chemotherapy: * See Disease Characteristics * At least 2 weeks since prior chemotherapy Endocrine therapy: * See Disease Characteristics * Concurrent steroid treatment allowed except for primary treatment of myeloma Radiotherapy: * See Disease Characteristics * Concurrent local radiotherapy for pain or symptom control allowed provided the pain or symptom is not related to disease progression Surgery: * Not specified Other: * No other concurrent ascorbic acid supplements * No other concurrent investigational drug or therapy * Concurrent bisphosphonates allowed

Design outcomes

Primary

MeasureTime frame
Disease response as measured by M protein quantitation and the percentage of plasma cell infiltration in bone marrow biopsies after every course

Secondary

MeasureTime frame
Toxicity as measured by CTCAE criteria

Countries

United States

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026