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Bortezomib and Pegylated Liposomal Doxorubicin Hydrochloride in Treating Patients With Previously Untreated Symptomatic Multiple Myeloma

Phase II Study of Bortezomib (PS-341) and Pegylated Liposomal Doxorubicin as Initial Therapy for Adult Patients With Symptomatic Multiple Myeloma

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00088855
Enrollment
55
Registered
2004-08-05
Start date
2004-06-15
Completion date
2008-01-08
Last updated
2019-09-23

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

Conditions

DS Stage III Plasma Cell Myeloma, DS Stage II Plasma Cell Myeloma, DS Stage I Plasma Cell Myeloma

Brief summary

This phase II trial studies the side effects and how well bortezomib and pegylated liposomal doxorubicin hydrochloride work in treating patients multiple myeloma that are experiencing symptoms and have not received prior treatment. Bortezomib and pegylated liposomal doxorubicin hydrochloride may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.

Detailed description

PRIMARY OBJECTIVE: I. To evaluate the complete response (CR) + near-complete response (nCR) rate of the bortezomib/pegylated liposomal doxorubicin (pegylated liposomal doxorubicin hydrochloride) regimen in patients with previously untreated, symptomatic multiple myeloma. II. To evaluate the toxicity of the bortezomib/pegylated liposomal doxorubicin regimen in patients with previously untreated, symptomatic multiple myeloma. SECONDARY OBJECTIVES: I. To evaluate the overall response rate, including patients with CR, nCR, and partial response (PR), of the bortezomib/pegylated liposomal doxorubicin regimen in patients with previously untreated, symptomatic multiple myeloma. II. To evaluate the impact of therapy with the bortezomib/pegylated liposomal doxorubicin regimen on the ability to collect peripheral blood stem cells in those patients going on to subsequent autologous stem cell transplantation. III. To evaluate the time to progression (TTP) in all patients receiving bortezomib/pegylated liposomal doxorubicin therapy, both those who go on to autologous stem cell transplantation and those who do not go on to transplantation. IV. To evaluate the value of early changes in levels of serum interleukin 6 (IL-6) and macrophage inflammatory protein 1 alpha (MIP-1α) as predictors of response to bortezomib/pegylated liposomal doxorubicin. V. To correlate pre-treatment clinical and biological characteristics with response to therapy and toxicity. OUTLINE: Patients receive bortezomib intravenously (IV) over 3-5 seconds on days 1, 4, 8, and 11 and pegylated liposomal doxorubicin hydrochloride IV over 1 hour on day 4. Treatment repeats every 21 days for up to 8 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 6 weeks for 2 years and then every 6 months for 3 years.

Interventions

DRUGBortezomib

Given IV

OTHERLaboratory Biomarker Analysis

Correlative studies

DRUGPegylated Liposomal Doxorubicin Hydrochloride

Given IV

Sponsors

National Cancer Institute (NCI)
Lead SponsorNIH

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

Inclusion criteria

* Patients must have a histologically confirmed diagnosis of symptomatic multiple myeloma with evaluable disease parameters * A diagnosis of symptomatic multiple myeloma requires: * A monoclonal serum and/or urine protein * Clonal bone marrow plasmacytosis, or a histologically confirmed plasmacytoma * Related organ or tissue impairment, consisting of: * Hypercalcemia (serum calcium \> 0.25 mmol/l above the upper limit of normal, or \> 2.75 mmol/l \[i.e. \> 11.5 mg/dl\]) AND/OR * Renal insufficiency (serum creatinine \> 173 mmol/l \[i.e., \> 2 mg/dL\]); (please note that serum creatinine may not be \>= 2.5 mg/dL) AND/OR * Anemia (hemoglobin 2 g/dl below the lower limit of normal, or hemoglobin \< 10 g/dl) AND/OR * Bony lesions (lytic bony lesions, or osteoporosis with compression fractures) AND/OR * Other findings, such as symptomatic hyperviscosity, amyloidosis, or recurring bacterial infections (\> 2 episodes in 12 months) * Patients may not have undergone any prior therapy, with the following exceptions: * Prior plasmapheresis with plasma exchange (PLEX) for a hyperviscosity syndrome is allowed, providing the patient has no current evidence of hyperviscosity and has not required PLEX for at least one week prior to initiation of therapy * Prior radiation therapy to areas of spinal cord compression by plasmacytomas, painful lesions due to bony involvement, or other myeloma-related indications, is allowed provided that radiation will have been completed 3 weeks before initiation of therapy * Prior surgical intervention, such as for bony fractures or other myeloma-related complications, is allowed provided that this will have been completed 3 weeks before the initiation of therapy, and patients have recovered from surgery * Prior therapy with corticosteroids for indications other than multiple myeloma is allowed, provided such therapy has been discontinued at least two weeks prior to study entry, and at least two weeks before their baseline disease evaluation * Prior supportive therapy with bisphosphonates or erythropoietin is allowed * Inclusion of females of childbearing potential requires a negative pregnancy test * Eastern Cooperative Oncology Group (ECOG) performance status =\< 2 * Patients may not have a prior history of a hypersensitivity reaction to pegylated liposomal doxorubicin or doxorubicin, bortezomib or other boronic acid-based compounds * Patients with a history of reactions to liposomal drug formulations other than pegylated liposomal doxorubicin will be evaluated individually, and if their reactions were felt to have been due to the liposomal component itself, as opposed to the encapsulated agent, they will be excluded at the discretion of the investigators * Patients who are known to be human immunodeficiency virus (HIV)-seropositive and are taking anti-retrovirals may not participate in this study; patients who are HIV-seropositive and not on anti-retroviral therapy, and who otherwise meet the organ function criteria, will be eligible for the study * Patients who are known to have active hepatitis A, B, or C viral infection may not participate in this study * No electrocardiogram (EKG) evidence of acute ischemia * No EKG evidence of medically significant conduction system abnormalities * No history of myocardial infarction within the last 6 months * Left ventricular ejection fraction (LVEF) must be \>= 45% by either echocardiography or radionuclide-based multiple gated acquisition (radionuclide ventriculography \[RNV\] or multiple gate acquisition scan \[MUGA\]) * No class 3 or class 4 New York Heart Association congestive heart failure * Creatinine \< 2.5 mg/dL * Alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) and aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\]) =\< 2.5 times the upper limit of the institutional normal value * Total bilirubin =\< 1.2 times the upper limit of the institutional normal value * Absolute neutrophil count (ANC) \>= 1,000/ul * Platelets \>= 100,000/ul * Hemoglobin \>= 8 g/dl (transfusion- and/or growth factor-dependent patients are not excluded if the above parameters can be achieved with such support) * For those patients receiving warfarin (Coumadin), unfractionated heparin, or low-molecular weight heparin therapy, the applicable coagulation parameter that is being monitored must be within the accepted therapeutic ranges for those indications

Design outcomes

Primary

MeasureTime frameDescription
CR+nCR rateAfter 18 weeks (6 courses of treatment)Will be estimated with an exact 90% confidence interval.

Secondary

MeasureTime frameDescription
Maximal response rateAfter 18 weeks (6 courses of treatment)
Incidence of adverse events, graded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0Up to 5 yearsToxicities will be tabulated by type and grade.
CR+nCR+PR rateAfter 18 weeks (6 courses of treatment)Will be estimated with an exact 90% confidence interval.
Overall survivalFrom on-study date to the date of death, assessed up to 5 yearsWill be estimated using the Kaplan-Meier method.
Changes in IL-6 and MIP-1Baseline to up to day 2 of course 1The association of response with pre-treatment characteristics such as cytogenetics and fluorescence in situ hybridization and with early changes in IL-6 and MIP-1 will be described by reporting response rates (and their confidence intervals) according to subgroup (e.g., response rates by age group; response rates by large/small change in IL-6 level).
Progression-free survivalFrom on-study date to the date of progression or death, whichever comes first, assessed up to 5 yearsWill be estimated using the Kaplan-Meier method.

Countries

United States

Outcome results

None listed

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