Multiple Myeloma
Conditions
Keywords
Myeloma, Aplidin, Plitidepsin, PharmaMar
Brief summary
This is a phase II study to determine the efficacy following treatment with Aplidin® 5 mg/m2, given as a 3 hours intravenous infusion every 2 weeks, in patients with relapsed or refractory multiple myeloma (MM).
Detailed description
This is a phase II study to determine the efficacy following treatment with Aplidin® 5 mg/m2, given as a 3 h iv infusion every 2 weeks, in patients with relapsed or refractory multiple myeloma (MM) and to obtain the following : * Additional pharmacokinetic information for Aplidin® given as 3-hour IV infusion every 2 weeks in patients with MM. * To obtain additional genomic and pharmacodynamics information on MM and Aplidin. * To assess the safety and tolerability of Aplidin® given as 3-hour IV infusion every 2 weeks in patients with MM alone or in combination with dexamethasone given orally as a 20 mg daily for 4 days * To determine the response rate in the second cohort of patients following treatment with Aplidin®, given as a 3 hour infusion every 2 weeks, plus dexamethasone given orally as a 20 mg daily for 4 days, starting the same day of Aplidin® administration, as a second treatment stage in patients with suboptimal response to Aplidin® as single agent (progressive disease after three cycles or stable disease after four cycles).
Interventions
DRUGPlitidepsin
3-hour infusion every 2 weeks alone or in combination with dexamethasone
Sponsors
PharmaMar
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Written informed consent obtained from the patient before starting any study-specific procedure. If any patient is unable to give consent, it may be obtained from the patient's legal representative if in accordance with local laws and regulations 2. Age ≥ 18 years 3. Performance status Eastern Cooperative Oncology Group (ECOG) ≤ 2 4. Life expectancy ≥ 3 months. 5. Patient was previously diagnosed with MM based on standard criteria and currently requires treatment because MM relapses following a response to standard chemotherapy or high-dose chemotherapy, or MM is refractory (i.e., failure to achieve at least complete response (CR), partial response (PR) or stable disease (SD)) to their most recent chemotherapy. 6. Patient has measurable disease, defined as follows: * For secretory multiple myeloma, measurable disease is defined as any quantifiable serum monoclonal protein value and, where applicable, urine light-chain excretion of ≥ 200 mg/24 hours. * For oligo or non-secretory multiple myeloma, measurable disease is defined by the presence of soft tissue (not bone) plasmacytomas as determined by clinical examination or applicable radiographs (i.e. Magnetic resonance imaging (MRI), Computerized Axial Tomography (CT-Scan)). 7. Recovery from any non-hematological toxicity derived from previous treatments. The presence of alopecia and National Cancer Institute Common Toxicity Criteria (NCI-CTC) grade \< 2 sensitive peripheral neuropathy is allowed. 8. Patient has the following laboratory values within 14 days before day 1, cycle 1: * Platelet count ≥ 50 x109/L, hemoglobin ≥ 8.0 g/dl and absolute neutrophil count (ANC) ≥ 1.0x109/L; lower values may be accepted if clearly are due to bone marrow involvement by multiple myeloma. * Corrected serum calcium \< 14mg/dL. * Aspartate transaminase (AST): ≤ 2.5 x the upper limit of normal. * Alanine transaminase (ALT): ≤ 2.5 x the upper limit of normal. * Total bilirubin: ≤ 1.5 x the upper limit of normal. * Calculated Creatinine clearance: ≥ 40 mL/minute (by means of Crockoft and Gault´s formula). 9. Left ventricular ejection fraction within normal limits.
Exclusion criteria
1. Prior therapy with Aplidin®. 2. Pregnant or lactating women; men and women of reproductive potential who are not using effective contraceptive methods (double barrier method, intrauterine device, oral contraception) 3. History of another neoplastic disease. The exceptions are: * non-melanoma skin cancer, * carcinoma in situ of uterine cervix, * any other cancer curatively treated and no evidence of disease for at least 10 years. 4. Other relevant diseases or adverse clinical conditions: * History or presence of unstable angina, myocardial infarction, valvular heart disease or congestive heart failure. * Previous mediastinal radiotherapy. * Uncontrolled arterial hypertension despite optimal medical therapy. * Previous treatment with doxorubicin at cumulative doses in excess of 400 mg/m². * Symptomatic arrhythmia or any arrhythmia requiring treatment. * History of significant neurological or psychiatric disorders * Active infection * Patient is known to be human immunodeficiency virus (HIV) positive, Hepatitis B surface antigen-positive or active hepatitis C infection. * Myopathy or any clinical situation that causes significant and persistent elevation of creatine kinase (CK)(\>2.5 ULN in two different determinations performed with one week apart) * Significant non-neoplastic liver disease (e.g. cirrhosis, active chronic hepatitis) * Uncontrolled endocrine diseases (e.g. diabetes mellitus, hypothyroidism or hyperthyroidism) (i.e. requiring relevant changes in medication within the last month, or hospital admission within the last 3 months) 5. Limitation of the patient's ability to comply with the treatment or follow-up protocol. 6. Treatment with any investigational product in the 30 days period before inclusion in the study or radiotherapy in the 4 weeks before inclusion in the study. Other previous treatments should have been completed 3 weeks before inclusion in the study, and in case of high dose chemotherapy, 8 weeks. 7. Known hypersensitivity to Aplidin®, mannitol, cremophor, or ethanol or dexamethasone.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Every 2 weeks until progression or death occurs. | Complete response(CR):0 percentage the original monoclonal protein level from blood and urine Partial response(PR): ≥50 percentage reduction in the level of serum monoclonal protein Minimal response(MR):≥25 percentage to ≤ 49 percentage reduction in the level of serum monoclonal protein Stable disease: Not meeting the criteria for MR or PD. Progressive disease: \>25 percentage increase in level of serum monoclonal paraprotein, which must also be an absolute increase of at least 5 g/L and confirmed on a repeat investigation. Treatmen failure: Reappearance of serum or urinary paraprotein |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Progression (TTP) | Every 2 weeks until progression or death due to progression occurs. Median TTP and TTP rates at 3 months and 6 months were assessed. | Time to Progression (TTP):date of first infusion to the date of documented progressive disease which can be defined as \>25 percentage increase in level of serum monoclonal paraprotein. |
| Progression Free Survival (PFS) | Every 2 weeks until progression or death occurs. Median PFS and PFS rates at 3 months and 6 months were assessed. | Progression Free Survival (PFS): time from the date of first infusion to the date of documented progression or death |
| Number of Patients With Overall Survival (OS) | Start of treatment to death. At each patient visit while on treatment, then every 3m during follow-up. Median OS and OS rates at 6 months and 12 months were assessed. | Overall Survival (OS): time from the date of first infusion to the date of documented death |
Countries
United States
Participant flow
Recruitment details
Patients were recruited in 10 centers in Spain and USA between June 2004 and June 2008.
Participants by arm
| Arm | Count |
|---|---|
| Plitidepsin Plitidepsin 5 mg/m2 given as a 3-hour i.v. infusion every two weeks. | 32 |
| Plitidepsin + Dexamethasone Plitidepsin 5 mg/m2 given as a 3-hour i.v. infusion every two weeks plus 20 mg of oral dexamethasone every day on days 1 to 4 of each cycle, starting at the same time than the plitidepsin infusion. | 19 |
| Total | 51 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 4 | 2 |
| Overall Study | Other | 3 | 3 |
| Overall Study | Progressive disease | 18 | 9 |
| Overall Study | Toxicity | 6 | 1 |
| Overall Study | Withdrawal by Subject | 1 | 4 |
Baseline characteristics
| Characteristic | Plitidepsin | Plitidepsin + Dexamethasone | Total |
|---|---|---|---|
| Age Continuous | 66 years | 63 years | 64.0 years |
| ECOG PS 0 Units of Scale | 6 patients | 6 patients | 12 patients |
| ECOG PS 1 Units of Scale | 18 patients | 9 patients | 27 patients |
| ECOG PS 2 Units of Scale | 8 patients | 4 patients | 12 patients |
| Sex: Female, Male Female | 15 Participants | 6 Participants | 21 Participants |
| Sex: Female, Male Male | 17 Participants | 13 Participants | 30 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 51 / 51 | 19 / 19 |
| serious Total, serious adverse events | 32 / 51 | 11 / 19 |
Outcome results
Primary
Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response
Complete response(CR):0 percentage the original monoclonal protein level from blood and urine Partial response(PR): ≥50 percentage reduction in the level of serum monoclonal protein Minimal response(MR):≥25 percentage to ≤ 49 percentage reduction in the level of serum monoclonal protein Stable disease: Not meeting the criteria for MR or PD. Progressive disease: \>25 percentage increase in level of serum monoclonal paraprotein, which must also be an absolute increase of at least 5 g/L and confirmed on a repeat investigation. Treatmen failure: Reappearance of serum or urinary paraprotein
Time frame: Every 2 weeks until progression or death occurs.
Population: Per protocol - Only 29 of 32 and 18 of 19 enrolled patients were evaluable (analyzed patients)
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Plitidepsin | Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Complete response | 0 percentage patients |
| Plitidepsin | Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Stable Disease/No changes | 41 percentage patients |
| Plitidepsin | Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Partial response | 3 percentage patients |
| Plitidepsin | Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Progressive Disease/Treatment failure | 48 percentage patients |
| Plitidepsin | Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Minimal response | 7 percentage patients |
| Plitidepsin + Dexamethasone | Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Progressive Disease/Treatment failure | 17 percentage patients |
| Plitidepsin + Dexamethasone | Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Partial response | 11 percentage patients |
| Plitidepsin + Dexamethasone | Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Minimal response | 11 percentage patients |
| Plitidepsin + Dexamethasone | Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Stable Disease/No changes | 61 percentage patients |
| Plitidepsin + Dexamethasone | Objective Response Rate (ORR), Defined as the Combined Rate of Complete Response, Partial Response and Minimal Response | Complete response | 0 percentage patients |
Secondary
Number of Patients With Overall Survival (OS)
Overall Survival (OS): time from the date of first infusion to the date of documented death
Time frame: Start of treatment to death. At each patient visit while on treatment, then every 3m during follow-up. Median OS and OS rates at 6 months and 12 months were assessed.
Population: Per protocol - Only 21 of 32 and 8 of 19 enrolled patients were evaluable (analyzed patients. For patient of group plitidepsin + dexamethasone the median overall survival could not be calculated due to follow-up short duration. The survival rates at 6 and 12 months are provided instead.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Plitidepsin | Number of Patients With Overall Survival (OS) | OS at 6 months | 70 percentage patients |
| Plitidepsin | Number of Patients With Overall Survival (OS) | OS at 12 months | 53 percentage patients |
| Plitidepsin + Dexamethasone | Number of Patients With Overall Survival (OS) | OS at 6 months | 76 percentage patients |
| Plitidepsin + Dexamethasone | Number of Patients With Overall Survival (OS) | OS at 12 months | 61 percentage patients |
Secondary
Progression Free Survival (PFS)
Progression Free Survival (PFS): time from the date of first infusion to the date of documented progression or death
Time frame: Every 2 weeks until progression or death occurs. Median PFS and PFS rates at 3 months and 6 months were assessed.
Population: Per protocol - Only 21 of 32 and 8 of 19 enrolled patients were evaluable (analyzed patients)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Plitidepsin | Progression Free Survival (PFS) | 2.3 months |
| Plitidepsin + Dexamethasone | Progression Free Survival (PFS) | 3.8 months |
Secondary
Time to Progression (TTP)
Time to Progression (TTP):date of first infusion to the date of documented progressive disease which can be defined as \>25 percentage increase in level of serum monoclonal paraprotein.
Time frame: Every 2 weeks until progression or death due to progression occurs. Median TTP and TTP rates at 3 months and 6 months were assessed.
Population: Per protocol - Only 29 of 32 and 18 of 19 enrolled patients were evaluable (analyzed patients)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Plitidepsin | Time to Progression (TTP) | 2.3 months |
| Plitidepsin + Dexamethasone | Time to Progression (TTP) | 4.2 months |