Multiple Myeloma and Plasma Cell Neoplasm
Conditions
Keywords
stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma
Brief summary
RATIONALE: Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as doxorubicin hydrochloride liposome, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Thalidomide may stop the growth of multiple myeloma by blocking blood flow to the cancer. Giving bortezomib together with doxorubicin hydrochloride liposome and thalidomide may kill more cancer cells. PURPOSE: This phase II trial is studying how well giving bortezomib together with doxorubicin hydrochloride liposome and thalidomide works as first-line therapy in treating patients with previously untreated multiple myeloma.
Detailed description
OBJECTIVES: Primary * To determine the overall response rate (complete response and partial response) in patients previously untreated stage I, II, or III multiple myeloma. Secondary * To evaluate the complete response rate in patients treated with this regimen. * To determine the time to disease progression from the start of this therapy in patients treated with this regimen. OUTLINE: Patients receive low-dose oral thalidomide once a day on days 1-28, bortezomib IV on days 1, 4, 15, and 18, and doxorubicin hydrochloride liposome IV over 60-90 minutes on days 1 and 15. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. Patients with residual disease who continue to show response after completion of 6 courses may receive 2 additional courses for a total of 8 courses. After completion of study treatment, patients are followed every 3 months.
Interventions
DRUGbortezomib
IV
DRUGpegylated liposomal doxorubicin hydrochloride
IV
DRUGthalidomide
Oral
Sponsors
Roswell Park Cancer Institute
Study design
Allocation
NA
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: * Diagnosis of stage I, II, or III multiple myeloma requiring therapy * No prior systemic therapy for multiple myeloma * Patients who have received steroids or radiotherapy for cord compression or spinal cord disease are eligible for this study * Patients who have received 1 prior course of antimyeloma therapy may be enrolled at the investigator's discretion provided disease progression is not noted PATIENT CHARACTERISTICS: Inclusion criteria: * Karnofsky performance status 60-100% * Platelet count ≥ 75,000 cells/mm\^3 (\< 75,000 cells/mm\^3 secondary to extensive bone marrow disease allowed at the PI's discretion with appropriate transfusion support) * ANC ≥ 1,000 cells/mm\^3 * Hemoglobin ≥ 8.0 g/dL (\< 8 g/dL secondary to extensive bone marrow disease allowed at the PI's discretion with appropriate transfusion support) * Creatinine clearance \> 20 mL/min * AST and ALT ≤ 2 times upper limit of normal (ULN) OR ≤ 3 times ULN (in the presence of liver metastases) * Alkaline phosphatase ≤ 2 times ULN OR ≤ 3 times ULN (in the presence of liver metastases) * Total bilirubin ≤ 2 times ULN OR ≤ 3 times ULN (in the presence of liver metastases) * Ejection fraction ≥ 50% by MUGA or 2-D echocardiogram * Negative pregnancy test * Fertile patients must use at least 1 highly effective and 1 additional effective contraception method 4 weeks prior to, during, and 3 months after completion of study therapy * HIV-negative * Must have sufficient mental capacity to understand the explanation of the study and to provide informed consent * Willingness and ability to comply with the FDA-mandated S.T.E.P.S. program
Exclusion criteria
* Pregnant or lactating * Active, serious infections uncontrolled by antibiotics * Any medical condition or reason that, in the investigator's opinion, makes the patient unsuitable to participate in this clinical trial * History of hypersensitivity reactions attributed to a conventional formulation of doxorubicin hydrochloride or the components of doxorubicin hydrochloride liposome or bortezomib, boron, or mannitol * Any of the following conditions: * History of uncontrolled New York Heart Association class II-IV heart disease or clinical evidence of congestive heart failure * Myocardial infarction within the past 6 months * Uncontrolled angina * Severe uncontrolled ventricular arrhythmias, ECG evidence of acute ischemia, or active conduction system abnormalities * Peripheral neuropathy ≥ grade 2 PRIOR CONCURRENT THERAPY: * See Disease Characteristics
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Overall Response Rate (Complete and Partial) | Every 3 months |
Secondary
| Measure | Time frame |
|---|---|
| Complete Response Rate | Every 3 months |
| Time to Disease Progression | Every 3 monthsntil the date of first documented progression or date of death from any cause, whichever came first |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| VDT: VELCADE, Doxil and Low-dose Thalidomide | 40 |
| Total | 40 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 11 |
| Overall Study | Disease Progression | 5 |
| Overall Study | NOT TREATED (Became ineligible) | 2 |
| Overall Study | Other, unspecified | 4 |
| Overall Study | Withdrawal by Subject | 2 |
Baseline characteristics
| Characteristic | VDT: VELCADE, Doxil and Low-dose Thalidomide |
|---|---|
| Age, Continuous | 60.13 years STANDARD_DEVIATION 9.34 |
| Gender Female | 14 Participants |
| Gender Male | 26 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 44 / 44 |
| serious Total, serious adverse events | 16 / 44 |
Outcome results
Primary
Overall Response Rate (Complete and Partial)
Time frame: Every 3 months
Population: Evaluable patients
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| VDT: VELCADE, Doxil and Low-dose Thalidomide | Overall Response Rate (Complete and Partial) | 77.50 percentage of participants |
Secondary
Complete Response Rate
Time frame: Every 3 months
Population: Evaluable patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| VDT: VELCADE, Doxil and Low-dose Thalidomide | Complete Response Rate | 22.50 percentage of participants |
Secondary
Time to Disease Progression
Time frame: Every 3 monthsntil the date of first documented progression or date of death from any cause, whichever came first
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| VDT: VELCADE, Doxil and Low-dose Thalidomide | Time to Disease Progression | 27.8 months |