Advanced Solid Tumors, Multiple Myeloma
Conditions
Keywords
Drug Therapy
Brief summary
The purpose of this study is to characterize the single-dose pharmacokinetic (PK) parameters of ixazomib (MLN9708) in cancer participants with either normal renal function or severe renal impairment (RI), including participants with end-stage renal disease (ESRD).
Detailed description
The drug tested in this study was called ixazomib (MLN9708). Ixazomib was administered to participants with cancer and either normal renal function or severe renal impairment, including end-stage renal disease (ESRD) requiring hemodialysis. This study characterized the PK, safety and efficacy of ixazomib. The study enrolled 41 participants (37 multiple myeloma and 4 advanced solid tumor). The study was conducted in 2 parts, Part A and Part B. Participants were enrolled to receive: * Ixazomib 3.0 mg In Part A, all participants were asked to take one 3 mg ixazomib capsule, orally on Day 1. Participants who tolerated ixazomib in Part A had the option of continuing the study by participating in Part B. In Part B, participants received ixazomib (4, 3, or 2.3 mg per protocol) on Days 1, 8, and 15 of each 28-day cycle until participants experienced disease progression or unacceptable toxicity. This multicenter trial was conducted at 6 study sites in the United States and Canada. The overall time to participate in this study was 435 days. Participants made multiple scheduled visits to the clinic.
Interventions
Ixazomib capsules
Sponsors
Study design
Eligibility
Inclusion criteria
* Male or female participants 18 years or older * Participants with multiple myeloma (MM) diagnosed according to standard criteria or participants with a diagnosis of an advanced malignant solid tumor for which standard, curative, or life prolonging treatment does not exist or is no longer effective. Participants with multiple myeloma must have had at least 1 prior therapy * A calculated creatinine clearance (CrCl) that meets entry criteria for enrollment (i.e., calculated CrCl either ≥ 90 mL/min for normal renal function or \< 30 mL/min for severe renal impairment) * Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2 * Female participants who are post menopausal, surgically sterile, or agree to practice 2 effective methods of contraception through 90 days after the last dose of study drug or agree to practice true abstinence * Male participants who agree to practice effective barrier contraception through 90 after the last dose of study drug or agree to practice true abstinence * Voluntary written informed consent * Suitable venous access
Exclusion criteria
* Female participants who are pregnant or lactating and breastfeeding * Failure to have recovered from clinically significant effects of prior chemotherapy (defined as toxicity greater than Grade 1 with the exception of alopecia) * Major surgery or radiotherapy within 14 days before study drug administration * Dexamethasone (or equivalent systemic steroid) higher than physiologic dosing within 7 days before study drug administration * Central nervous system involvement * Infection requiring IV antibiotic therapy or other serious infection within 14 days prior to first dose of study drug * Diagnosis of Waldenstrom's macroglobulinemia, POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome, plasma cell leukemia, myeloproliferative syndrome, or primary amyloidosis (with the exception of patients in whom amyloidosis has been documented as a complication of MM, who will be evaluated on a case-by-case basis for trial participation) * Systemic treatment with strong and moderate inhibitors of Cytochrome P1A2 (CYP1A2), strong and moderate inhibitors of Cytochrome P3A (CYP3A), or clinically significant CYP3A inducers or use of Ginkgo biloba or St. John's wort within 14 days before the first dose of study drug * Evidence of uncontrolled cardiovascular conditions * Ongoing or active infection, or known human immunodeficiency virus (HIV) positive * Comorbid systemic illness or psychiatric illness that could interfere with study completion * Known allergy to study medications * Inability to swallow oral medication or condition that could interfere with oral absorption or tolerance of treatment
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Unbound Cmax: Unbound Maximum Observed Plasma Concentration for Ixazomib | Part A, Day 1: Predose and at multiple timepoints (up to 336 hours) post-dose |
| Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for Ixazomib | Part A, Day 1: Predose and at multiple timepoints (up to 336 hours) post-dose |
| Unbound AUClast: Unbound Area Under the Plasma Concentration-Time Curve From Time 0 to the Time of the Last Quantifiable Concentration for Ixazomib | Part A, Day 1: Predose and at multiple timepoints (up to 336 hours) post-dose |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Adverse Events | From signing of first dose of study drug up to the 30 days after the last dose of study drug (approximately up to 885 days) | Adverse Event is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (eg, a clinically significant abnormal laboratory finding), symptom, or disease temporally associated with the use of a drug, whether or not it is considered related to the drug. A treatment-emergent adverse event (TEAE) is defined as an adverse event with an onset that occurs after receiving study drug. |
| Percentage of Participants With Overall Response (OR) in Relapsed/Refractory Multiple Myeloma (RRMM) Participants | Day 1 of every other cycle from cycle 1 (each cycle of 28 days) up to progression of disease (approximately up to 855 days) | Overall response rate defined as percentage of relapsed/refractory multiple myeloma participants who achieved partial response (PR), complete response (CR) and very good partial response (VGPR) according to International Myeloma Working Group Criteria. PR=\>50% reduction of serum M-protein and reduction in 24 hours urinary M-protein by \>90% or \<200 mg/24 h. If serum and urine M-protein are unmeasurable, \>50% decrease in difference between involved and uninvolved free light chain levels in place of M-protein criteria. If serum and urine M-protein and serum free light assay are not measurable, \>50% reduction in plasma cells in place of M-protein, provided baseline bone marrow plasma cell \>0%; CR=negative immunofixation on serum and urine and disappearance of any soft tissue plasmacytomas and \<5% plasma cells in bone marrow; VGPR=serum and urine M-protein detectable by immunofixation but not on electrophoresis or \> 90% reduction in serum M-protein plus urine M-protein level \<100 mg/24 h. |
| Duration of Response (DOR) in RRMM Participants | Day 1 of every other cycle from cycle 1 (each cycle of 28 days) up to progression of disease (approximately up to 855 days) | DOR was defined as time from date of first documentation of a PR or better to date of first documentation of progressive disease (PD) for responders. Increase of \>25% from lowest response value in any one or more of following: Serum M-component and/or (absolute increase must be \>0.5 g/dL); Urine M-component and/or (the absolute increase must be \>200 mg/24 h); difference between involved and uninvolved free light chain (FLC) levels and the absolute increase must be \> 10 mg/dL; Bone marrow plasma cell percentage; absolute percentage must be \> 5%; Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in size of existing bone lesions or soft tissue plasmacytomas; Development of hypercalcaemia (corrected serum calcium \> 11.5 mg/dL or 2.65 mmol/L) that can be attributed solely to the plasma cell proliferative disorder. Responders without PD were censored at the date of the last response assessment that was stable disease (SD) or better. |
Countries
Canada, United States
Participant flow
Recruitment details
Participants took part in the study at 6 investigative sites in the United States and Canada from 16 September 2013 up to 18 November 2016.
Pre-assignment details
Participants with a diagnosis of relapsed or refractory multiple myeloma (RRMM) or advanced solid tumors who had normal renal function or severe renal impairment including end-stage renal disease requiring hemodialysis (ESRD) were enrolled to receive ixazomib orally in the study.
Participants by arm
| Arm | Count |
|---|---|
| Normal Renal Function: Ixazomib Ixazomib 3.0 mg, capsule, orally on Day 1 of Part A (15-day PK cycle) and on Days 1, 8, and 15 of each 28-day cycle in Part B (4.0, 3.0, or 2.3 mg per protocol) until disease progression or unacceptable toxicity. | 20 |
| Severe Renal Impairment: Ixazomib Ixazomib 3.0 mg, capsule, orally on Day 1 of Part A (15-day PK cycle) and on Days 1, 8, and 15 of each 28-day cycle in Part B (4.0, 3.0, or 2.3 mg per protocol) until disease progression or unacceptable toxicity. | 14 |
| End-stage Renal Disease: Ixazomib Ixazomib 3.0 mg, capsule, orally on Day 1 of Part A (15-day PK cycle) and on Days 1, 8, and 15 of each 28-day cycle in Part B (4.0, 3.0, or 2.3 mg per protocol) until disease progression or unacceptable toxicity. | 7 |
| Total | 41 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 3 | 4 | 0 |
| Overall Study | Lost to Follow-up | 0 | 1 | 0 |
| Overall Study | Progressive Disease | 12 | 7 | 7 |
| Overall Study | Reason not Specified | 2 | 0 | 0 |
| Overall Study | Study Terminated by Sponsor | 1 | 1 | 0 |
| Overall Study | Symptomatic Deterioration | 1 | 0 | 0 |
| Overall Study | Withdrawal by Subject | 1 | 1 | 0 |
Baseline characteristics
| Characteristic | Normal Renal Function: Ixazomib | Total | End-stage Renal Disease: Ixazomib | Severe Renal Impairment: Ixazomib |
|---|---|---|---|---|
| Age, Continuous | 54.5 years STANDARD_DEVIATION 9.01 | 61.7 years STANDARD_DEVIATION 12.01 | 61.3 years STANDARD_DEVIATION 12.65 | 72.1 years STANDARD_DEVIATION 7.35 |
| Height | 173.2 cm STANDARD_DEVIATION 11.28 | 167.1 cm STANDARD_DEVIATION 11.76 | 160.3 cm STANDARD_DEVIATION 9.61 | 160.8 cm STANDARD_DEVIATION 8.49 |
| Race/Ethnicity, Customized Asian | 0 Participants | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Black or African American | 6 Participants | 12 Participants | 3 Participants | 3 Participants |
| Race/Ethnicity, Customized Hispanic or Latino | 1 Participants | 4 Participants | 1 Participants | 2 Participants |
| Race/Ethnicity, Customized Not Hispanic or Latino | 19 Participants | 35 Participants | 6 Participants | 10 Participants |
| Race/Ethnicity, Customized Not Reported | 1 Participants | 2 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 13 Participants | 27 Participants | 3 Participants | 11 Participants |
| Sex: Female, Male Female | 10 Participants | 25 Participants | 3 Participants | 12 Participants |
| Sex: Female, Male Male | 10 Participants | 16 Participants | 4 Participants | 2 Participants |
| Weight | 98.1 kg STANDARD_DEVIATION 27.66 | 83.3 kg STANDARD_DEVIATION 28.85 | 86.0 kg STANDARD_DEVIATION 27.11 | 60.7 kg STANDARD_DEVIATION 14.7 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 19 / 20 | 14 / 14 | 5 / 7 |
| serious Total, serious adverse events | 3 / 20 | 6 / 14 | 3 / 7 |
Outcome results
Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for Ixazomib
Time frame: Part A, Day 1: Predose and at multiple timepoints (up to 336 hours) post-dose
Population: PK evaluable population was defined as participants who received protocol-specified single dose in Part A; did not receive any excluded concomitant medications through the completion of PK sampling; and had sufficient concentration-time data to permit reliable estimation of PK parameters by non-compartmental analysis methods.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Normal Renal Function: Ixazomib | Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for Ixazomib | 1.0400 hours |
| Severe Renal Impairment: Ixazomib | Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for Ixazomib | 1.0000 hours |
| End-stage Renal Disease: Ixazomib | Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for Ixazomib | 1.2500 hours |
Unbound AUClast: Unbound Area Under the Plasma Concentration-Time Curve From Time 0 to the Time of the Last Quantifiable Concentration for Ixazomib
Time frame: Part A, Day 1: Predose and at multiple timepoints (up to 336 hours) post-dose
Population: PK evaluable population was defined as participants who received protocol-specified single dose in Part A; did not receive any excluded concomitant medications through the completion of PK sampling; and had sufficient concentration-time data to permit reliable estimation of PK parameters by non-compartmental analysis methods.
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Normal Renal Function: Ixazomib | Unbound AUClast: Unbound Area Under the Plasma Concentration-Time Curve From Time 0 to the Time of the Last Quantifiable Concentration for Ixazomib | 6.637 hr*ng/mL | Standard Deviation 4.8022 |
| Severe Renal Impairment: Ixazomib | Unbound AUClast: Unbound Area Under the Plasma Concentration-Time Curve From Time 0 to the Time of the Last Quantifiable Concentration for Ixazomib | 9.249 hr*ng/mL | Standard Deviation 6.2618 |
| End-stage Renal Disease: Ixazomib | Unbound AUClast: Unbound Area Under the Plasma Concentration-Time Curve From Time 0 to the Time of the Last Quantifiable Concentration for Ixazomib | 8.925 hr*ng/mL | Standard Deviation 5.7995 |
Unbound Cmax: Unbound Maximum Observed Plasma Concentration for Ixazomib
Time frame: Part A, Day 1: Predose and at multiple timepoints (up to 336 hours) post-dose
Population: Pharmacokinetic (PK) evaluable population was defined as participants who received protocol-specified single dose in Part A; did not receive any excluded concomitant medications through the completion of PK sampling; and had sufficient concentration-time data to permit reliable estimation of PK parameters by non-compartmental analysis methods.
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Normal Renal Function: Ixazomib | Unbound Cmax: Unbound Maximum Observed Plasma Concentration for Ixazomib | 0.300 ng/mL | Standard Deviation 0.247944 |
| Severe Renal Impairment: Ixazomib | Unbound Cmax: Unbound Maximum Observed Plasma Concentration for Ixazomib | 0.478 ng/mL | Standard Deviation 0.599519 |
| End-stage Renal Disease: Ixazomib | Unbound Cmax: Unbound Maximum Observed Plasma Concentration for Ixazomib | 0.213 ng/mL | Standard Deviation 0.136696 |
Duration of Response (DOR) in RRMM Participants
DOR was defined as time from date of first documentation of a PR or better to date of first documentation of progressive disease (PD) for responders. Increase of \>25% from lowest response value in any one or more of following: Serum M-component and/or (absolute increase must be \>0.5 g/dL); Urine M-component and/or (the absolute increase must be \>200 mg/24 h); difference between involved and uninvolved free light chain (FLC) levels and the absolute increase must be \> 10 mg/dL; Bone marrow plasma cell percentage; absolute percentage must be \> 5%; Definite development of new bone lesions or soft tissue plasmacytomas or definite increase in size of existing bone lesions or soft tissue plasmacytomas; Development of hypercalcaemia (corrected serum calcium \> 11.5 mg/dL or 2.65 mmol/L) that can be attributed solely to the plasma cell proliferative disorder. Responders without PD were censored at the date of the last response assessment that was stable disease (SD) or better.
Time frame: Day 1 of every other cycle from cycle 1 (each cycle of 28 days) up to progression of disease (approximately up to 855 days)
Population: Response evaluable population is defined as participants who received at least 1 cycle of Ixazomib treatment in Part B and at least 1 post-baseline response assessment. Here, number of participants analyzed is the participants who had confirmed response.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Normal Renal Function: Ixazomib | Duration of Response (DOR) in RRMM Participants | 134 days |
| Severe Renal Impairment: Ixazomib | Duration of Response (DOR) in RRMM Participants | 225 days |
Number of Participants With Adverse Events
Adverse Event is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (eg, a clinically significant abnormal laboratory finding), symptom, or disease temporally associated with the use of a drug, whether or not it is considered related to the drug. A treatment-emergent adverse event (TEAE) is defined as an adverse event with an onset that occurs after receiving study drug.
Time frame: From signing of first dose of study drug up to the 30 days after the last dose of study drug (approximately up to 885 days)
Population: Safety population is defined as participants who received at least 1 dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Normal Renal Function: Ixazomib | Number of Participants With Adverse Events | 19 participants |
| Severe Renal Impairment: Ixazomib | Number of Participants With Adverse Events | 14 participants |
| End-stage Renal Disease: Ixazomib | Number of Participants With Adverse Events | 6 participants |
Percentage of Participants With Overall Response (OR) in Relapsed/Refractory Multiple Myeloma (RRMM) Participants
Overall response rate defined as percentage of relapsed/refractory multiple myeloma participants who achieved partial response (PR), complete response (CR) and very good partial response (VGPR) according to International Myeloma Working Group Criteria. PR=\>50% reduction of serum M-protein and reduction in 24 hours urinary M-protein by \>90% or \<200 mg/24 h. If serum and urine M-protein are unmeasurable, \>50% decrease in difference between involved and uninvolved free light chain levels in place of M-protein criteria. If serum and urine M-protein and serum free light assay are not measurable, \>50% reduction in plasma cells in place of M-protein, provided baseline bone marrow plasma cell \>0%; CR=negative immunofixation on serum and urine and disappearance of any soft tissue plasmacytomas and \<5% plasma cells in bone marrow; VGPR=serum and urine M-protein detectable by immunofixation but not on electrophoresis or \> 90% reduction in serum M-protein plus urine M-protein level \<100 mg/24 h.
Time frame: Day 1 of every other cycle from cycle 1 (each cycle of 28 days) up to progression of disease (approximately up to 855 days)
Population: Response evaluable is defined as participants who received at least 1 cycle of ixazomib treatment in Part B and at least 1 post-baseline response assessment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Normal Renal Function: Ixazomib | Percentage of Participants With Overall Response (OR) in Relapsed/Refractory Multiple Myeloma (RRMM) Participants | 29 percentage of participants |
| Severe Renal Impairment: Ixazomib | Percentage of Participants With Overall Response (OR) in Relapsed/Refractory Multiple Myeloma (RRMM) Participants | 18 percentage of participants |
| End-stage Renal Disease: Ixazomib | Percentage of Participants With Overall Response (OR) in Relapsed/Refractory Multiple Myeloma (RRMM) Participants | 0 percentage of participants |