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Pharmacokinetics Study of Oral Ixazomib (MLN9708) in Relapsed/Refractory Multiple Myeloma and Advanced Solid Tumors Participants With Normal Renal Function or Severe Renal Impairment

Phase 1/1b Pharmacokinetics Study of Oral MLN9708 in Patients With Relapsed/Refractory Multiple Myeloma and Advanced Solid Tumors With Normal Renal Function or Severe Renal Impairment

Status
Completed
Phases
Phase 1
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01830816
Enrollment
41
Registered
2013-04-12
Start date
2013-09-16
Completion date
2016-11-18
Last updated
2019-06-10

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

Conditions

Advanced Solid Tumors, Multiple Myeloma

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

DRUGIxazomib

Ixazomib capsules

Sponsors

Millennium Pharmaceuticals, Inc.
Lead SponsorINDUSTRY

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

* 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

MeasureTime frame
Unbound Cmax: Unbound Maximum Observed Plasma Concentration for IxazomibPart A, Day 1: Predose and at multiple timepoints (up to 336 hours) post-dose
Tmax: Time to Reach the Maximum Plasma Concentration (Cmax) for IxazomibPart 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 IxazomibPart A, Day 1: Predose and at multiple timepoints (up to 336 hours) post-dose

Secondary

MeasureTime frameDescription
Number of Participants With Adverse EventsFrom 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) ParticipantsDay 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 ParticipantsDay 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

ArmCount
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
Total41

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Overall StudyAdverse Event340
Overall StudyLost to Follow-up010
Overall StudyProgressive Disease1277
Overall StudyReason not Specified200
Overall StudyStudy Terminated by Sponsor110
Overall StudySymptomatic Deterioration100
Overall StudyWithdrawal by Subject110

Baseline characteristics

CharacteristicNormal Renal Function: IxazomibTotalEnd-stage Renal Disease: IxazomibSevere Renal Impairment: Ixazomib
Age, Continuous54.5 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
Height173.2 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 Participants1 Participants1 Participants0 Participants
Race/Ethnicity, Customized
Black or African American
6 Participants12 Participants3 Participants3 Participants
Race/Ethnicity, Customized
Hispanic or Latino
1 Participants4 Participants1 Participants2 Participants
Race/Ethnicity, Customized
Not Hispanic or Latino
19 Participants35 Participants6 Participants10 Participants
Race/Ethnicity, Customized
Not Reported
1 Participants2 Participants0 Participants0 Participants
Race/Ethnicity, Customized
White
13 Participants27 Participants3 Participants11 Participants
Sex: Female, Male
Female
10 Participants25 Participants3 Participants12 Participants
Sex: Female, Male
Male
10 Participants16 Participants4 Participants2 Participants
Weight98.1 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 typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
19 / 2014 / 145 / 7
serious
Total, serious adverse events
3 / 206 / 143 / 7

Outcome results

Primary

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.

ArmMeasureValue (MEDIAN)
Normal Renal Function: IxazomibTmax: Time to Reach the Maximum Plasma Concentration (Cmax) for Ixazomib1.0400 hours
Severe Renal Impairment: IxazomibTmax: Time to Reach the Maximum Plasma Concentration (Cmax) for Ixazomib1.0000 hours
End-stage Renal Disease: IxazomibTmax: Time to Reach the Maximum Plasma Concentration (Cmax) for Ixazomib1.2500 hours
Primary

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.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Normal Renal Function: IxazomibUnbound AUClast: Unbound Area Under the Plasma Concentration-Time Curve From Time 0 to the Time of the Last Quantifiable Concentration for Ixazomib6.637 hr*ng/mLStandard Deviation 4.8022
Severe Renal Impairment: IxazomibUnbound AUClast: Unbound Area Under the Plasma Concentration-Time Curve From Time 0 to the Time of the Last Quantifiable Concentration for Ixazomib9.249 hr*ng/mLStandard Deviation 6.2618
End-stage Renal Disease: IxazomibUnbound AUClast: Unbound Area Under the Plasma Concentration-Time Curve From Time 0 to the Time of the Last Quantifiable Concentration for Ixazomib8.925 hr*ng/mLStandard Deviation 5.7995
Primary

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.

ArmMeasureValue (GEOMETRIC_MEAN)Dispersion
Normal Renal Function: IxazomibUnbound Cmax: Unbound Maximum Observed Plasma Concentration for Ixazomib0.300 ng/mLStandard Deviation 0.247944
Severe Renal Impairment: IxazomibUnbound Cmax: Unbound Maximum Observed Plasma Concentration for Ixazomib0.478 ng/mLStandard Deviation 0.599519
End-stage Renal Disease: IxazomibUnbound Cmax: Unbound Maximum Observed Plasma Concentration for Ixazomib0.213 ng/mLStandard Deviation 0.136696
Secondary

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.

ArmMeasureValue (MEDIAN)
Normal Renal Function: IxazomibDuration of Response (DOR) in RRMM Participants134 days
Severe Renal Impairment: IxazomibDuration of Response (DOR) in RRMM Participants225 days
Secondary

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.

ArmMeasureValue (NUMBER)
Normal Renal Function: IxazomibNumber of Participants With Adverse Events19 participants
Severe Renal Impairment: IxazomibNumber of Participants With Adverse Events14 participants
End-stage Renal Disease: IxazomibNumber of Participants With Adverse Events6 participants
Secondary

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.

ArmMeasureValue (NUMBER)
Normal Renal Function: IxazomibPercentage of Participants With Overall Response (OR) in Relapsed/Refractory Multiple Myeloma (RRMM) Participants29 percentage of participants
Severe Renal Impairment: IxazomibPercentage of Participants With Overall Response (OR) in Relapsed/Refractory Multiple Myeloma (RRMM) Participants18 percentage of participants
End-stage Renal Disease: IxazomibPercentage of Participants With Overall Response (OR) in Relapsed/Refractory Multiple Myeloma (RRMM) Participants0 percentage of participants

Source: ClinicalTrials.gov · Data processed: Mar 3, 2026