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SL-401 in Combination With Pomalidomide and Dexamethasone in Relapsed or Relapsed and Refractory Multiple Myeloma

A Phase 1/2 Open Label Study of SL-401 in Combination With Pomalidomide and Dexamethasone in Relapsed or Relapsed and Refractory Multiple Myeloma

Status
Terminated
Phases
Phase 1Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02661022
Enrollment
9
Registered
2016-01-21
Start date
2016-01-31
Completion date
2019-12-31
Last updated
2024-04-17

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

Conditions

Multiple Myeloma

Keywords

Relapsed or Relapsed and Refractory, Multiple Myeloma, CD123, SL-401/pom/dex, TAG/pom/dex, R/R, MM

Brief summary

A Phase 1/2, Open Label Study of SL-401 in Combination with Pomalidomide and Dexamethasone In Relapsed and Refractory Multiple Myeloma

Detailed description

This study is a phase 1/2 multicenter, open-label study of SL-401 (tagraxofusp-erzs) in combination with standard doses of pomalidomide and dexamethasone in patients with relapsed and refractory multiple myeloma (MM). The study will be conducted in 2 phases: Phase 1 is the dose-escalation phase to determine the maximum tested dose (MTD) of SL-401 in combination with standard doses of pomalidomide and dexamethasone. In Phase 1, each evaluated SL-401 dose level will incorporate an initial Run-in Cycle (i.e. cycle 1) of single agent SL-401 in at least 3 patients; following the Run-in Cycle, patients who have not experienced a dose-limiting toxicity (DLT) will receive combination SL-401/pomalidomide and dexamethasone in cycles 2 and beyond. All patients in Phase 2 will receive 1 cycle of SL-401 monotherapy in cycle 1, followed by combination of SL-401/pomalidomide/dexamethasone in cycle 2 and beyond. The dose of SL-401 will be the MTD of SL-401 or MTD given in combination with pomalidomide/dexamethasone determined during Phase 1.

Interventions

DRUGSL-401 7 µg/kg/day

SL-401 7 µg/kg/day in combination with pom/dex

DRUGSL-401 9 µg/kg/day

SL-401 9 µg/kg/day in combination with pom/dex

Sponsors

Stemline Therapeutics, 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

* Eligible patients will be considered for inclusion if they meet all of the following criteria. (All necessary baseline studies for determining eligibility must be obtained within 21 days prior to enrollment.) 1. Male or female patient who is at least 18 years of age. 2. Patient has given voluntary written informed consent before performance of any study-related procedures not part of standard (non-investigational) medical care. 3. Patient has been previously diagnosed with MM based on standard criteria. 4. Patient has received: 1. At least 2 prior therapies including a proteasome inhibitor (≥ 2 cycles) and lenalidomide (≥ 2 cycles), and 2. Has achieved at least stable disease (SD) for ≥ 1 cycle of treatment on ≥ 1 prior treatment, and 3. Has demonstrated disease progression subsequent to treatment, during or within 90 days following completion of the most recent therapy. 5. Patient has an Eastern Cooperative Oncology Group (ECOG) performance status score ≤ 2. 6. Patient has measurable disease defined as at least 1 of the following: 1. Serum M protein ≥ 0.5 /dL (≥5 g/L) 2. Urine M protein ≥ 200 mg/24 hours 3. Serum free light chain (FLC) assay: Involved FLC assay ≥10 mg/dL (≥100 mg/L) and an abnormal serum FLC ratio (\<0.26 or \>1.65) 7. Clinical Laboratory Inclusion Criteria: The following laboratory results must be met within 14 days (or as stipulated) prior to study drug (treatment) administration: 1. Absolute neutrophil count (ANC) ≥ 1000 cells/μl (growth factor cannot be used within the previous 7 days). 2. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 × upper limit of normal (ULN). 3. Platelet count ≥ 50,000/μl (without platelet transfusion in the previous 7 days). 4. Total bilirubin ≤ 1.5 mg/dL. 5. Serum creatinine ≤ 2.0 mL/dL and creatinine clearance ≥ 40 mL/min (calculated by the Cockcroft-Gault Equation or per 24 hour urine collection). 6. Serum albumin ≥ 3.2 g/dL in the absence of receipt of (IV) albumin within the previous 72 hours. 7. Serum creatine phosphokinase (CPK) ≤ 2.5 × the ULN. 8. Serum calcium (corrected for albumin) level at or below the ULN range (treatment of hypercalcemia is allowed and patient may enroll if hypercalcemia returns to normal range with standard treatment). 8. Left ventricular ejection fraction (LVEF) ≥ institutional lower limit of normal as measured by multigated acquisition scan (MUGA) scan or 2-dimensional echocardiography (ECHO) within 28 days prior to start of therapy and no clinically significant abnormalities on a 12-lead electrocardiogram (ECG). 9. Females of childbearing potential (FCBP)\* must have a negative serum or urine pregnancy test prior to initiation of the SL-401 Run in Cycle (if required) and repeated with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of starting Pomalidomide and must either commit to continued abstinence from heterosexual intercourse or begin 2 acceptable methods of birth control, 1 highly effective method and 1 additional effective method at the same time, at least 28 days before she starts taking Pomalidomide through 30 days after the last dose of Pomalidomide and 60 days after the last dose of SL-401. FCBP must also agree to ongoing pregnancy testing during the entire duration of treatment. Men must agree to use a latex or synthetic condom during sexual contact with a FCBP even if they have had a vasectomy from the time of signing the informed consent form through 60 days after the last dose of Pomalidomide or SL-401. These same patients must not donate sperm. All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure. All patients enrolled into this study, must agree to be registered in and must comply with all requirements of the Pomalidomide REMS(TM) program. * An FCBP is a sexually mature female who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).

Exclusion criteria

Patients will be ineligible for this study if they meet any 1 of the following criteria: 1. The patient has an active malignancy and/or cancer history that may confound the assessment of the study endpoints. Patients with a past cancer history (within 2 years of entry) with substantial potential for recurrence and/or ongoing active malignancy must be discussed with the Sponsor before study entry. Patients with the following neoplastic diagnoses are eligible: non-melanoma skin cancer, carcinoma in situ (including superficial bladder cancer), cervical intraepithelial neoplasia, organ-confined prostate cancer with no evidence of progressive disease. 2. Prior therapy with SL-401 or received any investigational drug within the prior 30 days or 5 half-lives of the investigational drug, whichever is longer. 3. Prior anti-cancer therapy (chemotherapy, targeted agents, radiotherapy, and immunotherapy) within the prior 14 days except for alkylating agents (e.g., melphalan) within the prior 28 days. 4. Pomalidomide (POM)-refractory disease (i.e., non-responsive to prior POM \[either as monotherapy or in combination\] or relapse/progressive disease within 60 days of prior POM (either as monotherapy or in combination). Prior POM exposure is permitted, provided the patient's MM is not considered POM-refractory as defined above. 5. Primary refractory MM defined as disease that is non-responsive in patients that have never achieved at least stable disease or better with any therapy. 6. Any \> grade 1 (according to the National Cancer Institute \[NCI\] Common Terminology Criteria for Adverse Events \[CTCAE\], v.4.03) adverse reaction unresolved from previous treatments or not readily managed and controlled with supportive care. The presence of alopecia of any grade and peripheral neuropathy ≤ grade 2 without pain is allowed. 7. Previous allogeneic stem cell transplantation with active graft-versus-host-disease, or treatment with immunosuppressive therapy in the 2 months prior to study entry. 8. Daily requirement for corticosteroids \>10 mg prednisone daily (or equivalent); inhaled corticosteroids are permitted. 9. Patient is known to be human immunodeficiency virus positive, or have chronic or active hepatitis B (core- or surface antigen-positive) or active hepatitis C infection. 10. Clinically significant cardiovascular disease (e.g., uncontrolled or any New York Heart Association \[NYHA\] Class 3 or 4, congestive heart failure, uncontrolled or unstable angina, history of myocardial infarction or stroke within 6 months prior to study entry, uncontrolled hypertension or clinically significant arrhythmias not controlled by medication) 11. Uncontrolled, clinically significant pulmonary disease (e.g., chronic obstructive pulmonary disease, pulmonary hypertension) that in the opinion of the Investigator would put the patient at significant risk for pulmonary complications during the study. 12. Uncontrolled intercurrent illness including, but not limited to, uncontrolled infection, disseminated intravascular coagulation, or psychiatric illness/social situations that would limit compliance with study requirements. 13. History of erythema multiforme or severe hypersensitivity to prior Immunomodulatory Drugs (IMiDs) such as thalidomide and lenalidomide. 14. The patient is receiving medications that are strong inhibitors of CYP1A2. Patients should have discontinued strong CYP1A2 inhibitors (e.g., ciprofloxacin and fluvoxamine) at least 5 half-lives before beginning study drug. 15. The patient continues to smoke cigarettes, which can induce CYP1A2. 16. Inability to tolerate thromboprophylaxis. 17. Pregnant or breast feeding.

Design outcomes

Primary

MeasureTime frameDescription
Number of Patients With Dose-limiting Toxicities and Treatment-emergent Adverse EventsFor a 28-day cycle, Cycle 1To evaluate the safety of single agent SL-401 in an initial run-in cycle in patients with multiple myeloma
Number of Patients With Treatment-related Adverse EventsUp to 12 monthsTo evaluate the safety of single agent SL-401 in an initial run-in cycle in patients with multiple myeloma
Treatment-Emergent Adverse Events Leading to Discontinuation of Study DrugUp to 12 MonthsTo evaluate the safety of single agent SL-401 in an initial run-in cycle in patients with multiple myeloma (MM)

Secondary

MeasureTime frameDescription
Overall Response RateUp to 12 MonthsOverall response rate is defined as complete response + very good partial response + partial response and clinical benefit rate (CR + VGPR + PR + minimal response \[MR\]) based on International Myeloma Working Group-defined response criteria and the duration of response (DOR) in relapsed refractory multiple myeloma (RRMM) patients.
Progression-free SurvivalUp to 12 MonthsPer International Myeloma Working Group Response Criteria, progression/progressive disease is defined as increase of \>25% from lowest response value in any 1 of the following: serum M-component (the absolute increase must be \>0.5 g/dL)4 and/or urine M-component (the absolute increase must be \>200 mg/24 h) and/or; only in patients without measurable serum and urine M-protein, the difference between involved and uninvolved FLC levels. The absolute increase must be \>10 mg/dL; only in patients without measurable serum and urine M-protein and without measurable disease by FLC levels; bone marrow plasma cell percentage (absolute % must be ≥10%); definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; development of hypercalcemia (corrected serum calcium \>11.5 mg/dL) that can be attributed solely to the plasma cell proliferative disorder.

Countries

United States

Participant flow

Participants by arm

ArmCount
SL-401 7 µg/kg/Day
SL-401 7 µg/kg/day in combination with Pomalidomide and Dexamethasone SL-401 7 µg/kg/day: SL-401 7 µg/kg/day in combination with Pomalidomide/Dexamethasone
7
SL-401 9 µg/kg/Day
SL-401 9 µg/kg/day in combination with Pomalidomide and Dexamethasone SL-401 9 µg/kg/day: SL-401 9 µg/kg/day in combination with Pomalidomide/Dexamethasone
2
Total9

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event11
Overall StudyPhysician Decision10
Overall StudyProgressive Disease21
Overall StudyWithdrawal by Subject30

Baseline characteristics

CharacteristicSL-401 7 µg/kg/DaySL-401 9 µg/kg/DayTotal
Age, Continuous65.3 years
STANDARD_DEVIATION 4.35
57.0 years
STANDARD_DEVIATION 0
63.4 years
STANDARD_DEVIATION 5.25
Eastern Cooperative Oncology Group Status (ECOG Status)
0
3 Participants2 Participants5 Participants
Eastern Cooperative Oncology Group Status (ECOG Status)
1
4 Participants0 Participants4 Participants
Eastern Cooperative Oncology Group Status (ECOG Status)
2
0 Participants0 Participants0 Participants
Height164.6 cm
STANDARD_DEVIATION 14.39
164.7 cm
STANDARD_DEVIATION 6.65
164.6 cm
STANDARD_DEVIATION 12.42
Race/Ethnicity, Customized
White
7 Participants2 Participants9 Participants
Region of Enrollment
United States
7 participants2 participants9 participants
Sex: Female, Male
Female
3 Participants1 Participants4 Participants
Sex: Female, Male
Male
4 Participants1 Participants5 Participants
Weight85.6 kg
STANDARD_DEVIATION 18.4
92.9 kg
STANDARD_DEVIATION 16.62
87.2 kg
STANDARD_DEVIATION 17.29

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 70 / 2
other
Total, other adverse events
7 / 72 / 2
serious
Total, serious adverse events
4 / 72 / 2

Outcome results

Primary

Number of Patients With Dose-limiting Toxicities and Treatment-emergent Adverse Events

To evaluate the safety of single agent SL-401 in an initial run-in cycle in patients with multiple myeloma

Time frame: For a 28-day cycle, Cycle 1

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
SL-401 7 µg/kg/DayNumber of Patients With Dose-limiting Toxicities and Treatment-emergent Adverse Events7 Participants
SL-401 9 µg/kg/DayNumber of Patients With Dose-limiting Toxicities and Treatment-emergent Adverse Events2 Participants
Primary

Number of Patients With Treatment-related Adverse Events

To evaluate the safety of single agent SL-401 in an initial run-in cycle in patients with multiple myeloma

Time frame: Up to 12 months

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsAt Least 1 Treatment-Related Treatment-Emergent Adverse Event7 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsFatigue5 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsNausea5 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsPyrexia4 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsHypoalbuminaemia4 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsChills4 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsInsomnia3 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsAspartate aminotransferase increased2 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsConstipation2 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsDizziness3 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsFlushing3 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsHeadache2 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsHypophosphataemia2 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsNeutropenia3 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsOedema peripheral3 Participants
SL-401 7 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsThrombocytopenia2 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsThrombocytopenia1 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsAt Least 1 Treatment-Related Treatment-Emergent Adverse Event2 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsConstipation1 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsFatigue1 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsHypophosphataemia1 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsNausea1 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsDizziness0 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsPyrexia2 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsOedema peripheral0 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsHypoalbuminaemia1 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsFlushing0 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsChills0 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsNeutropenia0 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsInsomnia1 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsHeadache1 Participants
SL-401 9 µg/kg/DayNumber of Patients With Treatment-related Adverse EventsAspartate aminotransferase increased1 Participants
Primary

Treatment-Emergent Adverse Events Leading to Discontinuation of Study Drug

To evaluate the safety of single agent SL-401 in an initial run-in cycle in patients with multiple myeloma (MM)

Time frame: Up to 12 Months

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
SL-401 7 µg/kg/DayTreatment-Emergent Adverse Events Leading to Discontinuation of Study DrugCapillary leak syndrome0 Participants
SL-401 7 µg/kg/DayTreatment-Emergent Adverse Events Leading to Discontinuation of Study DrugPancreatitis0 Participants
SL-401 7 µg/kg/DayTreatment-Emergent Adverse Events Leading to Discontinuation of Study DrugMetastatic malignant melanoma1 Participants
SL-401 7 µg/kg/DayTreatment-Emergent Adverse Events Leading to Discontinuation of Study DrugThrombocytopenia0 Participants
SL-401 7 µg/kg/DayTreatment-Emergent Adverse Events Leading to Discontinuation of Study DrugAt Least 1 TEAE Leading to Discontinuation of Study Drug1 Participants
SL-401 9 µg/kg/DayTreatment-Emergent Adverse Events Leading to Discontinuation of Study DrugThrombocytopenia1 Participants
SL-401 9 µg/kg/DayTreatment-Emergent Adverse Events Leading to Discontinuation of Study DrugAt Least 1 TEAE Leading to Discontinuation of Study Drug1 Participants
SL-401 9 µg/kg/DayTreatment-Emergent Adverse Events Leading to Discontinuation of Study DrugCapillary leak syndrome1 Participants
SL-401 9 µg/kg/DayTreatment-Emergent Adverse Events Leading to Discontinuation of Study DrugMetastatic malignant melanoma0 Participants
SL-401 9 µg/kg/DayTreatment-Emergent Adverse Events Leading to Discontinuation of Study DrugPancreatitis1 Participants
Secondary

Overall Response Rate

Overall response rate is defined as complete response + very good partial response + partial response and clinical benefit rate (CR + VGPR + PR + minimal response \[MR\]) based on International Myeloma Working Group-defined response criteria and the duration of response (DOR) in relapsed refractory multiple myeloma (RRMM) patients.

Time frame: Up to 12 Months

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
SL-401 7 µg/kg/DayOverall Response RateStringent Complete Response0 Participants
SL-401 7 µg/kg/DayOverall Response RateMinimal Response0 Participants
SL-401 7 µg/kg/DayOverall Response RateComplete Response0 Participants
SL-401 7 µg/kg/DayOverall Response RateStable Disease0 Participants
SL-401 7 µg/kg/DayOverall Response RateVery Good Partial Response0 Participants
SL-401 7 µg/kg/DayOverall Response RateProgressive Disease0 Participants
SL-401 7 µg/kg/DayOverall Response RateOverall Response Rate5 Participants
SL-401 7 µg/kg/DayOverall Response RatePartial Response5 Participants
SL-401 7 µg/kg/DayOverall Response RateCensored4 Participants
SL-401 7 µg/kg/DayOverall Response RateProgressive Disease or Death After Overall Response1 Participants
SL-401 9 µg/kg/DayOverall Response RateCensored0 Participants
SL-401 9 µg/kg/DayOverall Response RateOverall Response Rate0 Participants
SL-401 9 µg/kg/DayOverall Response RateComplete Response0 Participants
SL-401 9 µg/kg/DayOverall Response RateStringent Complete Response0 Participants
SL-401 9 µg/kg/DayOverall Response RateVery Good Partial Response0 Participants
SL-401 9 µg/kg/DayOverall Response RatePartial Response0 Participants
SL-401 9 µg/kg/DayOverall Response RateMinimal Response0 Participants
SL-401 9 µg/kg/DayOverall Response RateStable Disease1 Participants
SL-401 9 µg/kg/DayOverall Response RateProgressive Disease0 Participants
SL-401 9 µg/kg/DayOverall Response RateProgressive Disease or Death After Overall Response0 Participants
Secondary

Progression-free Survival

Per International Myeloma Working Group Response Criteria, progression/progressive disease is defined as increase of \>25% from lowest response value in any 1 of the following: serum M-component (the absolute increase must be \>0.5 g/dL)4 and/or urine M-component (the absolute increase must be \>200 mg/24 h) and/or; only in patients without measurable serum and urine M-protein, the difference between involved and uninvolved FLC levels. The absolute increase must be \>10 mg/dL; only in patients without measurable serum and urine M-protein and without measurable disease by FLC levels; bone marrow plasma cell percentage (absolute % must be ≥10%); definite development of new bone lesions or soft tissue plasmacytomas or definite increase in the size of existing bone lesions or soft tissue plasmacytomas; development of hypercalcemia (corrected serum calcium \>11.5 mg/dL) that can be attributed solely to the plasma cell proliferative disorder.

Time frame: Up to 12 Months

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
SL-401 7 µg/kg/DayProgression-free SurvivalDeath0 Participants
SL-401 7 µg/kg/DayProgression-free SurvivalPFS at 6 Months4 Participants
SL-401 7 µg/kg/DayProgression-free SurvivalCensored4 Participants
SL-401 7 µg/kg/DayProgression-free SurvivalPFS at 12 Months1 Participants
SL-401 7 µg/kg/DayProgression-free SurvivalDisease Progression1 Participants
SL-401 9 µg/kg/DayProgression-free SurvivalPFS at 12 Months0 Participants
SL-401 9 µg/kg/DayProgression-free SurvivalDisease Progression0 Participants
SL-401 9 µg/kg/DayProgression-free SurvivalDeath0 Participants
SL-401 9 µg/kg/DayProgression-free SurvivalCensored1 Participants
SL-401 9 µg/kg/DayProgression-free SurvivalPFS at 6 Months0 Participants

Source: ClinicalTrials.gov · Data processed: Feb 28, 2026