The median overall survival (OS) of relapsed/refractory multiple myeloma (MM) is less than nine months. However, phase II data with the proteasome inhibitor bortezomib (Velcade®) has been heartening, with 35% overall response rates and median survival of 16 months. In-vitro data has shown that this agent dramatically increases the sensitivity to chemotherapeutic agents. Liposomal doxorubicin (Doxil), melphalan, and bortezomib all have different mechanisms of action and toxicity profiles. Clinical studies employing two drug combinations with these agents in patients with refractory MM have found favorable efficacy (nearly no progression of disease) and tolerance data. Thus, the investigators are initiating a phase I/II study to examine the safety and efficacy of combining all three agents into the regimen DMV (Doxil® + melphalan + Velcade).
Dose Level 1: Doxil 10 mg/m2, Melphalan 5 mg/m2, Velcade 0.7 mg/m2 Dose Level 2: Doxil 10 mg/m2, Melphalan 10 mg/m2, Velcade 0.7 mg/m2 Dose Level 3: Doxil 20 mg/m2, Melphalan 10 mg/m2, Velcade 0.7 mg/m2 Dose Level 4: Doxil 20 mg/m2, Melphalan 10 mg/m2, Velcade 1.0 mg/m2 Adjunctive therapy with a bisphosphonate, either pamidronate or zoledronic acid, will be given monthly. Dose Escalation Schedule: Dose escalation will occur only after patients have completed at least two cycles at a given dose level. 1. If 0/3 experience DLT (as defined in attachment Section 6.0), the next three patients will be escalated by one dose level. 2. If 1/3 experience DLT, 3 additional patients enrolled at this dose level. * If 0, 1, or 2 of these additional patients experience DLT (i.e. total 3/6), the dose will be escalated. * If 3/3 experience DLT (i.e. total 4/6) then the next lower dose will be considered the MTD.. 3. If 2/3 experience DLT, 3 additional patients enrolled at this dose level. * If 0 or 1 of these additional patients experience DLT (i.e. total 3/6), the dose will be escalated. * If 2 or more/3 experience DLT (i.e. total more than 3/6) then the next lower dose level is MTD
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
13
Doxil®: IV over 30-60 min, Day 1 q28d Melphalan: IV over 30 min, Day 1 q28d Velcade®: IV bolus, Day 1, 4, 8, 11 q28d Dose Level 1: Doxil 10 mg/m2, Melphalan 5 mg/m2, Velcade 0.7 mg/m2 Dose Level 2: Doxil 10 mg/m2, Melphalan 10 mg/m2, Velcade 0.7 mg/m2 Dose Level 3: Doxil 20 mg/m2, Melphalan 10 mg/m2, Velcade 0.7 mg/m2 Dose Level 4: Doxil 20 mg/m2, Melphalan 10 mg/m2, Velcade 1.0 mg/m2
University of California, San Francisco
San Francisco, California, United States
St. Vincent's Comprehensive Cancer Center
New York, New York, United States
Number of Participants With Dose Limiting Toxicities (DLT) (Phase 1)
Safety assessments will be evaluated as the proportion of patients experiencing the following: treatment-related grade 3 or higher toxicity (hematologic and nonhematologic) and treatment-related death.
Time frame: Up to 2 cycles of treatment, approximately 56 days
Maximum Tolerated Dose (MTD) (Phase 1)
The MTD will be considered the dose below where \<= 3 patients experience a DLT and the dose that two cycles can be given without meeting toxicity criteria.
Time frame: Up to 1 year
Number of All Treatment-related Toxicities at the MTD (Phase 1)
NCI Common Terminology Criteria for Adverse Events (CTCAE) version 3 will be used to determine all treatment related toxicities at the MTD. Participants entered at the MTD Dose level from the phase I portion of the study will also be included in this analysis
Time frame: 5 years
Overall Response Rate
At each cycle, participants will be assessed for treatment response: Complete Response (CR), Near CR(nCR), Partial Response (PR), Minimal Response (MR), Stable Disease (SD), or Progressive Disease (PD) on at least 2 measurements at minimum of a 4 week interval. The overall response rate will use the best response of CR, nCR, PR, MR, or SD. In order to qualify for responses, the following events may NOT have occurred - new/increased size of plasmacytomas or bone lesions, recurrence or persistence of hypercalcemia. Collapse of bony structure from previous disease will not constitute progression or failure to respond. Participants entered at the MTD Dose level from the phase I portion of the study will also be included in this analysis
Time frame: Up to 5 years
Time to Response (Phase 2)
Efficacy of DMV as determined by time to first observed response. Participants entered at the MTD Dose level from the phase I portion of the study will also be included in this analysis
Time frame: 28 days
Progression-free Survival (Phase 2)
Efficacy of DMV as determined by progression free survival. Participants entered at the MTD Dose level from the phase I portion of the study will also be included in this analysis
Time frame: Up to 5 years
Overall Survival (Phase 2)
Overall survival is defined as the amount of time from start of study therapy until death, or study completion. Participants entered at the MTD Dose level from the phase I portion of the study will also be included in this analysis
Time frame: Up to 5 years
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