The purpose of this study is to determine whether the association of Carfilzomib, Cyclophosphamide and Dexamethasone (CCd) as induction treatment is safe and provides benefits in patients with newly diagnosed Multiple Myeloma (MM).
This protocol is a phase II multicenter, international, non-comparative, open label study designed to jointly assess the safety and the efficacy of the association Carfilzomib with Cyclophosphamide and Dexamethasone (CCd) as induction treatment and Carfilzomib alone as maintenance in newly diagnosed MM patients. Patients will be evaluated at scheduled visits in up to 4 study periods: pre-treatment, treatment, maintenance and long-term follow-up. The pre-treatment period includes screening visits, performed at study entry. After providing written informed consent to participate in the study, patients will be evaluated for study eligibility. The screening period includes the availability of inclusion criteria described above. The treatment period includes administration of Carfilzomib, Cyclophosphamide and Dexamethasone for 9 4-week courses. In order to assess the toxicity of treatment, patients will attend the study centre visits at each scheduled Carfilzomib administration. The response will be assessed after each 4-week cycle. The maintenance period includes carfilzomib alone on days 1, 2, 15, 16 at 36mg/m2. For patients who show evidence of progression during maintenance phase, the frequency of Carfilzomib can be increased to days 1, 2, 8, 9, 15, 16 at the discretion of the investigator. It will be initiated at the end of the 9th course and will be stopped at progression or intolerance. The median expected duration of the maintenance treatment is approximately 2 years. The Long Term Follow Up periods will start after development of confirmed Progression Disease, all patients are to be followed for survival during the Long Term Follow Up period every 3 months via telephone or office visit. Approximately 15 Italian centers and foreign centers will participate to the protocol. Patients with symptomatic newly diagnosed MM whose age is ≥ 65 years or who are ineligible for autologous stem cell transplantation. Up to 53 patients will be enrolled from different centers. The duration of the treatment is approximately 9 months. This length of time is required to complete 9 courses of CCd. At the end of the first stage (19 patients), the trial will be temporarily stopped until all 19 patients complete the toxicity and efficacy evaluation (3 cycle): if there are more than 7 responses and less than 8 toxicities, a further group of 34 patients (total=53) will be enrolled. Otherwise, the trial will be definitively stopped or the DSMC will recommend testing other doses of the drugs. The maintenance period in both phases will start at the end of the 9th course and will be stopped at progression or intolerance. The median expected duration of the maintenance treatment is approximately 2 years. The duration of follow-up from relapse will be approximately 2 years. The occurrence of PD will determine the duration of TTP of each patient. The occurrence of death will determine the duration of overall survival. The first analysis to evaluate safety and efficacy is planned when the 19 patients enrolled in the first stage of the study have completed the third cycle of induction treatment. The trial will be stopped if there are \< 6 responses, or \> 9 toxicities or the Data Safety Monitoring Committee recommends testing other doses of the drugs; Otherwise, a further group of 34 patients (total=53) will be enrolled. The final conclusion will be negative if there are ≤ 23/53 responses, or ≥ 20/53 drug-related toxicities.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
58
Patients will start induction treatment with Cyclophosphamide given orally at the dose of 300 mg/m2 on days 1, 8, 15. Low dose Dexamethasone will be given orally at the dose of 40 mg on days 1, 8, 15, 22 or 20 mg on days 1-2, 8-9,15-16, 22-23. Carfilzomib = 20 mg/m2 IV once daily on days 1, 2, of cycle 1 only followed by 36 mg/ m2 days 8, 9, 15, 16 in cycle 1, then for all subsequent doses 36 mg/ m2 IV once daily on days 1, 2, 8, 9, 15, 16, followed by 13-day rest period (day 17 through 28). Each cycle will be repeated every 28 days for a total of 9 courses. MANTEINANCE PERIOD At the end of induction phase (9 courses), maintenance phase with Carfilzomib alone IV at 36 mg/ m2 IV on days 1, 2, 15, 16 will start, until progression or intolerance. For patients who show evidence of progression during maintenance phase, the frequency of Carfilzomib can be increased to days 1, 2, 8, 9, 15, 16 at the discretion of the investigator, or the patient may be removed from the study
IRCCS CROB UOC di Ematologia e trapianto cellule staminali Ospedale Oncologico Regionale
Rionero in Vulture, PZ, Italy
azienda ospedaliero-universitaria umberto I Clinica di Ematologia
Ancona, Italy
Toxicity: Assessment of adverse events will be performed at the end of third cycle according to the National Cancer Institute Common Terminology Criteria of Adverse Events (CTCAE version 4.0)
Toxicity is defined as the first occurrence of a grade 4 hematologic drug-related toxicity excluding anemia, (grade 4 neutropenia must last longer than 3 days and grade 4 thrombocytopenia must last longer than 7 days in order to be considered a toxicity) with the exception of (grade 4 neutropenia \> 3 days , or grade 4 thrombocytopenia \>7 days duration) or grade 3 non-hematologic drug-related toxicity.
Time frame: 4 years
Efficacy will be assessed by considering partial response (PR) following the proposed regimen. Assessment of Partial Response rate will be performed at the end of third cycle according to the criteria of the International Myeloma Working Group.
Time frame: 4 years
Response rate
Time frame: 4 years
Duration of Progression Free Survival
Time frame: 4 years
Time to progression (TTP)
Time frame: 4 years
Duration of Response (DOR)
Time frame: 4 years
Duration of Overall Survival
Time frame: 4 years
Time to next therapy
Time frame: 4 years
Progressio Free Survival
Relation between responses and Progression Free Survival, in responding and non-responding patients.
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Policlinico S. Orsola Istituto di Ematologia e Oncologia Medica
Bologna, Italy
Ospedale Ferrarotto_Reparto di Ematologia
Catania, Italy
Az.Osp. Di Careggi_Dh ematologia
Florence, Italy
Istituto Nazionale per lo Studio e la Cura dei Tumori_UO Ematologia_Trapianto di Midollo Osseo Allogenico
Milan, Italy
Divisione di Ematologia Dipartimento di Medicina Clinica e Sperimentale Università Amedeo Avogadro
Novara, Italy
Cattedra di ematologia Università La Sapienza
Roma, Italy
Divisione di Ematologia Ospedale S. Eugenio
Roma, Italy
S.C.di Oncoematologia, Azienda Ospedaliera S. Maria di Terni
Terni, Italy
...and 3 more locations
Time frame: 4 years
β2-microglobulin as prognostic factors
Subgroups analysis on prognostic factors
Time frame: 4 years
peripheral neuropathy
Rates of peripheral neuropathy, according to the National Cancer Institute Common Toxicity Criteria (version 4.0)
Time frame: 4 years
Progression Free Survival
Effect on Progression Free Survival of maintenance with low dose of Carfilzomib (days 1 and 2 every other week)
Time frame: 4 years
C reactive protein as prognostic factors
Subgroups analysis on prognostic factors
Time frame: 4 years
cytogenetics as prognostic factors
Subgroups analysis on prognostic factors
Time frame: 4 years
microRNA
Subgroups analysis on prognostic factors
Time frame: 4 years
gene expression profile
Subgroups analysis on prognostic factors
Time frame: 4 years
Overall Survival
Effect on Overall Survival of maintenance with low dose of Carfilzomib (days 1 and 2 every other week)
Time frame: 4 years