The purpose of this study is to evaluate the safety and efficacy of NOX A12 alone and in combination with a background therapy of bortezomib and dexamethasone (VD) chemotherapy in previously treated patients with multiple myeloma (MM).
Malignant plasma cells express high levels of CXCR4 chemokine receptors, which cause cell migration and adhesion to stromal cells secreting the CXCR4 ligand, CXCL12 (SDF-1). NOX A12 is a specific CXCL12 antagonist and may improve chemotherapy by disrupting CXCR4-CXCL12 interactions, thereby mobilizing plasma cells from protective tissue microenvironments to the blood. Furthermore, SDF-1 inhibition may alter the activation status of plasma cells, thereby triggering apoptosis or sensitization of plasma cells towards chemotherapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
28
Pilot Group (NOX A12 single agent, and combined with VD): * 3 cohorts of 3 patients will receive treatment with NOX A12 alone at a single dose of 1, 2 or 4 mg/kg i.v. 2 weeks before the combination treatment of NOX A12 and VD will start. The combination of NOX A12 and VD will follow a dose titration design beginning at 1 mg/kg NOX A12 (cycle 1) proceeding to dose levels of 2 mg/kg (cycle 2) and 4 mg/kg (cycle 3) NOX A12 in combination with VD. This is followed by consolidation in cycles 4-8 when NOX-A12 will be kept at the highest individually titrated dose. Expansion Group (NOX A12 in combination with VD): * Expansion patients will not receive single agent NOX-A12, but will receive combination treatment as for the pilot group.
University Hospital Salzburg, Department of Medicine III, Center of Oncology and Hematology
Salzburg, Austria
Wilhelminenspital, Department of Medicine I, Center of Oncology and Hematology
Vienna, Austria
Hôpital Huriez, Centre Hospitalier Régional Universitaire de Lille
Lille, France
Overall response rate (ORR = best response at least partial response (PR))
Assessment of the overall tumor response after cycle 4 and 8 will be the primary efficacy endpoint. The recommendations for the uniform reporting of clinical trials as published by the International Myeloma Workshop Consensus Panel 1 in 2011 will be applied.
Time frame: 6 months
Safety and tolerability of NOX A12 alone and in combination with VD
The safety evaluation will be based on the following assessments: * Adverse events * Vital signs * 12 lead ECGs * Laboratory parameters * Abdominal ultrasound * Immunogenicity
Time frame: 18 months
Effect of NOX A12 alone and combined with VD on the mobilization of peripheral blood CD34+ cells, plasma cells and myeloma cells
Time frame: 6 months
Additional response criteria such as Minor Response (MR), immunophenotypic Complete Response and molecular Complete Response
Time frame: 6 months
Time to event endpoints such as Progression Free Survival (PFS), Time To Progression (TTP) and Duration Of Response (DOR) following treatment with NOX A12 in combination with VD
Time frame: 18 months
Plasma concentration of SDF-1 after treatment with NOX-A12 alone (pilot group only) and in combination with VD
Time frame: 6 months
Pharmacokinetics of NOX A12 alone (pilot group only) and combined with VD
Time frame: 6 months
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Hôpital Saint Antoine - Service des maladies du sang et de thérapie cellulaire
Paris, France
University Hospital Freiburg, Medizinische Universitätsklinik, Innere Medizin I, Haematologie und Onkologie
Freiburg im Breisgau, Germany
University Hospital Münster, Medizinische Klinik und Poliklinik A
Münster, Germany
University Hospital Ulm, Zentrum für Innere Medizin,
Ulm, Germany
University Hospital San Martino, Department of Hematology and Oncology
Genova, Italy
Niguarda Ca'Granda Hospital, Department of Hematology
Milan, Italy
Sapienza University of Rome, Department of Hematology
Rome, Italy