This protocol is a phase I/II multicenter study designed to assess the safety and the efficacy of the proposed combinations as up-front treatment in elderly Multiple Myeloma (MM) patients.
TREATMENT PERIOD Patients will start the induction treatment with wCCyd, as soon as the screening visits of the pre-treatment period have been terminated. Each cycle will be repeated every 28 days for a total of 9 courses. Treatment schedule for 9 cycles of induction: Phase I: In the phase I part of the study, the following dose levels of carfilzomib will be studied with constant doses of dexamethasone and cyclophosphamide to define the maximum tolerated dose (MTD): Level -1 1. Cyclophosphamide given orally at the dose of 300 mg/m2 on days 1, 8, 15. 2. Dexamethasone 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. 3. Carfilzomib given 20 mg/m2 IV once daily on Day 1 of Cycle 1 only followed by 36 mg/m2 on days 8, 15 of Cycle 1, then for all subsequent doses 36 mg/m2 IV once daily on days 1, 8, 15, followed by 14-day rest period (day 16 through 28). Level 0 (starting dose) 1. Cyclophosphamide given orally at the dose of 300 mg/m2 on days 1, 8, 15. 2. Dexamethasone 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. 3. Carfilzomib given 20 mg/m2 IV once daily on Day 1 of Cycle 1 only followed by 45 mg/m2 on days 8, 15 of Cycle 1, then for all subsequent doses 45 mg/m2 IV once daily on days 1, 8, 15, followed by 14-day rest period (day 16 through 28). Level +1 1. Cyclophosphamide given orally at the dose of 300 mg/m2 on days 1, 8, 15. 2. Dexamethasone 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. 3. Carfilzomib given 20 mg/m2 IV once daily on Day 1 of Cycle 1 only followed by 56 mg/m2 on days 8, 15 of Cycle 1, then for all subsequent doses 56 mg/m2 IV once daily on days 1, 8, 15, followed by 14-day rest period (day 16 through 28). Level +2 1. Cyclophosphamide given orally at the dose of 300 mg/m2 on days 1, 8, 15. 2. Dexamethasone 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. 3. Carfilzomib given 20 mg/m2 IV once daily on Day 1 of Cycle 1 only followed by 70 mg/m2 on days 8, 15 of Cycle 1, then for all subsequent doses 70 mg/m2 IV once daily on days 1, 8, 15, followed by 14-day rest period (day 16 through 28). Patients will be observed during the first cycle of therapy for the assessment of side effects and observation of DLTs. Dose escalation will proceed as follows: * 3 patients will be entered at dose level 0. * If 0/3 patients experience DLT, dose escalation will continue. * If 1/3 patients experience DLT, 3 additional patients will be added to this cohort (max 6). * If no further patients experience DLT (1/6) dose escalation will continue. * If 2/6 patients experience DLT, the MTD will have been exceeded and the MTD will be the previous dose at which \< 2/6 experienced DLT. * If 2/3 patients experience a DLT at any given dose, the MTD will have been exceeded and the MTD will be the preceding dose at which \< 2/6 (or 1/3) patients experienced a DLT. Phase II: The dose used to treat patients in the phase II will be the MTD defined in the phase I of the study. MAINTENANCE PERIOD At the end of the induction phase, patients will start the maintenance phase with Carfilzomib at the MTD defined by the phase I study IV once daily on days 1, 8, 15 until progression or intolerance. Treatment schedule for maintenance until progression or intolerance: Carfilzomib at the MTD defined by phase I study IV once daily on days 1, 8, 15.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
63
Fondazione EMN Italy Onlus
Torino, Italy
Identification of Dose-limiting toxicity (DLT)
Non-hematologic: * Grade2 neuropathy with pain * any Grade 3 toxicity (excluding nausea, vomiting, diarrhea) * Grade3 nausea, vomiting, or diarrhea despite maximal antiemetic/antidiarrheal therapy * Grade4 fatigue lasting for ≥7days * Any non-hematologic toxicity requiring a dose reduction within Cycle1 * Inability to receive Day 1 dose of Cycle2 due to drug related toxicity persisting from Cycle1 or drug related toxicity newly encountered on Day1 of Cycle2. Hematologic: * Grade 4 neutropenia (ANC\<0.5x109/L) lasting for ≥7days * Febrile neutropenia (ANC\<1.0x109/L with a fever ≥38.3ºC) * Grade 4 thrombocytopenia (platelets\<25.0x109/L) lasting ≥7 days despite dose delay * Grade 3-4 thrombocytopenia associated with bleeding * Any hematologic toxicity requiring a dose reduction within Cycle1 * Inability to receive Day1 dose of Cycle2 due to drug related toxicity persisting from Cycle1 or drug related toxicity newly encountered on Day1 of Cycle2.
Time frame: 1 year
Partial Response (PR)
The primary efficacy endpoints will be assessed by considering partial response (PR) following the proposed regimen, at the end of third cycle.
Time frame: 1 year
Response rate (RR)
Determine the response rate
Time frame: 3 years
Progression free-survival (PFS)
Determine progression free-survival
Time frame: 3 years
Time to progression (TTP)
Determine the time to progression
Time frame: 3 years
Duration of response (DOR)
Determine the duration of response
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: 3 years
Overall survival (OS)
Determine the overall survival
Time frame: 3 years
Time to next therapy (TTNT)
Determine the time to next therapy
Time frame: 3 years
Responses
Determine whether responses obtained with wCCyd treatment are associated with a prolongation of PFS, in comparison with non-responding patients
Time frame: 3 years
Response and survival
Determine whether tumor response and survival might significantly change in particular subgroups of patients defined on prognostic factors (β2-microglobulin, C-reactive protein (CRP), FISH, gene expression profile)
Time frame: 3 years
Maintenance
* Determine the benefit on PFS and OS of maintenance with Carfilzomib * Determine the benefit on tumor load of maintenance with Carfilzomib
Time frame: 3 years