Phase II Study of IRD (Ixazomib, Lenalidomide, Dexamethasone) Post Autologous Stem Cell Transplantation Followed by Maintenance Ixazomib or Lenalidomide for Multiple Myeloma

Phase 2Active Not RecruitingNCT02253316

Washington University School of Medicine236 enrolled

Overview

The purpose of this research study is to evaluate a treatment regimen called IRD which will be given to participants after their stem cell transplant in an effort to help prolong the amount of time the participants are disease-free after transplant. IRD is a three-drug regimen consisting of ixazomib, lenalidomide (also called Revlimid), and dexamethasone. After 4 cycles of IRD, the participants will be randomized to receive maintenance therapy either with ixazomib or lenalidomide.

Based on the further need to improve progression-free survival and overall survival post-autologous stem cell transplantation (ASCT) for multiple myeloma and the benefits seen of consolidation/maintenance treatment with immunomodulatory drugs thalidomide and lenalidomide and the proteasome inhibitor bortezomib, the natural next step is to evaluate combination regimens of immunomodulatory drugs and proteasome inhibitors as consolidation/maintenance post-ASCT. The regimen consisting of ixazomib, lenalidomide, and dexamethasone (IRD) has been shown to have low toxicity, and the availability of an oral formulation of ixazomib allows for easier administration when compared to bortezomib. In this study, following consolidation with IRD, patients will be randomized to maintenance therapy with lenalidomide or ixazomib in order to collect pilot data comparing the toxicity and efficacy of maintenance therapy with immunomodulatory drugs and proteasome inhibitors. 09/23/2019: Upon review of the interim analysis, there will be no further randomizations into the maintenance portion of the trial. All patients will be enrolled into the lenalidomide arm with the exception of those who discontinue lenalidomide during the consolidation phase due to toxicity. Patients who discontinue lenalidomide may be enrolled into the ixazomib arm following approval from the principal investigator. 09/30/2021: Following analysis 4 in 2021, analysis of the primary endpoint, all patients receiving lenalidomide maintenance will be transitioned off-study. Patients receiving ixazomib may remain on trial until disease progression or unacceptable toxicity at the discretion of the treating physician and the site principal investigator.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria Each patient must meet all of the following inclusion criteria to begin IRD Consolidation: * Between the ages of 18 and 70 years of age (inclusive) at time of enrollment * Voluntary written consent must be given before performance of any study-related procedure not part of standard medical care, with the understanding that consent may be withdrawn by the patient at any time without prejudice to future medical care * Confirmed diagnosis of symptomatic multiple myeloma. (Patients with multiple myeloma with secondary amyloidosis are eligible.) * Received at least two cycles of any regimen as initial systemic therapy for multiple myeloma and are within 2-16 months of the first dose of initial therapy * Eastern Cooperative Oncology Group (ECOG) performance status and/or other performance status 0, 1, or 2 * Adequate organ function as defined below: Absolute neutrophil count (ANC) \>= 1,000 mm\^3 Platelet count \>= 75,000/mm\^3; platelet transfusions to help patient meet eligibility criteria are not allowed within 7 days before study enrollment Total bilirubin \<= 1.5 x upper limit of normal range (ULN) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \<=3 x ULN Calculated creatinine clearance \>= 30 mL/min * Women of childbearing potential must follow pregnancy testing requirements as outlined in the Revlimid REMS program material. This is defined as either committing to continued abstinence from heterosexual intercourse or beginning TWO acceptable methods of contraception (one highly effective method and one additional effective method AT THE SAME TIME) at least 28 days prior to the start of lenalidomide, for the duration of study participation, and for 28 days following the last dose of lenalidomide. Women of childbearing potential must also agree to ongoing pregnancy testing. * Men must agree to use a latex condom during sexual contact with a woman of childbearing potential even if they have had a successful vasectomy. All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. * All study participants must be registered into the mandatory Revlimind REMS program and be willing to comply with its requirements. Per standard Revlimid REMS program requirements, all physicians who prescribe lenalidomide for research subjects enrolled into this trial, must be registered in, and must comply with, all requirements of the Revlimid REMS program. Exclusion Criteria Patients meeting any of the following exclusion criteria are not to be enrolled in the study: * Female patients who are lactating or have a positive serum pregnancy test during the screening period * Evidence of MM disease progression any time prior to enrollment. Progression from smoldering/asymptomatic MM to symptomatic MM is not exclusionary. * Tandem autologous transplantation * History of plasma cell leukemia or MM CNS involvement * Administration or planned administration of any other concomitant chemotherapy, immunotherapy, radiotherapy, or any ancillary therapy which would be considered a treatment of multiple myeloma until Day +28 post-transplant through discontinuation from study. Patients may be on corticosteroids if they are being given for disorders other than multiple myeloma (e.g., adrenal insufficiency, rheumatoid arthritis, etc.) * Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol. * Prior organ transplant requiring immunosuppressive therapy * Active hepatitis A, B or C virus infection, or known human immunodeficiency virus (HIV) positive * Known allergy to any of the study medications, their analogues, or excipients in the various formulations of any agent * Known GI disease or GI procedure that could interfere with the oral absorption or tolerance of ixazomib * Concurrent hematologic or non-hematologic malignancy requiring treatment (other than multiple myeloma and secondary amyloidosis) * Cardiac syncope, uncompensated NYHA Class 3 or 4 congestive heart failure, myocardial infarction within the previous six months, unstable angina pectoris, clinically significant repetitive ventricular arrhythmias despite antiarrhythmic treatment, severe orthostatic hypotension, or clinically important autonomic disease * Grade \>= 3 peripheral neuropathy, or Grade 2 with pain on clinical examination during the screening period * Major surgery within 14 days prior to enrollment * Infection requiring systemic antibiotic therapy or other serious infection within 14 days prior to enrollment * Participation in other clinical trials, including those with other investigational agents not included in this trial, within 30 days prior to enrollment and throughout the duration of this trial

Locations (10)

City of Hope

Duarte, California, United States

University of California, San Francisco

San Francisco, California, United States

Colorado Blood Cancer Institute

Denver, Colorado, United States

Emory University - Winship Cancer Institute

Atlanta, Georgia, United States

Karmanos Cancer Institute

Detroit, Michigan, United States

Mayo Clinic

Rochester, Minnesota, United States

Washington University School of Medicine

St Louis, Missouri, United States

Icahn School of Medicine at Mount Sinai

New York, New York, United States

Ohio State University Comprehensive Cancer Center

Columbus, Ohio, United States

Tennessee Oncology, PLLC

Nashville, Tennessee, United States

Outcomes

Primary Outcomes

Number of Participants With Improvement in Minimal Residual Disease (MRD)

For the purposes of this study, a patient will be considered as having minimal residual disease if a positive result (1x10E06) is obtained using the Adaptive Clonoseq MRD testing.

Time frame: After 4 cycles of IRD consolidation treatment (approximately Day 112 of consolidation treatment)

Secondary Outcomes

MRD-negative Rate After ASCT

For the purposes of this study, a patient will be considered as having minimal residual disease if a positive result (1x10E06) is obtained using the Adaptive Clonoseq MRD testing

Time frame: Prior to beginning consolidation treatment (Day -28 to Day 0)

Toxicity of IRD Consolidation

For the purposes of this study, toxicity will be defined as inability to receive 4 cycles of IRD consolidation due to toxicity.

Time frame: After 4 cycles of IRD consolidation treatment (approximately Day 112 of consolidation treatment)

Response Rate of IRD Consolidation

For the purposes of this study, response rate is defined as the improvement in complete response rate. Response will be determined by the International Myeloma Working Group (IMWG) Uniform Response Criteria.

Time frame: After 4 cycles of IRD consolidation treatment (approximately Day 112 of consolidation treatment)

Progression-free Survival of IRD Consolidation

Progression-free survival (PFS) will be defined as time from ASCT to progression, relapse, or death, whichever occurs first, and those event-free survivors will be censored at withdrawal or study closeout.

Time frame: Up to 18 months after completion of maintenance therapy (Up to 5 years after starting the study)

Overall Survival of IRD Consolidation

Overall survival (OS) will be defined as time from ASCT to death due to any causes, and survivors will be censored at withdrawal or study closeout.

Time frame: Up to 18 months after completion of maintenance therapy (Up to 5 years after starting the study)

Compare Toxicity Between the Two Maintenance Arms

The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all toxicity reporting.

Time frame: 30 days after the completion of maintenance treatment (estimated to be Day 1125 of maintenance treatment)

Compare Response Rate Between the Two Maintenance Arms

* Response will be determined by the International Myeloma Working Group (IMWG) Uniform Response Criteria. Response includes stringent complete response (sCR) and complete response (CR). * sCR requires all of the following: * CR as defined below * Normal free light chain ratio (0.26-1.65) * Absence of clonal cells in the bone marrow by immunohistochemistry or immunofluorescence * CR requires all of the following: * Disappearance of monoclonal protein by both protein electrophoresis and immunofixation studies from the blood and urine * If serum and urine monoclonal protein are unmeasurable, Normal free light chain ratio (0.26-1.65) * \<5% plasma cells in the bone marrow * Disappearance of soft tissue plasmacytoma

Time frame: Through completion of maintenance treatment (estimated to be day 1095 of maintenance treatment)

Compare Progression-free Survival Between the Two Maintenance Arms

Time frame: Up to 18 months after completion of maintenance therapy (Up to 5 years after starting the study)

Compare Overall Survival Between the Two Maintenance Arms

Overall survival (OS) will be defined as time from ASCT to death due to any causes, and survivors will be censored at withdrawal or study closeout.

Time frame: Up to 18 months after completion of maintenance therapy (Up to 5 years after starting the study)

Rate of MRD-positive to MRD-negative Conversion Between the Two Maintenance Arms

Time frame: Cycle 13 Day 1 of maintenance treatment (Approximately Day 364 of maintenance treatment)

Association of Progression-free Survival With MRD-negativity

Time frame: Up to 18 months after completion of maintenance therapy (Up to 5 years after starting the study)

Association of Progression-free Survival With MRD-positivity

Time frame: Up to 18 months after completion of maintenance therapy (Up to 5 years after starting the study)

Association of Overall Survival With MRD-negativity

Overall survival (OS) will be defined as time from ASCT to death due to any causes, and survivors will be censored at withdrawal or study closeout.

Time frame: Up to 18 months after completion of maintenance therapy (Up to 5 years after starting the study)

Association of Overall Survival With MRD-positivity

Overall survival (OS) will be defined as time from ASCT to death due to any causes, and survivors will be censored at withdrawal or study closeout.

Time frame: Up to 18 months after completion of maintenance therapy (Up to 5 years after starting the study)

Phase II Study of IRD (Ixazomib, Lenalidomide, Dexamethasone) Post Autologous Stem Cell Transplantation Followed by Maintenance Ixazomib or Lenalidomide for Multiple Myeloma

Overview

Conditions

Interventions

Eligibility

Locations (10)

Outcomes

Primary Outcomes

Secondary Outcomes