This pilot phase II trial studies how well carfilzomib works in treating patients with chronic graft-versus-host disease. Chronic graft-versus-host disease is a complication of a donor bone marrow or blood cell transplant, usually occurring more than three months after transplant, in which donor cells damage the host tissue. Carfilzomib may be an effective treatment for chronic graft-versus-host disease.
PRIMARY OBJECTIVE: I. Determine proportion of subjects with treatment failure by 6 months of carfilzomib therapy for chronic graft-versus-host disease (GVHD). SECONDARY OBJECTIVES: I. Determine 3 month overall (complete + partial), and complete response rate. II. Determine 6 month overall (complete + partial), and complete response rate. III. Report overall survival, non-relapse mortality, primary malignancy relapse, failure-free survival, treatment success, and discontinuation of immune suppression at 6 months and 1 year. IV. Examine functional outcome (2-minute walk test) and patient-reported outcomes (Lee Chronic GVHD Symptom Scale, quality of life \[Short Form Health Survey (SF)-36, Functional Assessment of Cancer Therapy Bone Marrow Transplant (FACT-BMT) Questionnaire\], Human Activity Profile \[HAP\]) at study enrollment, 6 months, and 1 year. V. Study biologic effects of proteasome inhibition. OUTLINE: Patients receive carfilzomib intravenously (IV) over approximately 30 minutes on days 1, 8, and 15. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 3, 6, and 12 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Moffitt Cancer Center
Tampa, Florida, United States
Roswell Park Cancer Institute
Buffalo, New York, United States
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, United States
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, United States
Incidence of Adverse Events
according to National Cancer Institute CTCAE, version 4.03
Time frame: Up to 30 days following completion of study treatment
Probability of Treatment Failure at 6mo
Kaplan-Meier estimate assessed at 6 months for treatment failure, defined as requirement of an additional line of systemic immune-suppressive therapy, recurrent malignancy, or death.
Time frame: 6 months
Complete Response Rate
Complete response (CR) at 6 months will be determined by both clinician-defined CR, as well as separately calculated according to the proposed response definitions of the NIH Consensus Conference.
Time frame: Up to 6 months
Cumulative Incidence of Non-relapse Mortality and Primary Malignancy Relapse
The cumulative incidence of non-relapse mortality (defined as death in the absence of primary malignancy relapse after transplant) and relapse (defined as hematologic relapse or any unplanned intervention to prevent progression of disease in patients with evidence (molecular, cytogenetic, flow cytometric, radiographic) of malignant disease after transplantation) will be estimated from time of study therapy initiation. These will be treated as competing-risk events, and estimated at 1 year.
Time frame: 1 year
Probability of Failure-free Survival at 1 Year
Kaplain-Meier estimate assessed at 1 year for failure-free survival, defined as absence of death from any cause, relapse, or addition of secondary immune-suppressive agents.
Time frame: 1 year
Impact of Proteasome Inhibition
The biologic impact of proteasome inhibition in the treatment of chronic GVHD will be assessed at baseline, 3 and 6 months. The association between biologic outcome measures and clinical parameters (response, treatment failure, mortality) will be studied.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Ancillary studies
Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
Time frame: Up to 6 months
Incidence of Discontinuation of All Systemic Immune-suppressive Therapies
The incidence of complete discontinuation of all systemic immune-suppressive therapies will be determined at 1 year.
Time frame: 1 year
Overall Response Rate
Overall response rate (ORR) (complete response + partial response) at 6 months will be determined by both clinician-defined categories of complete response and partial response, as well as separately calculated according to the proposed response definitions of the NIH Consensus Conference.
Time frame: 6 months
Probability of Overall Survival at 1 Year
Kaplan-Meier estimate assessed at 1 year for overall survival, defined as absence of death from any cause.
Time frame: 1 year
Treatment Success
Treatment success will be estimated at 1 year with a composite outcome of complete resolution of all reversible chronic GVHD manifestations, discontinuation of all systemic immune suppressive agents, and freedom from death or primary malignancy relapse after transplant.
Time frame: 1 year
Use of Additional Systemic Immune-suppressive Therapies
Addition of therapy after carfilzomib constitutes failure, could occur at any time from baseline to 12mo.
Time frame: 1 year
Symptoms as Measured by Patient Self-report--Short Form-36 (SF-36)
SF-36 subscales have min=0 and max=100; results given are actual scores at 12mo, with higher scores indicating higher quality of life.
Time frame: baseline
Symptoms as Measured by Patient Self-report--Functional Assessment of Chronic Illness Therapy (FACT)
FACT-BMT subscales have various min/max, see below; results given are actual 12mo scores, with higher scores indicating better functioning. FACT physical well-being (0-28) FACT social/family well-being (0-28) FACT emotional well-being (0-24) FACT functional well-being (0-28) FACT Bone Marrow Transplant (BMT) subscale (0-40) FACT trial outcome index (0-96) FACT-General (G) (0-108) FACT-BMT total (0-148)
Time frame: baseline
Symptoms as Measured by Patient Self-report--Human Activities Profile (HAP)
HAP subscales have min=0 and max=94; results given are actual 12mo scores, with higher scores indicating better functioning. Maximum Activity Score (MAS) is highest item number answered still doing. Represents highest oxygen demanding activity that respondent still performs. Adjusted Activity Score (AAS) is MAS minus total number of stopped doing responses below MAS. A measure of usual daily activities. Modified AAS is MAS minus total number of stopped doing responses below MAS but not penalized for not doing activities not permitted post transplant. The following items are not counted against the score:11,15,19,20,22,25,34,41,42,47,49,50,52,53,54,57,72,73,77,78.
Time frame: baseline
Symptoms as Measured by Patient Self-report--Lee Chronic GVHD Symptom Scale
Lee symptom scale (LSS) has subscales with min=0, max=100; results given are 12mo scores, with higher numbers indicating higher symptom burden.
Time frame: baseline