Effects of Daratumumab Monotherapy on Bone Parameters in Patients With Relapsed and /or Refractory Multiple Myeloma

Hellenic Society of Hematology57 enrolled

Overview

The purpose of this study is to evaluate the effects of daratumumab monotherapy on bone disease in patients with relapsed/refractory MM who have received at least 2 prior lines of therapy, including lenalidomide and a PI.

This is a prospective, multicenter, non-comparative, open-label Phase II study. Daratumumab will be administered according to approved label. Approximately 57 subjects located in Greece will be enrolled in the study. Patients shall receive treatment until disease progression, physician decision, unacceptable toxicity, withdrawal of consent, or death (whichever occurs first). Survival status and data of subsequent anti-myeloma treatment will be collected post-treatment. Primary and secondary variables related to bone disease markers will be evaluated every other cycle of therapy. Disease evaluations will occur monthly and consist mainly of measurements of myeloma proteins. Other parameters may include bone marrow examinations, skeletal surveys, assessment of extramedullary plasmacytomas, and measurements of serum calcium corrected for albumin, and β2- microglobulin and albumin. Assessment of myeloma response and disease progression will be conducted in accordance with the modified IMWG response criteria

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Multiple Myeloma

Interventions

DaratumumabDRUG

Daratumumab will be given at a dose of 16 mg/kg administered as an IV infusion at weekly intervals (QW) for 8 weeks, then every 2 weeks (Q2W) for an additional 16 weeks, then every 4 weeks (Q4W) thereafter. Subjects will receive pre-infusion medications prior to Daratumumab infusion to mitigate potential IRRs and post- infusion medications after Daratumumab infusion for the prevention of delayed IRRs

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Males and females at least 18 years of age. 2. Voluntary written informed consent. 3. Subject must have documented relapsed or refractory multiple myeloma as defined by the criteria below: a. Measurable disease as defined by any of the following: * Serum monoclonal paraprotein (M-protein) level ≥ 1.0 g/dL (except for IgA subtype: ≥ 0.5 g/dL) or urine M-protein level ≥ 200 mg/24 hours; or * Light chain multiple myeloma for subjects without measurable disease in the serum or urine by SPEP/UPEP: Serum immunoglobulin free light chain ≥ 10 mg/dL and abnormal serum immunoglobulin kappa lambda free-light-chain ratio. 4. Prior treatment with at least two lines of therapy including lenalidomide and a PI for MM (induction followed by any planned high dose therapy or consolidation or maintenance would be considered as one regimen). 5. Documented evidence of progressive disease as defined by the IMWG 2014 on or after the last regimen. 6. Karnofsky Performance Status score of ≥ 70. 7. All of the following laboratory test results during screening: * Absolute neutrophil count (ANC) of ≥1.0 x 109/L. * Platelet count of ≥ 75 x 109/L in patients in whom \<50% of bone marrow nucleated cells are plasma cells and ≥50 x 109/L in patients in whom more than 50% of bone marrow nucleated cells are plasma cells. * Hemoglobin value (\> 7.5 g/dL). * Alanine aminotransferase level ≤2.5 times the upper limit of normal (ULN). 8. Adequate renal function (CrCl ≥ 30 mL/min by CKD-EPI). 9. Willingness and ability to participate in study procedures. 10. Reproductive Status: 1. Women of childbearing potential (WOCBP) must have two negative serum or urine pregnancy tests, one 10-14 days prior to start of the study drug and one within 24 hours prior to the start of study drug. 2. Women must not be breastfeeding. 3. WOCBP must agree to follow instructions for effective methods of contraception for 4 weeks before the start of treatment with study drugs, for the duration of treatment with study drugs, and for 3 months after cessation of study treatment. Male patients must use a latex or synthetic condom during any sexual contact with females of reproductive potential, even if they have undergone a successful vasectomy. They must also agree to follow instructions for methods of contraception for 4 weeks before the start of treatment with study drugs, for the duration of treatment with study drugs, and for a total of 3 months post-treatment completion. Exclusion Criteria: 1. Patient has received any of the following therapies: * Radiotherapy or systemic therapy within 2 weeks of baseline. * Prior Allogeneic hematopoietic stem cell transplantation within 12 weeks of baseline. * Prior Treatment with any CD38-antibody (i.e. isatuximab). 2. Clinically significant cardiac disease, including: 1. Myocardial infarction within 6 months, or unstable or uncontrolled condition (e.g., unstable angina, congestive heart failure, New York Heart Association Class III-IV). 2. Cardiac arrhythmia (CTCAE Grade 3 or higher) or clinically significant ECG abnormalities. 3. ECG showing a baseline QT interval as corrected \>470 msec. 3. Chronic obstructive pulmonary disease (COPD) with a Forced Expiratory Volume in 1 second (FEV1) \<50% of predicted normal. Note that FEV1 testing is required for subjects suspected of having COPD and subjects must be excluded if FEV1 \<50% of predicted normal. 4. Known active hepatitis A, B, or C. 5. Known HIV infection. 6. Significant neuropathy (Grades 3-4, or Grade 2 with pain) within 14 days prior to enrolment. 7. Hypersensitivity to the active substance or to any of the excipients. 8. Any concurrent medical or psychiatric condition or disease (e.g., active systemic infection, uncontrolled diabetes, acute diffuse infiltrative pulmonary disease) that is likely to interfere with subject's ability to give informed consent, the study procedures or results, or that in the opinion of the investigator, would constitute a hazard for participating in this study. 9. Pregnant or breastfeeding women.

Locations (1)

General Hospital of Athens "Alexandra"

Athens, Attica, Greece

RECRUITING

Outcomes

Primary Outcomes

changes in bone resorption marker, C-telopeptide of collagen type 1 (CTX), after 4 months of daratumumab monotherapy

The evaluation of the changes in bone resorption marker after 4 months of daratumumab monotherapy. CTX (measured in pg/ml) will be evaluated at baseline and then every 2 months of therapy.

Time frame: assessed on baseline and after 4 months from initiation of daratumumab monotherapy

changes in bone resorption marker, namely, tartrate-resistant acid phosphatase-5b (TRACP-5b) after 4 months of daratumumab monotherapy

The evaluation of the changes in bone resorption marker after 4 months of daratumumab monotherapy. TRACP-5b (measured in mU/dL) will be evaluated at baseline and then every 2 months of therapy

Time frame: assessed on baseline and after 4 months from initiation of daratumumab monotherapy

Secondary Outcomes

Changes in bone formation marker, bALP.

Change from baseline in bone formation marker bALP (measured in U/L) after 4, 8 and 12 months of daratumumab monotherapy (or at the end of therapy)

Time frame: from baseline up to 12 months of daratumumab monotherapy or at end of treatment

Changes in bone formation marker, OC.

Change from baseline in bone formation marker OC (measured in ng/ml) after 4, 8 and 12 months of daratumumab monotherapy (or at the end of therapy)

Time frame: from baseline up to 12 months of daratumumab monotherapy or at end of treatment

Changes in bone formation marker, PINP.

Change from baseline in bone formation marker PINP (measured in ng/ml) after 4, 8 and 12 months of daratumumab monotherapy (or at the end of therapy)

Time frame: from baseline up to 12 months of daratumumab monotherapy or at end of treatment

Central Contacts

Panayiotidis Panayiotis, Prof.

CONTACT

+30 2107211806 infohaema@eae.gr

Data from ClinicalTrials.gov

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