This phase II trial studies how well daratumumab-based therapy works in treating patients with newly diagnosed multiple myeloma with kidney failure. Daratumumab-based therapy includes daratumumab, bortezomib, dexamethasone, and thalidomide or lenalidomide. Daratumumab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Bortezomib is a drug that prevents myeloma cells from getting rid of their waste products, leading to being targeted for death. Dexamethasone is a steroid that is commonly used, either alone or in combination with other drugs, to treat multiple myeloma. Lenalidomide and thalidomide may stop the growth of multiple myeloma by blocking the growth of new blood vessels necessary for tumor growth. Giving daratumumab, bortezomib, dexamethasone, and thalidomide or lenalidomide may be a good way to treat patients with newly diagnosed multiple myeloma with kidney failure.
PRIMARY OBJECTIVE: I. To determine the proportion of patients with newly diagnosed myeloma and acute kidney injury (AKI) who have renal function recovery following 2 cycles (6 weeks) of treatment with a daratumumab-based induction regimen. SECONDARY OBJECTIVES: I. Overall response rate at the end of 2 and 4 cycles of therapy. II. Adverse event profile of the combination in patients with AKI. III. Pharmacokinetic parameters of maximum concentration (Cmax), area under the curve (AUC), time to maximum concentration (tmax), clearance, and half life (t1/2) of daratumumab in combination treatment in the AKI population. IV. Global assessment of renal function at cycle initiation including creatinine clearance (CrCl). V. Timeline of changes in pharmacodynamic markers of light chains, urine paraprotein, and serum paraprotein measures. OUTLINE: Patients receive daratumumab intravenously (IV) weekly of cycles 1-3 and on day 1 only of cycle 4, bortezomib subcutaneously (SC) on days 1, 4, 8, and 11, and dexamethasone IV or orally (PO) on days 1-4 of cycle 1 and on day 1 of cycles 2-4 and PO on days 8 and 15 of all cycles. Beginning cycle 2, patients may also receive lenalidomide PO daily on days 1-14 or thalidomide PO once daily (QD) on days 1-21. Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up for 30 days.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
17
Given SC
Given IV
Given PO and IV
Given PO
Given PO
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, United States
Change in creatinine clearance
Renal function comparisons of creatinine clearance between methods for the cohort will be conducted, with the primary objective of change from baseline, using the same formula, serving as the analysis dataset.
Time frame: Screening until end of Cycle 4 at day 1(12 weeks), each cycle=21 days
Pharmacokinetic parameters of Cmax
Maximum concentrations for each patient obtained at the end of daratumumab infusion.
Time frame: Cycle 1 at day 1 (12 weeks) to Cycle 2 at Day 15 (12 Weeks), each cycle=21 days
Pharmacokinetic parameters of AUC
Area under the plasma concentration time curve from time 0-24 hours and extrapolated to infinity to understand dose exposures.
Time frame: Starting at Cycle 1 at day 1(12 weeks) to Cycle 2 at Day 15 (12 weeks), each cycle=21 days
Pharmacokinetic parameters of CI
Clearance for each patient to assess the effect of renal insufficiency and potential changes with myeloma treatment that includes daratumumab.
Time frame: Cycle 1 at day (12 weeks) 1 to Cycle 2 at Day 15 (12 weeks), each cycle=21 days
Incidence of adverse events
Will track grade 3, 4, and 5 adverse events collected clinically in the routine course of care, with particular interest in those associated with daratumumab. Subject incidence of all treatment emergent adverse events of interest will be tabulated by system organ class and preferred term. Tables of fatal adverse events, serious adverse events, adverse events leading to withdrawal from investigational product, other protocol-required therapies or from study, and adverse events of interest will also be provided. Relevant laboratory and vital sign (temperature, heart rate, respiratory rate, and blood pressure) data will be displayed by visit and time (when available), with Common Terminology Criteria for Adverse Events (CTCAE). Additionally, all laboratory data will be summarized by CTCAE grade, again, with grade 3, 4 and 5 values to be collected.
Time frame: Through study completion, an average of 1 year
Overall response rate
All efficacy assessments will follow International Myeloma Working Group (IMWG) uniform response criteria and be performed every cycle. Will be defined as the proportion of best overall response of stringent complete response (sCR), complete response (CR), very good partial response (VGPR), and partial response (PR).
Time frame: Through study completion, an average of 1 year
Best overall response
All efficacy assessments will follow IMWG uniform response criteria and be performed every cycle.
Time frame: Through study completion, an average of 1 year
Progression free survival
Will be defined as number of months from subject's first study dose date to the earlier of disease progression or death due to any cause.
Time frame: Time from randomization date of first documented progression or date of death from any cause, whichever came first, assessed up to 100 months
Duration of response
Will be summarized for all subjects overall, by formulation, by dose cohort level, and by formulation and dose cohort level along with 95% confidence intervals when applicable. Duration of therapy, dose density, and frequency of dose holds or reductions will also be recorded.
Time frame: Time from initiation of first response to first documented progression or death, from any cause, whichever came first, assessed up to 100 months
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