This phase I trial studies the possible benefits and side effects of adding panobinostat to a combination of daratumumab, bortezomib and dexamethasone in treating patients with multiple myeloma that has come back (relapsed) or has not responded to treatment (refractory). Panobinostat may stop or slow multiple myeloma by blocking the growth of new blood vessels necessary for cancer growth. Giving panobinostat in combination with daratumumab, bortezomib and dexamethasone may work better in treating relapsed/refractory multiple myeloma.
PRIMARY OBJECTIVE: I. To evaluate the safety and tolerability of Farydak (panobinostat lactate)/Darzalex Faspro (daratumumab and hyaluronidase-fihj)/Velcade (bortezomib)/dexamethasone (FDVd) in patients with relapsed/refractory multiple myeloma (RRMM) who have previously received one line of therapy including lenalidomide or cyclophosphamide, bortezomib (V) or other proteasome inhibitor (PI), with or without autologous stem cell transplant (ASCT). SECONDARY OBJECTIVES: I. To evaluate the overall response rate (ORR) (per International Myeloma Working Group \[IMWG\] criteria) of FDVd. II. Determine the time to response (TTR). III. Determine the duration of response (DOR). IV. Determine the progression-free survival (PFS) at 1 year. V. Determine the overall survival (OS) at 1 year. CORRELATIVE OBJECTIVES: I. Baseline and end of-study plasma cell expression of CD38. II. Changes in lymphocyte subsets with therapy. III. Baseline and end-of study analysis of total number and ratio of regulatory T cells (Tregs) with CD38+ expression. IV. Check minimal residual disease (MRD) negativity rates by next generation sequencing in patients who attain and maintain very good partial response (VGPR) or better for at least three months. OUTLINE: This is a dose-escalation study of panobinostat. Patients receive panobinostat orally (PO) once daily (QD) on days 1, 3, 5, 15, 17, 19, daratumumab and hyaluronidase-fihj subcutaneously (SC) on days 1, 8, 15, 22 of cycles 1-2, days 1 and 15 of cycles 3-6, and day 1 of subsequent cycles, bortezomib SC on days 1, 8, 15, 22 and dexamethasone PO (intravenously \[IV\] on days of daratumumab and hyaluronidase-fihj administration) QD on days 1, 8, 15, 22. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up on days 30 and 60.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
1
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, United States
Recommended phase 2 dose
A standard "3+3" design will be used to determine the safe and tolerable dose level.
Time frame: End of cycle 1 (1 cycle = 28 days)
Incidence of adverse events
Assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. The maximum grade for each type of toxicity will be recorded for each patient, and frequency tables will be reviewed to determine toxicity patterns.
Time frame: Up to 3 years
Time to progression
Cumulative incidence rates will be calculated and compared using Gray's test accounting for competing risks.
Time frame: From start of treatment until objective tumor progression, assessed up to 3 years
Progression-free survival
Will be calculated using the Kaplan-Meier method. Will be calculated together with 95% confidence intervals, and log-rank test will be used for the comparison between patient subgroups.
Time frame: From start of treatment until disease progression or death, assessed at 1 year
Objective response rate (ORR)
ORR will be defined as the total number of subjects whose best response is partial response (PR) or better divided by the number of patients. ORR will be reported overall as well as by dose level, with 95% binomial exact confidence intervals. Comparison of ORR among patient subgroups will be conducted using Fisher exact test.
Time frame: Up to 3 years
Time to response
Cumulative incidence rates will be calculated and compared using Gray's test accounting for competing risks.
Time frame: From start of treatment until measurement criteria are first met for PR, very good partial response, or complete response, assessed up to 3 years
Duration of overall response
Will be calculated using the Kaplan-Meier method. Will be calculated together with 95% confidence intervals, and log-rank test will be used for the comparison between patient subgroups.
Time frame: From the time measurement criteria are first met for partial response or better (whichever status is recorded first) until the first date of progressive disease or death, assessed up to 3 years
Overall survival
Will be calculated using the Kaplan-Meier method. Will be calculated together with 95% confidence intervals, and log-rank test will be used for the comparison between patient subgroups.
Time frame: From start of treatment to the date of his or her death, assessed at 1 year
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