This phase I trial finds out the best dose and side effects of venetoclax and tocilizumab in treating patients with t(11;14) multiple myeloma that has come back (relapsed) or does not respond to treatment (refractory). Venetoclax may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Tocilizumab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. Tocilizumab is used to treat side effects from immune therapy in patients with myeloma. Giving venetoclax and tocilizumab may kill more cancer cells.
PRIMARY OBJECTIVE: I. To determine the dose limiting toxicity (DLT), safety profile, and the recommended phase 2 dose (RPTD) of venetoclax and tocilizumab when administered in subjects with relapsed and recurrent (RR) multiple myeloma t(11;14) (MM). SECONDARY OBJECTIVES: I.To evaluate the preliminary efficacy data regarding the effect of venetoclax and tocilizumab by objective response rate per IMWG criteria. II. To evaluate the effect of chronic tocilizumab administration on venetoclax exposure. TERTIARY/EXPLORATORY OBJECTIVES: I. To evaluate the preliminary efficacy data regarding the effect of venetoclax and tocilizumab by time to response (TTR), time to disease progression (TTP), duration of response (DOR), progression free survival (PFS) and overall survival (OS). II. To measure the effect of IL6 receptor blockade on ex vivo venetoclax sensitivity. III. To evaluate the cell populations in the bone marrow of responders versus non-responders as well as the effect of IL6 receptor blockade on those populations. IV. To evaluate the expression of B cell markers on venetoclax sensitive myeloma. V. To determine the expression of key BCL2 family members with and without IL6 receptor blockade. VI. To correlate differences in somatic mutations, structural alterations, gene expression and chromatin accessibility with venetoclax response. OUTLINE: This is a dose-escalation study of venetoclax and tocilizumab. Patients receive tocilizumab intravenously (IV) on day -7 of cycle 1, and on day 1 of subsequent cycles. Patients also receive venetoclax orally (PO) on days 1-21. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up for 4 weeks, then every 6 months thereafter.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
7
Given IV
Given PO
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, United States
Maximum tolerated dose (MTD)
The MTD for each arm is selected based on isotonic regression27, using the shiny app BOINComb (http://www.trialdesign.org). The dose is selected as the MTD for which the isotonic estimate of the toxicity rate is closest to the target toxicity rate. If there are ties, the higher dose level is selected when the isotonic estimate is lower than the target toxicity rate; the lower dose level is selected when the isotonic estimate is greater than or equal to the target toxicity rate.
Time frame: Completion of cycle 1 (each cycle is 21 days)
Incidence of adverse events (AEs)
AEs, related AEs, serious (S)AEs, related SAEs, and AEs leading to interruptions and/or discontinuation of study drug will be analyzed descriptively, using frequencies and percentages.
Time frame: Up to 30 days post-treatment
Overall response rate (ORR)
ORR will be calculated with an exact 95% confidence interval (CI) for each arm, using the Clopper-Pearson method.
Time frame: Up to 5 years
Complete response rate
Complete response rate will be calculated with an exact 95% CI for each arm, using the Clopper-Pearson method.
Time frame: Up to 5 years
Time to response (TTR)
TTR will be estimated using the Kaplan-Meier method. Median TTR will be reported, along with a 95% confidence interval estimated using the Brookmeyer-Crowley method.
Time frame: From date of receipt of study treatment to date of treatment response, where those not responding are censored at date of last follow-up or death from any cause, assessed up to 5 years
Time to disease progression (TTP)
TTP will be estimated using the Kaplan-Meier method. Median TTP will be reported, along with a 95% confidence interval estimated using the Brookmeyer-Crowley method.
Time frame: From date of receipt of study treatment to date of disease progression, where those not progressing or have died are censored at date of last follow-up or death from any cause, assessed up to 5 years
Duration of response (DOR)
Median DOR will be reported, along with the 25th and 75th percentiles.
Time frame: From date of treatment response to date of disease progression, assessed up to 5 years
Progression-free survival (PFS)
PFS will be estimated using the Kaplan-Meier method. Median PFS will be reported, along with a 95% confidence interval estimated using the Brookmeyer-Crowley method.
Time frame: From date of receipt of study treatment to date of disease progression or death from any cause, where those alive without are censored at date of last follow-up, assessed up to 5 years
Overall survival (OS)
OS will be estimated using the Kaplan-Meier method. Median OS will be reported, along with a 95% confidence interval estimated using the Brookmeyer-Crowley method.
Time frame: From date of receipt of study treatment to date of death from any cause, where those alive without are censored at date of last follow-up, assessed up to 5 years
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