This phase I/II trial studies the side effects and best dose of iberdomide and how well it works in combination with daratumumab, bortezomib, and dexamethasone in treating patients with newly diagnosed multiple myeloma. Immunotherapy with iberdomide, may induce changes in body's immune system and may interfere with the ability of tumor cells to grow and spread. Daratumumab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Chemotherapy drugs, such as dexamethasone, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving iberdomide in combination with daratumumab, bortezomib, and dexamethasone may kill more cancer cells in patients with newly diagnosed multiple myeloma.
PRIMARY OBJECTIVES: I. To assess the maximum tolerated dose (MTD) of iberdomide in combination with daratumumab, bortezomib, and dexamethasone. (Phase 1 \[Dose Confirmation Cohort\]) II. To determine the complete response rate as best response during induction therapy with (1) iberdomide, daratumumab, bortezomib and dexamethasone (IberDVd) when used as initial therapy in patients with previously untreated symptomatic multiple myeloma. (Phase 2) SECONDARY OBJECTIVES: I. To assess the expanded response definition, overall response rate (ORR), and very good partial response (VGPR) rate of iberdomide in combination with daratumumab, bortezomib and dexamethasone. (Phase 2) II. To assess the progression free survival and overall survival among patients with previously untreated symptomatic multiple myeloma following treatment with iberdomide in combination with daratumumab, bortezomib and dexamethasone. (Phase 2) III. To assess the time to response (defined as the time between the date of first dose and the first documented evidence of a partial response or better) following treatment with iberdomide in combination with daratumumab, bortezomib and dexamethasone in patients with previously untreated symptomatic multiple myeloma (MM). (Phase 2) IV. To describe the toxicities associated with iberdomide in combination with daratumumab, bortezomib and dexamethasone in patients with previously untreated symptomatic MM and toxicities associated with dose attenuated iberdomide monotherapy administered from cycles 13 through 36. (Phase 2) CORRELATIVE RESEARCH OBJECTIVES: I. Examine the proportion of next generation flow cytometry assessed measurable residual disease (MRD) negative complete response following induction therapy with the combination of iberdomide in combination with daratumumab, bortezomib and dexamethasone. (Phase 2) II. To identify the proportion of patients with MRD negative complete response (as measured by the next-generation flow cytometry, sensitivity 10-5) at the end of cycles 24 and 36 during the deescalated phase of iberdomide monotherapy administration. (Phase 2) III. Examine the proportion of sustained MRD negative complete response following 6 months after attaining complete response (CR) and at the end of cycles 24 and 36. (Phase 2) IV. Evaluate pharmacokinetics and pharmacodynamics of iberdomide in combination with daratumumab, bortezomib and dexamethasone. (Phase 2) OUTLINE: This is a phase I, dose-escalation study of iberdomide followed by a phase II study. INDUCTION PHASE: Patients receive iberdomide orally (PO) once daily (QD) on days 1-21, bortezomib subcutaneously (SC) on days, 1, 8, 15, and 22, and dexamethasone PO on days 1, 8, 15, 22. Patients also receive daratumumab SC on days 1, 8, 15, 22 of cycles 1 and 2, days 1 and 15 of cycles 3-6, and day 1 of subsequent cycles. Treatment repeats every 28 days for 12 cycles in the absence of disease progression or unacceptable toxicity. CYCLES 13-36 CYCLES: Patients receive iberdomide PO QD on days 1-21. Treatment repeats every 28 days for up to 36 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo bone marrow aspiration and/or biopsy, magnetic resonance imaging (MRI) or positron emission tomography (PET) and computed tomography (CT) scan, and collection of blood samples throughout the trial. After completion of study treatment, patients are followed up at 30 days and then every 6 months for 3 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
49
Mayo Clinic in Rochester
Rochester, Minnesota, United States
Maximum tolerated dose (MTD) of iberdomide (Phase I)
MTD is defined as the highest tested dose level that is determined to have acceptable toxicity and tolerability based on dose limiting toxicity definitions.
Time frame: Up to 12 cycles. Each cycle is 28 days.
Complete response rate (Phase II)
A confirmed complete response is defined as a patient who has achieved an stringent complete response (sCR) or complete response (CR) and maintained it on two consecutive evaluations at any time during induction therapy. The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. 95% confidence intervals for the true success proportion will be calculated according to the approach of Duffy and Santner.
Time frame: Up to 3 years
Overall response rate (Phase II)
Will be estimated by the total number of patients who achieve a sCR, CR, very good partial response (VGPR), or partial response divided by the total number of evaluable patients. All evaluable patients will be used for this analysis. Exact binomial 95% confidence intervals for the true overall response rate will be calculated.
Time frame: Up to 3 years
VGPR or better response rate (Phase II)
Will be estimated by the total number of patients who achieve at least a VGPR divided by the total number of evaluable patients. All evaluable patients will be used for this analysis. Exact binomial 95% confidence intervals for the true VGPR or better response rate will be calculated.
Time frame: Up to 3 years
Progression-free survival (Phase II)
Assessed as the time from registration to the earliest date of documentation of disease progression or death due to any cause. The distribution of progression-free survival will be estimated using the method of Kaplan-Meier.
Time frame: Up to 3 years
Overall survival (Phase II)
Assessed as from registration to death due to any cause. The distribution of overall survival will be estimated using the method of Kaplan-Meier.
Time frame: Up to 3 years
Incidence of adverse events (AEs) (Phase II)
The maximum grade for each type of AE will be recorded for each patient, and frequency tables will be reviewed to determine patterns.
Time frame: Up to 30 days after discontinuation
Proportion of patients with measurable residual disease (MRD) negative complete response (Phase II)
The proportion of patients who achieve MRD negative complete response at the end of cycles 24 and 36 will be estimated by the number of patients who are MRD negative (as measured by the next-generation flow cytometry, sensitivity 10-5) at the end of end of cycles 24 and 36 divided by the total number of evaluable patients. Exact binomial 95% confidence intervals for the true MRD negative rates end of cycles 24 and 36 of therapy will be calculated.
Time frame: At the end of cycles 24 and 36. Each cycle is 28 days
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