The purpose of this study is assess safety, safest dose, and effectiveness of venetoclax in combination with dexamethasone in participants with t(11;14) positive relapsed (comes back) or refractory (did not get better) light chain amyloidosis.
This study is a phase 1/2 study of venetoclax-dexamethasone combination therapy in relapsed/refractory t(11;14) systemic immunoglobulin light chain amyloidosis (AL) amyloidosis. The phase 1 is a dose escalation designed to determine the maximum tolerated dose (MTD) and the recommended phase 2 dose (RP2D) of venetoclax in combination with low-dose weekly dexamethasone. There will be four candidate-dosing cohorts of venetoclax with or without dexamethasone in the Phase I dose-escalation. Dose escalation will be guided by the Bayesian optimal interval (BOIN) design with accelerated titration up to a total sample size of 15 participants. The phase 2 portion is a randomized open-label study comparing the MTD or RP2D of venetoclax in combination with dexamethasone versus investigator's choice (daratumumab, pomalidomide, bendamustine, or ixazomib (with or without dexamethasone).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
53
200 mg oral tablet daily
Cytogenetic analysis is intended for evaluation of relapsed/refractory AL amyloidosis using fluorescence in situ hybridization (FISH) using known translocation probes. Bone marrow aspirate (BMA) samples are collected in lavender top (Ethylenediaminetetraacetic acid (EDTA)) or green top (Sodium heparin) tubes. Specimen tubes shall be transported at room temperature to the laboratory on the same day of collection.
400 mg oral tablet daily
Boston Medical Center
Boston, Massachusetts, United States
RECRUITINGMayo Clinic Rochester
Rochester, Minnesota, United States
RECRUITINGNew York Presbyterian Hospital/Columbia University Irving Medical Center
New York, New York, United States
Number of Participants with Dose Limiting Toxicities (DLT) (Phase 1)
The number of participants with dose limiting toxicities for each treatment dose will be used to determine the MTD. Dose limiting toxicity defined as grade 4 neutropenia lasting more than 5 days, any grade febrile neutropenia, grade 4 thrombocytopenia, grade 3 thrombocytopenia with bleeding, other therapy related non-hematologic toxicity of grade 2 or higher that requires discontinuation of therapy, clinical tumor lysis syndrome (TLS), laboratory TLS if the metabolic abnormalities are considered clinically significant by the investigator. All other grade 3 or higher adverse events (AEs) will be considered as DLTs with a few exceptions.
Time frame: Up to 6 cycles (approximately 6 months)
Hematologic ≥ Very Good Partial Response (VGPR) Rate (Phase 2)
Hematologic ≥VGPR rate defined as proportion of participants achieving VGPR, low serum differential free light chain concentration (dFLC) partial response (PR), or a complete (CR). VGPR is defined as the difference between involved and uninvolved free light chain (FLC) \[dFLC\] \< 40 mg/L. Low dFLC PR is defined as achieving a dFLC\<10 mg/L, low dFLC PR will be considered as a deep hematologic response and included in the ≥VGPR category). CR is defined as negative serum and urine immunofixation electrophoresis along with a serum free light chain ratio that lies within the normal range or skewed towards the non-amyloid forming light chain, as per institutional laboratory values
Time frame: Up to 6 cycles (approximately 6 months)
Overall Organ Response Rate (ORR) (Phase 2)
ORR defined as proportion of evaluable participants achieving organ response in each involved organ
Time frame: Up to 1 year
Progression Free Survival (PFS) (Phase 2)
PFS defined as time from the date of enrollment to hematologic progression or death, whichever is earlier
Time frame: Up to 1 year
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10 mg oral tablet weekly
20 mg oral tablet weekly
Daratumumab will be administered at a dose of 16 mg/kg by IV infusion once weekly for weeks 1 to 8, every 2 weeks for weeks 9 to 24, and every 4 weeks thereafter for a maximum of 6 months of therapy. If subcutaneous formulation is available, participants can also receive subcutaneous daratumumab (1800 mg in 15 ml) in the same schedule.
Bendamustine will be given at an initial dose of 100 mg/m\^2 intravenously on days 1 and 2 in each 28-day cycle.
Pomalidomide will be administered at an initial dose of 2 mg per days on days 1-21 every 28 days.
Ixazomib will be administered at an initial dose of 4 mg per days on days 1, 8, and 15 every 28 days.
Venetoclax MTD (200 mg or 400 mg) with Dexamethasone (10 mg or 20 mg) as determined by the phase I results
Froedtert Hospital & the Medical College of Wisconsin
Milwaukee, Wisconsin, United States
RECRUITINGOverall Hematologic Response Rate (HRR) (Phase 2)
HRR defined as proportion of patients achieving partial response (PR) or better
Time frame: Up to 1 year
Duration of Hematologic Response (DOHR) (Phase 2)
DOHR defined as time from the date of first documentation of hematologic response to the date of first documented hematologic disease progression
Time frame: Up to 1 year
Time to hematologic ≥VGPR (Phase 2)
Time to hematologic ≥VGPR defined as time from the first dose of study treatment to achievement of deep hematologic response (VGPR, low dFLC PR, or a CR)
Time frame: Up to 1 year
Time to next treatment (TTNT) (Phase 2)
TTNT defined as time from the date of enrollment to initiation of a subsequent line of therapy
Time frame: Up to 1 year
Major Organ Deterioration-Progression Free Survival (MOD-PFS) (Phase 2)
MOD-PFS defined as time from the date of enrollment to one of the following events (whichever occurs first): death, clinical manifestation of cardiac/renal failure, or development of hematologic progression of disease
Time frame: Up to 1 year
Overall Survival (OS) (Phase 2)
OS defined as the time from the date of enrollment to death from any cause
Time frame: Up to 1 year
Patient-reported outcomes (PROs) (Phase 2)
PROs defined as longitudinal score of "Physical Functioning" domain of Patient-Reported Outcomes Measurement Information System (PROMIS)-29 Profile v2.0 The Physical Functioning domain contains four items with a 1 (unable to do) to 5 (without any difficulty) numeric rating.
Time frame: Start of each cycle (Day 1 of each 28 day cycle) and Follow-up (every 8 weeks for up to 1 year)