Teclistamab-Daratumumab in AL Amyloidosis

Phase 2RecruitingNCT07110844

Rajshekhar Chakraborty, MD25 enrolled

Overview

The purpose of this study is to investigate whether teclistamab-daratumumab combination is effective and safe in AL amyloidosis. The study treatment is divided into cycles (C) and each cycle is 28 days (D). Study treatment is expected to last 6 months.

The purpose of this study is to assess the effectiveness and safety of teclistamab-daratumumab combination in newly diagnosed AL amyloidosis. The study aims to evaluate whether this combination is able to effectively decrease the level of toxic amyloid-producing light chains circulating in the participants' blood, with the overarching goal of avoiding organ damage, improving organ function, and prolonging life.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Amyloid Light-chain Amyloidosis

Interventions

TeclistamabDRUG

Teclistamab is a T-cell redirecting bispecific antibody (BsAb) targeting CD3 on T-cells and B-cell maturation antigen (BCMA) on plasma cells.

Daratumumab and Hyaluronidase-fihjDRUG

Daratumumab is an monoclonal antibody that targets the CD38 protein on the surface of myeloma cells.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 100 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age \>18 years and able to sign Informed Consent Form (ICF). If the individual being considered for participation in this study is unable to provide informed consent due to medical, cognitive, or other conditions, a legally authorized representative (LAR) may consent on their behalf. 2. Ability to comply with the study protocol, in the investigator's judgment. 3. Confirmed histopathological diagnosis of systemic AL amyloidosis by mass spectrometry or immunohistochemistry (IHC) or Immunofluorescence (IF) on a tissue biopsy that is positive for Congo Red. 4. Patient must not have received any prior plasma cell clone-directed therapy. 5. Measurable hematologic disease, defined as one of the following: 1. Difference between involved and uninvolved serum free light chain (dFLC) ≥50 mg/L and/or 5 mg/dL 2. Serum M-protein ≥0.5 g/dL on protein electrophoresis 6. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2. 7. One or more organs involved by AL amyloidosis as per consensus guidelines 8. Pre-treatment clinical laboratory values meeting the following criteria during the screening phase: 1. Absolute neutrophil count ≥0.75 × 10\^9/L 2. Hemoglobin level ≥8.0 g/dL; red blood cell transfusion allowed until 7 days before C1D0. 3. Platelet count ≥50 × 10\^9/L; Platelet transfusions are acceptable without restriction during the Screening period 4. Alanine aminotransferase level (ALT) ≤2.5 times the Upper Limit of Normal (ULN) 5. Aspartate aminotransferase (AST) ≤2.5 times the ULN 6. Total bilirubin level ≤1.5 × ULN except for subjects with Gilbert syndrome, in which case direct bilirubin ≤2 × ULN 7. Estimated glomerular filtration rate (eGFR) ≥20 mL/min/1.73 m\^2, measured by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. 9. For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraception and agreement to refrain from donating eggs. For men: Agreement to remain abstinent (refrain from heterosexual intercourse) or use a condom, and agreement to refrain from donating sperm. Exclusion Criteria: 1. Prior therapy for AL amyloidosis or multiple myeloma with the exception of 160 mg dexamethasone (or equivalent corticosteroid) maximum exposure prior to C1D0. 2. Patients meeting criteria for symptomatic multiple myeloma by any one of the following: (a) Lytic lesions on imaging (Skeletal survey, whole body CT or MRI, or PET/CT) (b) Plasmacytoma, (c) Hypercalcemia without any alternate etiology, (d) Bone marrow plasma cell infiltrate of greater than 60%. Patients with involved/uninvolved serum FLC ratio\>100 as the sole myeloma-defining event will be allowed. 3. Evidence of significant cardiovascular conditions as specified below: 1. NT-Pro BNP \> 8500 pg/mL, and/or 2. NYHA Class IIIb or IV functional class 4. History of other malignancy that could affect compliance with the protocol or interpretation of results. Patients with a history of curatively treated basal or squamous cell carcinoma of the skin, in situ carcinoma of the cervix, breast cancer, or Hodgkin's Lymphoma are generally eligible. Patients with a malignancy that has been treated, but not with curative intent, will be excluded, unless the malignancy has been in remission without treatment for ≥ 2 years prior to enrollment. 5. Evidence of other clinically significant uncontrolled condition(s) including, but not limited to, uncontrolled systemic infection (viral, bacterial, or fungal). 6. Patients on renal replacement therapy 7. Patients with HIV who are not on HAART or those with active hepatitis A, B, or C infection. 8. Planned stem cell transplant during the first 6 cycles of protocol therapy are excluded. Stem cell collection during the first 6 cycles of protocol therapy is permitted, as per investigators' discretion. 9. Known hypersensitivity to any of the agents 10. Patients who are receiving any other investigational agent concurrently.

Locations (3)

Boston Medical Center

Boston, Massachusetts, United States

NOT_YET_RECRUITING

Columbia University Irving Medical Center

New York, New York, United States

RECRUITING

Medical College of Wisconsin

Milwaukee, Wisconsin, United States

RECRUITING

Outcomes

Primary Outcomes

Hematologic Complete Response (Heme-CR) rate

Heme-CR will be defined as: involved free light-chain level less than the upper limit of the normal range with negative serum and urine immunofixation; normalization of the uninvolved free light-chain level or free light-chain ratio will not be required to determine a complete response.

Time frame: 6 months from treatment initiation

Secondary Outcomes

Minimal Residual Disease (MRD) negativity rate by Free Light Chain Mass Spectrometry (FLC-MS) in serum

Secondary outcome is to assess the rate of minimal residual disease (MRD)-negativity and sustained MRD-negativity with Teclistamab-Daratumumab

Time frame: 1 month, 3 months, 6 months, and 18 months

MRD-negativity rate by multiparameter flow cytometry (MFC) in bone marrow

The MRD-negativity rate by 6 and 18 months will be reported descriptively.

Time frame: 6 months and 18 months

Time to heme-CR

Time to heme-CR will be calculated from the day of treatment initiation (C1D0), and will be reported as median (range).

Time frame: Day 1 of each cycle, and every 6 weeks after treatment cessation (up to 1 year)

Major organ deterioration-progression-free survival (MOD-PFS) rate

MOD-PFS will be calculated as a time-to-event endpoint using Kaplan-Meier method.

Time frame: From Cycle 2 to Cycle 6 Day 1 (Each cycle is 28 days), End of treatment visit (up to 6 months from treatment initiation), and up to 18 months from treatment initiation

Overall survival rate

Overall survival frequency from initiation of study drug, including cause of death for patients who die on study

Central Contacts

Central Nurse Navigator, RN

CONTACT

(212) 342 5162 cancerclinicaltrials@cumc.columbia.edu

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.

Time frame: Through study completion, up to 18 months from treatment initiation

Frequency of Cytokine Release Syndrome (CRS)

Frequency of CRS (all-grade and grade ≥3) events

Time frame: Throughout Cycle 1 (each cycle is 28 days), Day 0, Day 1, Day 3, Day 8, Day 15, Day 22; Throughout Cycle 2 and Cycle 6 on Day 1 and Day 15; End of treatment visit (up to 6 months from treatment initiation), Post treatment follow-up (up to 18 months)

Rate of infections

Frequency rate of infections (all-grade and grade ≥3) will be reported descriptively.

Number of participants with a heart response after treatment

Heart response is defined as N-terminal pro Brain Natriuretic Peptide (NT-ProBNP) response (\>30% and \>300 ng/l decrease in subjects with baseline NT-proBNP\>650 ng/l) or New York Heart Association (NYHA) class response (\>2 class decrease in subjects with baseline NYHA class 3 or 4)

Time frame: 6 months and 18 months

Number of No Responses in the heart after treatment

No response in the heart is defined as ≤30% reduction in NT-proBNP from baseline

Time frame: 6 months and 18 months

Number of Partial Responses (PR) in participants who experienced a heart response after treatment

Partial Response in the heart is defined as 31-60% reduction in NT-proBNP from baseline.

Time frame: 6 months and 18 months

Number of Very Good Partial Responses (VGPR) in participants who experienced a heart response after treatment

VGPR in the heart is defined as \>60% reduction in NT-proBNP from baseline to a nadir of \>350 ng/L

Time frame: 6 months and 18 months

Number of Complete Response (CR) in participants who experienced a heart response after treatment

Complete Response in the heart is defined as Nadir NT-proBNP≤350 ng/L

Time frame: 6 months and 18 months

Number of participants with heart progression after treatment

Heart progression is defined as NT-proBNP progression (\>30% and \>300 ng/l increase) or cardiac troponin progression (\>33% increase) or ejection fraction progression (\>10% decrease). Subjects with progressive worsening renal function cannot be scored for NT-proBNP progression.

Time frame: 6 months and 18 months

Number of participants with a kidney response after treatment

Kidney response is defined as 50% decrease (at least 0.5 g/day) of 24-h urine protein (urine protein must be \>0.5g/day pretreatment). Creatinine and creatinine clearance must not worsen by 25% over baseline.

Time frame: 6 months and 18 months

Number of No Responses in the kidneys after treatment

No response in the kidneys is defined as ≤30% reduction in proteinuria from baseline

Time frame: 6 months and 18 months

Number of Partial Responses (PR) in participants who experienced a kidney response after treatment

Partial Response in the kidneys is defined as 31-60% reduction in proteinuria from baseline

Time frame: 6 months and 18 months

Number of Very Good Partial Responses (VGPR) in participants who experienced a kidney response after treatment

VGPR in the kidneys is defined as \>60% reduction in proteinuria from baseline level to a nadir level \>200 mg/24 hours

Time frame: 6 months and 18 months

Number of Complete Response (CR) in participants who experienced a kidney response after treatment

Complete Response in the kidneys is defined as Nadir proteinuria ≤200 mg/24 hours

Time frame: 6 months and 18 months

Number of participants with kidney progression after treatment

Kidney progression is defined as 50% increase (at least 1 g/day) of 24-h urine protein to \>1 g/day or 25% worsening of serum creatinine or creatinine clearance.

Time frame: 6 months and 18 months

Number of participants with liver response after treatment

Liver response is defined as 50% decrease in abnormal alkaline phosphatase value.

Time frame: 6 months and 18 months

Number of No Responses in the liver after treatment

No response in the liver is defined as ≤30% reduction in alkaline phosphatase (ALP) from baseline.

Time frame: 6 months and 18 months

Number of Partial Responses (PR) in participants who experienced liver response after treatment

Partial Response in the liver is defined as 31-60% reduction in ALP from baseline.

Time frame: 6 months and 18 months

Number of Very Good Partial Responses (VGPR) in participants who experienced liver response after treatment

VGPR in the liver is defined as \>60% reduction in ALP from baseline to a nadir \>2x lower limit of normal (LLN)

Time frame: 6 months and 18 months

Number of Complete Response (CR) in participants who experienced liver response after treatment

Complete Response in the liver is defined as Nadir ALP ≤2X LLN

Time frame: 6 months and 18 months

Number of participants with liver progression after treatment

Liver progression is defined as 50% increase of ALP from nadir value

Time frame: 6 months and 18 months