Ixazomib Plus Pomalidomide and Dexamethasone in Treating Patients With Relapsed or Relapsed/Refractory Multiple Myeloma
Study Details
Study Description
Brief Summary
This phase I/II trial studies the side effects and best dose of ixazomib and to see how well it works when given together with pomalidomide and dexamethasone in treating patients with relapsed or relapsed/refractory multiple myeloma. Ixazomib may stop the growth of cancer by interfering with proteasomes (the protein breakdown mechanism in the cells). Pomalidomide and dexamethasone can modify and regulate the immune system and may stop cancer cells from growing. Giving ixazomib with pomalidomide and dexamethasone may be an effective treatment for relapsed or relapsed/refractory multiple myeloma.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 1/Phase 2 |
Detailed Description
PRIMARY OBJECTIVES:
- To determine the recommended phase II dose (RP2D) of MLN9708 (ixazomib), when given in combination with pomalidomide and dexamethasone, in patients with relapsed or relapsed/refractory multiple myeloma. (Phase I) II. To estimate the response rate and to evaluate the antitumor activity of the three drug combination: MLN9708 (at the RP2D), pomalidomide and dexamethasone, in patients with relapsed or relapsed/refractory multiple myeloma. (Phase II)
SECONDARY OBJECTIVES:
- To evaluate the safety of MLN9708 at each dose level when given as part of a three drug combination by assessing the following: type, frequency, severity, attribution, time course and duration of adverse events; and clinical laboratory tests at various points in the study. (Phase I) II. To characterize and evaluate toxicities, including type, frequency, severity, attribution, time course and duration, at the RP2D, for the three drug combination. (Phase
-
- To obtain estimates of response duration, depth of response, clinical benefit response, and survival (overall and progression-free), at the RP2D, for the three drug combination. (Phase II)
OUTLINE: This is a phase I, dose-escalation study of ixazomib followed by a phase II study.
Patients receive ixazomib orally (PO) on days 1, 8, and 15; dexamethasone PO on days 1, 8, 15, and 22; and pomalidomide PO on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 2 years.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Treatment (3mg MLN9708) Patients receive 3mg ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Drug: ixazomib citrate
Given orally
Other Names:
Drug: dexamethasone
Given orally
Other Names:
Drug: pomalidomide
Given orally
Other Names:
|
Experimental: Treatment (4mg MLN9708) Patients receive 4mg ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Drug: ixazomib citrate
Given orally
Other Names:
Drug: dexamethasone
Given orally
Other Names:
Drug: pomalidomide
Given orally
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Number of Patients With Dose-Limiting Toxicities (Phase I) [From the initial treatment to Day 28 (Cycle #1)]
Dose Limiting Toxicity (DLT) is defined as any of the toxicities in Section 7.3 that are at least possibly related to either Pomalidomide or MLN9708 that occur during cycle 1. Toxicity graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events version 4.03. The highest dose level that produces 1/6 dose-limiting toxicities (DLTs) in course 1 will be the maximum tolerated dose (MTD). The RP2D of ixazomib and pomalidomide will generally be the MTD, but it may be less than the MTD based on a review of available data/cumulative toxicities from phase I.
- Overall Response Rate at the Recommended Phase II Dose (RP2D) [From the initial treatment to 24 months]
Over response rate is calculated as the percent of evaluable patients that have confirmed stringent complete remission (sCR), complete remission (CR), very good partial remission (VGPR) or partial remission [PR]) per modified IMWG criteria. sCR as defined below plus normal FLC ratio and absence of clonal cells in bone marrow. CR defined as negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and < 5% plasma cells in bone marrow. VGPR defined as serum and urine M-protein detectable or > 90% reduction in serum M-protein plus urine M-protein level < 100 mg/24 h. PR defined as > 50% reduction of serum M-protein and reduction in 24 hours urinary M-protein by >90% or to < 200 mg/24 h. The exact 95% confidence intervals are calculated for the estimate.
- Maximum Tolerated Dose (MTD) of MLN9708 (Phase I) [From the initial treatment to Day 28 (Cycle #1)]
The highest dose level that produces 1/6 dose-limiting toxicities (DLTs) in Cycle #1 will be the maximum tolerated dose (MTD). The RP2D of ixazomib and pomalidomide will generally be the MTD, but it may be less than the MTD based on a review of available data/cumulative toxicities from phase I.
Secondary Outcome Measures
- Duration of Response at the Recommended Phase II Dose (RP2D) [Time interval from the date of first documented response (sCR/CR/VGPR or PR) to documented disease relapse, progression or death whichever occurs first, up to 24 months]
Time from the date of first documented response (sCR/CR/VGPR or PR) to documented disease relapse, progression or death whichever occurs first. sCR as defined below plus normal FLC ratio and absence of clonal cells in bone marrow. CR defined as negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and < 5% plasma cells in bone marrow. VGPR defined as serum and urine M-protein detectable or > 90% reduction in serum M-protein plus urine M-protein level < 100 mg/24 h. PR defined as > 50% reduction of serum M-protein and reduction in 24 hours urinary M-protein by >90% or to < 200 mg/24 h.
- Clinical Benefit Response Rate at the Recommended Phase II Dose (RP2D) [From the initial treatment up to 24 months]
Clinical benefit response rate is calculated as the percent of evaluable patients that have confirmed stringent complete remission (sCR), complete remission (CR), very good partial remission (VGPR), partial remission (PR), minimal response (MR) or stable disease (SD) per modified IMWG criteria. The exact 95% confidence intervals are calculated for the estimate.
- One-Year Overall Survival at the Recommended Phase II Dose (RP2D) [Date of first dose of study drug to date of death from any cause, up to 24 months. And the median follow-up for the surviving patients is at least one year.]
Overall survival (OS) was measured from initial treatment to death from any cause. It was estimated using the Kaplan-Meier method; the 95% confidence interval was calculated using Greenwood's formula.
- One-Year Progression-Free Survival at the Recommend Phase II Dose (RP2D) [Date of first dose of study drug to first documented disease relapse, progression or death from any cause, whichever occurs first, up to 24 months. And the median follow-up for the surviving patients is at least one year.]
Progression-free survival (PFS) was defined as time from initial treatment to recurrence, progression or death. In a clinical trial, measuring the progression-free survival is one way to see how well a new treatment works. Progression-free survival was estimated using the Kaplan-Meier method; the 95% confidence interval was calculated using Greenwood's formula [Breslow NE, Day NE. Statistical methods in cancer research: volume II, the design and analysis of cohort studies. IARC Sci Publ 1987;82:1-406.]
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Voluntary written informed consent must be given before performance of any study related procedure not part of standard medical care, with the understanding that consent may be withdrawn by the patient at any time without prejudice to future medical care
-
Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL within 10-14 days prior to and again within 24 hours of starting pomalidomide or MLN9708 and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking pomalidomide or MLN9708 through 90 days after the last dose of study drug; FCBP must also agree to ongoing pregnancy testing; men must agree to use a latex condom during sexual contact with a FCBP even if they have had a vasectomy from the time of signing the informed consent form through 90 days after the last dose of study drug; all patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure
-
All patients enrolled into this trial, must be registered in and must comply with all requirements of the POMALYST (pomalidomide) Risk Evaluation and Mitigation Strategy (REMS) program
-
Patients must have a diagnosis of relapsed or relapsed and refractory multiple myeloma with a minimum of one prior regimen and a maximum of 5 prior regimens
-
Patients must have had therapy with a proteasome inhibitor and lenalidomide and be refractory to lenalidomide according to the International Myeloma Working Group (IMWG) criteria definition of refractory disease (progressive disease on or within 60 days of stopping lenalidomide)
-
Patients must have measurable disease defined as one of the following:
-
Serum M protein >= 0.5 g/dL
-
Urine M protein >= 200 mg/24 hours
-
Serum free light chain >= 10 mg/dL provided the free light chain (FLC) ratio is abnormal
-
Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2
-
Absolute neutrophil count (ANC) >= 1,000/mm^3
-
Platelet count >= 75,000/uL for patients in whom < 50% of bone marrow nucleated cells are plasma cells; or a platelet count >= 50,000/uL for patients in whom >= 50% of bone marrow nucleated cells are plasma cells; platelet transfusions are not allowed within 3 days of last platelet assessment to confirm eligibility
-
Total bilirubin =< 1.5 × the institutional upper limit of the normal range (IULN)
-
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 × IULN
-
Calculated creatinine clearance >= 45 mL/min
Exclusion Criteria:
-
Female patients who are pregnant or breastfeeding or have a positive serum pregnancy test during the screening period
-
Failure to have fully recovered (ie, =< grade 1 toxicity) from the reversible effects of prior chemotherapy
-
Prior therapy with a combination regimen containing pomalidomide except the 2 drug combination of pomalidomide and dexamethasone
-
Major surgery within 14 days before enrollment
-
Radiotherapy within 14 days before enrollment; if the involved field is small, 7 days will be considered a sufficient interval between treatment and administration of the MLN9708
-
Central nervous system involvement
-
Infection requiring systemic antibiotic therapy or other serious infection within 14 days before study enrollment
-
Evidence of current uncontrolled cardiovascular conditions, including uncontrolled hypertension, uncontrolled cardiac arrhythmias, symptomatic congestive heart failure, unstable angina, or myocardial infarction within the past 6 months
-
Systemic treatment, within 14 days before the first dose of MLN9708, with strong inhibitors of cytochrome P450, family 1, subfamily A, polypeptide 2 (CYP1A2) (fluvoxamine, enoxacin, ciprofloxacin), strong inhibitors of cytochrome P450, family 3, subfamily A (CYP3A) (clarithromycin, telithromycin, itraconazole, voriconazole, ketoconazole, nefazodone, posaconazole) or strong CYP3A inducers (rifampin, rifapentine, rifabutin, carbamazepine, phenytoin, phenobarbital), or use of Ginkgo biloba or St. John's wort
-
Unable or unwilling to undergo antithrombotic prophylaxis
-
Ongoing or active systemic infection, active hepatitis B or C virus infection, or known human immunodeficiency virus (HIV) positive
-
Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol
-
Known allergy to any of the study medications, their analogues, or excipients in the various formulations of any agent
-
Known gastrointestinal (GI) disease or GI procedure that could interfere with the oral absorption or tolerance of MLN9708 or pomalidomide including difficulty swallowing
-
Diagnosed or treated for another malignancy within 2 years before study enrollment or previously diagnosed with another malignancy with evidence of residual disease; patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection
-
Patient has > grade 2 peripheral neuropathy on clinical examination during the screening period
-
Participation in other clinical trials, including those with other investigational agents not included in this trial, within 21 days of the start of this trial and throughout the duration of this trial (for all other standard therapies, no treatment within 14 days of the start of this trial)
-
Patients who are pomalidomide refractory, defined as patients who progress on or within 60 days of pomalidomide when given as a single agent or with dexamethasone
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Mayo Clinic | Scottsdale | Arizona | United States | 85259 |
2 | City of Hope Medical Center | Duarte | California | United States | 91010 |
3 | Emory University/Winship Cancer Institute | Atlanta | Georgia | United States | 30322 |
4 | Mayo Clinic | Rochester | Minnesota | United States | 55905 |
5 | Sarah Cannon Research Institute (SCRI) | Nashville | Tennessee | United States | 37203 |
Sponsors and Collaborators
- City of Hope Medical Center
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Amrita Krishnan, City of Hope Medical Center
Study Documents (Full-Text)
More Information
Publications
None provided.- 12267
- NCI-2014-00803
- 12267
Study Results
Participant Flow
Recruitment Details | |
---|---|
Pre-assignment Detail |
Arm/Group Title | Dose Level #1 (3mg MLN9708) | Dose Level #2 (4mg MLN9708) |
---|---|---|
Arm/Group Description | Patients receive ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. ixazomib citrate: Given orally dexamethasone: Given orally pomalidomide: Given orally | Patients receive ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Period Title: Overall Study | ||
STARTED | 7 | 25 |
COMPLETED | 7 | 25 |
NOT COMPLETED | 0 | 0 |
Baseline Characteristics
Arm/Group Title | Dose Level #1 (3mg MLN9708) | Dose Level #2 (4mg MLN9708) | Total |
---|---|---|---|
Arm/Group Description | Patients receive ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. ixazomib citrate: Given orally dexamethasone: Given orally pomalidomide: Given orally | Patients receive ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. ixazomib citrate: Given orally dexamethasone: Given orally pomalidomide: Given orally | Total of all reporting groups |
Overall Participants | 7 | 25 | 32 |
Age (years) [Median (Full Range) ] | |||
Median (Full Range) [years] |
53
|
63
|
62
|
Sex: Female, Male (Count of Participants) | |||
Female |
2
28.6%
|
10
40%
|
12
37.5%
|
Male |
5
71.4%
|
15
60%
|
20
62.5%
|
Ethnicity (NIH/OMB) (Count of Participants) | |||
Hispanic or Latino |
1
14.3%
|
1
4%
|
2
6.3%
|
Not Hispanic or Latino |
6
85.7%
|
23
92%
|
29
90.6%
|
Unknown or Not Reported |
0
0%
|
1
4%
|
1
3.1%
|
Race (NIH/OMB) (Count of Participants) | |||
American Indian or Alaska Native |
0
0%
|
0
0%
|
0
0%
|
Asian |
0
0%
|
2
8%
|
2
6.3%
|
Native Hawaiian or Other Pacific Islander |
0
0%
|
0
0%
|
0
0%
|
Black or African American |
0
0%
|
3
12%
|
3
9.4%
|
White |
7
100%
|
20
80%
|
27
84.4%
|
More than one race |
0
0%
|
0
0%
|
0
0%
|
Unknown or Not Reported |
0
0%
|
0
0%
|
0
0%
|
Region of Enrollment (Count of Participants) | |||
United States |
7
100%
|
25
100%
|
32
100%
|
Outcome Measures
Title | Number of Patients With Dose-Limiting Toxicities (Phase I) |
---|---|
Description | Dose Limiting Toxicity (DLT) is defined as any of the toxicities in Section 7.3 that are at least possibly related to either Pomalidomide or MLN9708 that occur during cycle 1. Toxicity graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events version 4.03. The highest dose level that produces 1/6 dose-limiting toxicities (DLTs) in course 1 will be the maximum tolerated dose (MTD). The RP2D of ixazomib and pomalidomide will generally be the MTD, but it may be less than the MTD based on a review of available data/cumulative toxicities from phase I. |
Time Frame | From the initial treatment to Day 28 (Cycle #1) |
Outcome Measure Data
Analysis Population Description |
---|
Patients were considered evaluable for DLT if receiving at least 75% of both Pomalidomide and MLN9708 and followed for the full 28 days during cycle 1 or experience a DLT. All patients who are not evaluable for DLT were replaced. |
Arm/Group Title | Dose Level #1: 3mg MLN9708 | Dose Level #2: 4mg MLN9708 |
---|---|---|
Arm/Group Description | Patients receive ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. | Patients receive ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Measure Participants | 6 | 6 |
Count of Participants [Participants] |
1
14.3%
|
1
4%
|
Title | Overall Response Rate at the Recommended Phase II Dose (RP2D) |
---|---|
Description | Over response rate is calculated as the percent of evaluable patients that have confirmed stringent complete remission (sCR), complete remission (CR), very good partial remission (VGPR) or partial remission [PR]) per modified IMWG criteria. sCR as defined below plus normal FLC ratio and absence of clonal cells in bone marrow. CR defined as negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and < 5% plasma cells in bone marrow. VGPR defined as serum and urine M-protein detectable or > 90% reduction in serum M-protein plus urine M-protein level < 100 mg/24 h. PR defined as > 50% reduction of serum M-protein and reduction in 24 hours urinary M-protein by >90% or to < 200 mg/24 h. The exact 95% confidence intervals are calculated for the estimate. |
Time Frame | From the initial treatment to 24 months |
Outcome Measure Data
Analysis Population Description |
---|
Patients received 4 mg MLN9708, 4mg pomalidomide, and 40 mg dexamethasone (RP2D). |
Arm/Group Title | Dose Level #2 (4mg MLN9708) |
---|---|
Arm/Group Description | Patients receive 4mg ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Measure Participants | 25 |
Number (95% Confidence Interval) [Percentage of Participants (%)] |
48
685.7%
|
Title | Maximum Tolerated Dose (MTD) of MLN9708 (Phase I) |
---|---|
Description | The highest dose level that produces 1/6 dose-limiting toxicities (DLTs) in Cycle #1 will be the maximum tolerated dose (MTD). The RP2D of ixazomib and pomalidomide will generally be the MTD, but it may be less than the MTD based on a review of available data/cumulative toxicities from phase I. |
Time Frame | From the initial treatment to Day 28 (Cycle #1) |
Outcome Measure Data
Analysis Population Description |
---|
6 patients treated at dose level #2 in Phase I are evaluable for dose limiting toxicity. |
Arm/Group Title | Dose Level #2 (4mg MLN9708) |
---|---|
Arm/Group Description | Patients receive 4mg ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Measure Participants | 6 |
Number [mg] |
4
|
Title | Duration of Response at the Recommended Phase II Dose (RP2D) |
---|---|
Description | Time from the date of first documented response (sCR/CR/VGPR or PR) to documented disease relapse, progression or death whichever occurs first. sCR as defined below plus normal FLC ratio and absence of clonal cells in bone marrow. CR defined as negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and < 5% plasma cells in bone marrow. VGPR defined as serum and urine M-protein detectable or > 90% reduction in serum M-protein plus urine M-protein level < 100 mg/24 h. PR defined as > 50% reduction of serum M-protein and reduction in 24 hours urinary M-protein by >90% or to < 200 mg/24 h. |
Time Frame | Time interval from the date of first documented response (sCR/CR/VGPR or PR) to documented disease relapse, progression or death whichever occurs first, up to 24 months |
Outcome Measure Data
Analysis Population Description |
---|
Patients received 4 mg MLN9708, 4mg pomalidomide, and 40 mg dexamethasone (RP2D). |
Arm/Group Title | Dose Level #2 (4mg MLN9708) |
---|---|
Arm/Group Description | Patients receive 4mg ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Measure Participants | 25 |
Median (Full Range) [Months] |
9.2
|
Title | Clinical Benefit Response Rate at the Recommended Phase II Dose (RP2D) |
---|---|
Description | Clinical benefit response rate is calculated as the percent of evaluable patients that have confirmed stringent complete remission (sCR), complete remission (CR), very good partial remission (VGPR), partial remission (PR), minimal response (MR) or stable disease (SD) per modified IMWG criteria. The exact 95% confidence intervals are calculated for the estimate. |
Time Frame | From the initial treatment up to 24 months |
Outcome Measure Data
Analysis Population Description |
---|
Patients received 4 mg MLN9708, 4mg pomalidomide, and 40 mg dexamethasone (RP2D). |
Arm/Group Title | Dose Level #2 (4mg MLN9708) |
---|---|
Arm/Group Description | Patients receive 4mg ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Measure Participants | 25 |
Number (95% Confidence Interval) [Percentage of Participants (%)] |
76
1085.7%
|
Title | One-Year Overall Survival at the Recommended Phase II Dose (RP2D) |
---|---|
Description | Overall survival (OS) was measured from initial treatment to death from any cause. It was estimated using the Kaplan-Meier method; the 95% confidence interval was calculated using Greenwood's formula. |
Time Frame | Date of first dose of study drug to date of death from any cause, up to 24 months. And the median follow-up for the surviving patients is at least one year. |
Outcome Measure Data
Analysis Population Description |
---|
Patients received 4 mg MLN9708, 4mg pomalidomide, and 40 mg dexamethasone (RP2D). |
Arm/Group Title | Dose Level #2 (4mg MLN9708) |
---|---|
Arm/Group Description | Patients receive 4mg ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Measure Participants | 25 |
Number (95% Confidence Interval) [Percentage of Participants (%)] |
82
1171.4%
|
Title | One-Year Progression-Free Survival at the Recommend Phase II Dose (RP2D) |
---|---|
Description | Progression-free survival (PFS) was defined as time from initial treatment to recurrence, progression or death. In a clinical trial, measuring the progression-free survival is one way to see how well a new treatment works. Progression-free survival was estimated using the Kaplan-Meier method; the 95% confidence interval was calculated using Greenwood's formula [Breslow NE, Day NE. Statistical methods in cancer research: volume II, the design and analysis of cohort studies. IARC Sci Publ 1987;82:1-406.] |
Time Frame | Date of first dose of study drug to first documented disease relapse, progression or death from any cause, whichever occurs first, up to 24 months. And the median follow-up for the surviving patients is at least one year. |
Outcome Measure Data
Analysis Population Description |
---|
Patients received 4 mg MLN9708, 4mg pomalidomide, and 40 mg dexamethasone (RP2D). |
Arm/Group Title | Dose Level #2 (4mg MLN9708) |
---|---|
Arm/Group Description | Patients receive 4mg ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Measure Participants | 25 |
Number (95% Confidence Interval) [Percentage of Participants (%)] |
34
485.7%
|
Adverse Events
Time Frame | From the date of the first dose up to 2 years | |||
---|---|---|---|---|
Adverse Event Reporting Description | ||||
Arm/Group Title | Dose Level #1 (3mg MLN9708) | Dose Level #2 (4mg MLN9708) | ||
Arm/Group Description | Patients receive 3mg ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. ixazomib citrate: Given orally dexamethasone: Given orally pomalidomide: Given orally | Patients receive 4mg ixazomib citrate (MLN9708) orally on days 1, 8, and 15; dexamethasone orally on days 1, 8, 15, and 22; and pomalidomide orally on days 1-21. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. ixazomib citrate: Given orally dexamethasone: Given orally pomalidomide: Given orally | ||
All Cause Mortality |
||||
Dose Level #1 (3mg MLN9708) | Dose Level #2 (4mg MLN9708) | |||
Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
Total | 4/7 (57.1%) | 6/25 (24%) | ||
Serious Adverse Events |
||||
Dose Level #1 (3mg MLN9708) | Dose Level #2 (4mg MLN9708) | |||
Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
Total | 4/7 (57.1%) | 11/25 (44%) | ||
Blood and lymphatic system disorders | ||||
Anemia | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Febrile neutropenia | 0/7 (0%) | 0 | 2/25 (8%) | 2 |
Cardiac disorders | ||||
Sinus tachycardia | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Heart failure | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Gastrointestinal disorders | ||||
Rectal hemorrhage | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Small intestinal obstruction | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
General disorders | ||||
Death NOS | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Fever | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Infections and infestations | ||||
Skin infection | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Lung infection | 2/7 (28.6%) | 2 | 2/25 (8%) | 4 |
Sepsis | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Upper respiratory infection | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Injury, poisoning and procedural complications | ||||
Spinal fracture | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Investigations | ||||
Neutrophil count decreased | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Musculoskeletal and connective tissue disorders | ||||
Back pain | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Muscle weakness lower limb | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Buttock pain | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Reproductive system and breast disorders | ||||
Pelvic pain | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Respiratory, thoracic and mediastinal disorders | ||||
Dyspnea | 1/7 (14.3%) | 1 | 1/25 (4%) | 1 |
Respiratory, thoracic and mediastinal disorders - Other, specify | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Hypoxia | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Pneumonitis | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Respiratory failure | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Other (Not Including Serious) Adverse Events |
||||
Dose Level #1 (3mg MLN9708) | Dose Level #2 (4mg MLN9708) | |||
Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
Total | 7/7 (100%) | 25/25 (100%) | ||
Blood and lymphatic system disorders | ||||
Anemia | 6/7 (85.7%) | 17 | 19/25 (76%) | 88 |
Blood and lymphatic system disorders - Other, specify | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Thrombotic thrombocytopenic purpura | 1/7 (14.3%) | 1 | 1/25 (4%) | 1 |
Cardiac disorders | ||||
Atrial fibrillation | 1/7 (14.3%) | 1 | 1/25 (4%) | 2 |
Heart failure | 0/7 (0%) | 0 | 1/25 (4%) | 2 |
Paroxysmal atrial tachycardia | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Sinus bradycardia | 1/7 (14.3%) | 8 | 1/25 (4%) | 4 |
Sinus tachycardia | 2/7 (28.6%) | 5 | 2/25 (8%) | 2 |
Tricuspid valve disease | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Ear and labyrinth disorders | ||||
Ear and labyrinth disorders - Other, specify | 0/7 (0%) | 0 | 1/25 (4%) | 2 |
Hearing impaired | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Vertigo | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Eye disorders | ||||
Blurred vision | 1/7 (14.3%) | 2 | 5/25 (20%) | 24 |
Cataract | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Dry eye | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Eye disorders - Other, specify | 0/7 (0%) | 0 | 1/25 (4%) | 11 |
Eye pain | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Photophobia | 1/7 (14.3%) | 2 | 0/25 (0%) | 0 |
Gastrointestinal disorders | ||||
Abdominal distension | 0/7 (0%) | 0 | 1/25 (4%) | 2 |
Abdominal pain | 1/7 (14.3%) | 1 | 3/25 (12%) | 13 |
Bloating | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Constipation | 2/7 (28.6%) | 2 | 10/25 (40%) | 35 |
Diarrhea | 4/7 (57.1%) | 4 | 9/25 (36%) | 20 |
Dry mouth | 2/7 (28.6%) | 4 | 1/25 (4%) | 1 |
Dyspepsia | 1/7 (14.3%) | 3 | 4/25 (16%) | 8 |
Fecal incontinence | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Flatulence | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Gastrointestinal disorders - Other, specify | 0/7 (0%) | 0 | 3/25 (12%) | 3 |
Hemorrhoidal hemorrhage | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Hemorrhoids | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Mucositis oral | 0/7 (0%) | 0 | 3/25 (12%) | 3 |
Nausea | 3/7 (42.9%) | 8 | 10/25 (40%) | 26 |
Vomiting | 2/7 (28.6%) | 4 | 5/25 (20%) | 9 |
General disorders | ||||
Chills | 2/7 (28.6%) | 3 | 3/25 (12%) | 3 |
Edema face | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Edema limbs | 2/7 (28.6%) | 3 | 6/25 (24%) | 22 |
Fatigue | 5/7 (71.4%) | 10 | 15/25 (60%) | 79 |
Fever | 3/7 (42.9%) | 6 | 3/25 (12%) | 6 |
Flu like symptoms | 2/7 (28.6%) | 4 | 1/25 (4%) | 1 |
Gait disturbance | 1/7 (14.3%) | 1 | 1/25 (4%) | 1 |
General disorders and administration site conditions - Other, specify | 1/7 (14.3%) | 2 | 1/25 (4%) | 1 |
Localized edema | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Malaise | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Non-cardiac chest pain | 1/7 (14.3%) | 1 | 2/25 (8%) | 2 |
Pain | 1/7 (14.3%) | 1 | 3/25 (12%) | 4 |
Infections and infestations | ||||
Bronchial infection | 1/7 (14.3%) | 1 | 1/25 (4%) | 2 |
Infections and infestations - Other, specify | 0/7 (0%) | 0 | 3/25 (12%) | 5 |
Lung infection | 1/7 (14.3%) | 2 | 2/25 (8%) | 2 |
Nail infection | 1/7 (14.3%) | 1 | 1/25 (4%) | 1 |
Otitis media | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Rhinitis infective | 0/7 (0%) | 0 | 2/25 (8%) | 2 |
Sinusitis | 1/7 (14.3%) | 1 | 2/25 (8%) | 3 |
Upper respiratory infection | 1/7 (14.3%) | 2 | 7/25 (28%) | 12 |
Injury, poisoning and procedural complications | ||||
Bruising | 1/7 (14.3%) | 4 | 2/25 (8%) | 5 |
Fall | 0/7 (0%) | 0 | 3/25 (12%) | 7 |
Fracture | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Investigations | ||||
Alanine aminotransferase increased | 3/7 (42.9%) | 8 | 1/25 (4%) | 17 |
Alkaline phosphatase increased | 1/7 (14.3%) | 1 | 2/25 (8%) | 2 |
Aspartate aminotransferase increased | 3/7 (42.9%) | 12 | 1/25 (4%) | 4 |
Blood bilirubin increased | 3/7 (42.9%) | 5 | 4/25 (16%) | 13 |
CD4 lymphocytes decreased | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Cardiac troponin I increased | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Creatinine increased | 4/7 (57.1%) | 11 | 4/25 (16%) | 21 |
Ejection fraction decreased | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Electrocardiogram QT corrected interval prolonged | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
INR increased | 1/7 (14.3%) | 20 | 1/25 (4%) | 2 |
Investigations - Other, specify | 0/7 (0%) | 0 | 1/25 (4%) | 2 |
Lymphocyte count decreased | 6/7 (85.7%) | 24 | 13/25 (52%) | 46 |
Neutrophil count decreased | 5/7 (71.4%) | 39 | 17/25 (68%) | 105 |
Platelet count decreased | 5/7 (71.4%) | 43 | 19/25 (76%) | 95 |
Weight gain | 2/7 (28.6%) | 22 | 2/25 (8%) | 10 |
Weight loss | 0/7 (0%) | 0 | 2/25 (8%) | 3 |
White blood cell decreased | 6/7 (85.7%) | 40 | 16/25 (64%) | 83 |
Metabolism and nutrition disorders | ||||
Acidosis | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Alkalosis | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Anorexia | 1/7 (14.3%) | 1 | 1/25 (4%) | 2 |
Dehydration | 0/7 (0%) | 0 | 3/25 (12%) | 4 |
Hypercalcemia | 1/7 (14.3%) | 2 | 3/25 (12%) | 4 |
Hyperglycemia | 1/7 (14.3%) | 5 | 11/25 (44%) | 20 |
Hyperkalemia | 2/7 (28.6%) | 3 | 0/25 (0%) | 0 |
Hypermagnesemia | 2/7 (28.6%) | 2 | 0/25 (0%) | 0 |
Hypernatremia | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Hypertriglyceridemia | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Hyperuricemia | 1/7 (14.3%) | 2 | 1/25 (4%) | 2 |
Hypoalbuminemia | 4/7 (57.1%) | 6 | 5/25 (20%) | 17 |
Hypocalcemia | 3/7 (42.9%) | 11 | 6/25 (24%) | 16 |
Hypoglycemia | 1/7 (14.3%) | 13 | 2/25 (8%) | 9 |
Hypokalemia | 3/7 (42.9%) | 6 | 4/25 (16%) | 15 |
Hypomagnesemia | 0/7 (0%) | 0 | 2/25 (8%) | 2 |
Hyponatremia | 4/7 (57.1%) | 10 | 5/25 (20%) | 21 |
Hypophosphatemia | 2/7 (28.6%) | 4 | 1/25 (4%) | 1 |
Obesity | 2/7 (28.6%) | 20 | 3/25 (12%) | 13 |
Tumor lysis syndrome | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Musculoskeletal and connective tissue disorders | ||||
Arthralgia | 1/7 (14.3%) | 1 | 2/25 (8%) | 3 |
Arthritis | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Back pain | 3/7 (42.9%) | 5 | 8/25 (32%) | 14 |
Bone pain | 1/7 (14.3%) | 1 | 3/25 (12%) | 3 |
Flank pain | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Generalized muscle weakness | 1/7 (14.3%) | 3 | 6/25 (24%) | 34 |
Muscle weakness lower limb | 0/7 (0%) | 0 | 3/25 (12%) | 5 |
Musculoskeletal and connective tissue disorder - Other, specify | 1/7 (14.3%) | 2 | 5/25 (20%) | 17 |
Myalgia | 0/7 (0%) | 0 | 3/25 (12%) | 29 |
Neck pain | 1/7 (14.3%) | 1 | 2/25 (8%) | 3 |
Pain in extremity | 2/7 (28.6%) | 7 | 7/25 (28%) | 12 |
Neoplasms benign, malignant and unspecified (incl cysts and polyps) | ||||
Neoplasms benign, malignant and unspecified (incl cysts and polyps) - Other, specify | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Nervous system disorders | ||||
Amnesia | 0/7 (0%) | 0 | 2/25 (8%) | 15 |
Dizziness | 3/7 (42.9%) | 5 | 8/25 (32%) | 15 |
Dysgeusia | 0/7 (0%) | 0 | 3/25 (12%) | 3 |
Headache | 1/7 (14.3%) | 3 | 5/25 (20%) | 6 |
Nervous system disorders - Other, specify | 0/7 (0%) | 0 | 2/25 (8%) | 4 |
Neuralgia | 1/7 (14.3%) | 2 | 0/25 (0%) | 0 |
Peripheral motor neuropathy | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Peripheral sensory neuropathy | 4/7 (57.1%) | 20 | 12/25 (48%) | 59 |
Somnolence | 1/7 (14.3%) | 1 | 1/25 (4%) | 7 |
Syncope | 0/7 (0%) | 0 | 3/25 (12%) | 3 |
Tremor | 1/7 (14.3%) | 12 | 2/25 (8%) | 17 |
Psychiatric disorders | ||||
Agitation | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Anxiety | 1/7 (14.3%) | 1 | 1/25 (4%) | 7 |
Confusion | 0/7 (0%) | 0 | 5/25 (20%) | 36 |
Depression | 1/7 (14.3%) | 1 | 1/25 (4%) | 1 |
Insomnia | 1/7 (14.3%) | 12 | 5/25 (20%) | 17 |
Mania | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Renal and urinary disorders | ||||
Acute kidney injury | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Chronic kidney disease | 1/7 (14.3%) | 5 | 2/25 (8%) | 6 |
Hematuria | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Proteinuria | 5/7 (71.4%) | 50 | 5/25 (20%) | 37 |
Reproductive system and breast disorders | ||||
Irregular menstruation | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Pelvic pain | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Reproductive system and breast disorders - Other, specify | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Respiratory, thoracic and mediastinal disorders | ||||
Allergic rhinitis | 0/7 (0%) | 0 | 2/25 (8%) | 2 |
Atelectasis | 1/7 (14.3%) | 1 | 1/25 (4%) | 1 |
Cough | 2/7 (28.6%) | 2 | 5/25 (20%) | 10 |
Dyspnea | 3/7 (42.9%) | 5 | 6/25 (24%) | 45 |
Epistaxis | 1/7 (14.3%) | 1 | 2/25 (8%) | 3 |
Hiccups | 0/7 (0%) | 0 | 3/25 (12%) | 5 |
Hypoxia | 2/7 (28.6%) | 2 | 0/25 (0%) | 0 |
Nasal congestion | 1/7 (14.3%) | 2 | 4/25 (16%) | 6 |
Pleuritic pain | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Postnasal drip | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Productive cough | 2/7 (28.6%) | 3 | 1/25 (4%) | 3 |
Sinus disorder | 0/7 (0%) | 0 | 1/25 (4%) | 1 |
Wheezing | 2/7 (28.6%) | 2 | 0/25 (0%) | 0 |
Skin and subcutaneous tissue disorders | ||||
Alopecia | 2/7 (28.6%) | 3 | 0/25 (0%) | 0 |
Dry skin | 0/7 (0%) | 0 | 2/25 (8%) | 14 |
Hyperhidrosis | 1/7 (14.3%) | 1 | 2/25 (8%) | 4 |
Pruritus | 3/7 (42.9%) | 4 | 6/25 (24%) | 16 |
Rash maculo-papular | 2/7 (28.6%) | 3 | 5/25 (20%) | 6 |
Skin and subcutaneous tissue disorders - Other, specify | 1/7 (14.3%) | 2 | 5/25 (20%) | 16 |
Vascular disorders | ||||
Hot flashes | 1/7 (14.3%) | 1 | 0/25 (0%) | 0 |
Hypertension | 4/7 (57.1%) | 122 | 7/25 (28%) | 42 |
Hypotension | 0/7 (0%) | 0 | 5/25 (20%) | 7 |
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
Name/Title | Dr. Amrita Krishnan |
---|---|
Organization | City of Hope National Medical Center |
Phone | 626-256-4673 ext 62405 |
AKrishnan@coh.org |
- 12267
- NCI-2014-00803
- 12267