Lenalidomide With or Without Dexamethasone in Treating Patients With Newly Diagnosed Multiple Myeloma
Condition: Multiple Myeloma and Plasma Cell Neoplasm
MeSH terms: Multiple Myeloma; Neoplasms, Plasma Cell; Plasmacytoma
Study type: Interventional
Phase: Phase 2

Summary: 
      RATIONALE: Lenalidomide and dexamethasone may stop the growth of multiple myeloma by blocking
      blood flow to the tumor.

      PURPOSE: This phase II trial is studying how well lenalidomide works with or without
      dexamethasone in treating patients with newly diagnosed multiple myeloma.
    

Detailed description: 
      OBJECTIVES:

      Primary

        -  To assess the progression-free survival at 1 year in patients with newly diagnosed
           symptomatic multiple myeloma treated with lenalidomide alone or in combination with
           dexamethasone added for disease progression or lack or partial response.

      Secondary

        -  To assess the response rate of this regimen in these patients.

        -  To assess the toxicity of this regimen in these patients.

      Tertiary

        -  To examine the effect of lenalidomide alone on tumor specific immunity and global
           parameters of immune function.

        -  To examine the effect of dexamethasone addition in patients requiring steroids.

        -  To correlate changes in parameters of immune response and measures of disease response.

        -  To examine the antiangiogenic activity of lenalidomide alone and in combination with
           dexamethasone.

        -  To examine the effect of lenalidomide alone on tumor cell survival and proliferation.

      OUTLINE: Patients receive oral lenalidomide once daily on days 1-21. Treatment repeats every
      28 days for up to 18 courses in the absence of second disease progression or unacceptable
      toxicity. Beginning in course 4, patients experiencing stable or progressive disease also
      receive concurrent oral dexamethasone once daily on days 1, 8, 15, and 22 and for all
      subsequent courses.

      Blood and bone marrow samples are collected periodically for pharmacological and correlative
      studies. Samples are analyzed for parameters of immune activation, cell proliferation and
      apoptosis, and circulating tumor cells and endothelial cells via flow cytometry; global
      impact of therapy on immune cell subsets via immunophenotype analysis; and angiogenesis via
      CD34 staining.

      After completion of study therapy, patients are followed periodically for up to 2 years.
    

Intervention name(s): dexamethasone; lenalidomide
Intervention type(s): Drug; Drug
Intervention description(s): Dose: -40 mg once weekly (days 1, 8, 15, & 22) orally with food until progression.
If after 3 cycles, a partial response is not achieved on lenalidomide alone, dexamethasone 10 mg weekly will be added, and the weekly dexamethasone dose will be increased by 10 mg each cycle to a maximum of 40 mg weekly, as long as a partial response is not achieved. If a partial response is achieved at a dose of dexamethasone less than 40 mg weekly, patients will continue on that dose. If progression at any time, increase dexamethasone to 40 mg weekly. Patient will go off study only when progression is documented while receiving 40 mg/week of dexamethasone or the maximum tolerated dose of dexamethasone (if prior dose reductions have been implemented for toxicity). Increases in dexamethasone dose are to be made only at the initiation of a cycle.
If progression at any time while on lenalidomide alone (first 3 cycles), add dexamethasone 40 mg weekly.; 25mg once daily orally with food on days 1-21 of 28 day cycle until progression or to a maximum of 18 cycles.
Lenalidomide alone will be administered for the first 3 cycles, then in combination with dexamethasone as needed (described).
Intervention MeSH terms: Dexamethasone; Lenalidomide
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: stage I multiple myeloma; stage II multiple myeloma; stage III multiple myeloma