High-Dose Weekly Carfilzomib Plus Cyclophosphamide and Dexamethasone in the Treatment of Relapsed Multiple Myeloma
Condition: Multiple Myeloma
MeSH terms: Multiple Myeloma; Neoplasms, Plasma Cell
Intervention: Carfilzomib; Cyclophosphamide; Dexamethasone
Intervention MeSH terms: Dexamethasone; Cyclophosphamide
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 76.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      The purpose of this study is to find out what effects carfilzomib has on relapsed multiple
      myeloma when administered in combination with cyclophosphamide and dexamethasone.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Relapsed symptomatic multiple myeloma as per the International Myeloma Working group
             criteria [Palumbo 2009].

          -  Measurable disease, as defined by one or more of the following (assessed within 21
             days prior to registration):

               -  Serum M-protein ≥ 5 g/L (0.5g/dL)

               -  Urine Bence-Jones protein ≥ 200 mg/24 hours

               -  Involved serum free light chain (FLC) measurement ≥ 100 mg/L (10 mg/dL), provided
                  serum FLC ratio is abnormal (abnormal if FLC ratio is <0.26 or >1.65)

               -  Biopsy proven plasmacytoma

               -  For IgA patients whose disease can only be reliably measured by serum
                  quantitative immunoglobulin (qIgA) ≥ 750 mg/dL (0.75 g/dL)

          -  Prior treatment with at least one, but no more than three, regimens for multiple
             myeloma

          -  Documented relapse or progressive disease on or after any regimen (subjects refractory
             to the most recent line of therapy are eligible except those who are refractory to
             bortezomib and cyclophosphamide as described in exclusion criteria 1.

          -  Achieved a response to at least one prior regimen (defined as ≥ 25% decrease in
             M-protein)

          -  Age ≥ 18 years.

          -  Life expectancy ≥ 3 months.

          -  ECOG performance status 0-2.

          -  Laboratory Requirements (must be done within 21 days of registration):

          -  Hematology:

               -  Absolute neutrophil count (ANC) ≥ 1.0 × 10^9/L

               -  Hemoglobin ≥ 8 g/dL (80 g/L) (subjects may be receiving red blood cell (RBC)
                  transfusions in accordance with institutional guidelines)

               -  Platelet count ≥ 50 × 10^9/L, independent of platelet transfusions for 7 days. (≥
                  30 × 10^9/L if myeloma involvement in the bone marrow is ≥ 50%)

          -  Biochemistry:

               -  ALT ≤ 3.5 x UNL

               -  Serum direct bilirubin ≤ 2 mg/dL (34 μmol/L) (only required if total bilirubin ≥
                  2mg/dL (34μmol/L)

               -  Creatinine clearance (CrCl) ≥ 30 mL/minute (Crockcroft and Gault formula) and not
                  on dialysis.

          -  Patient consent must be appropriately obtained in accordance with applicable local and
             regulatory requirements. Each patient must sign a consent form prior to enrollment in
             the trial to document their willingness to participate.

          -  Patients must be accessible for treatment and follow up. Patients registered on this
             trial must be treated and followed at the participating centre.

          -  In accordance with CRO policy, protocol treatment is to begin within 2 working days of
             patient registration.

          -  Women/men of childbearing potential must have agreed to use a highly effective
             contraceptive method.

        Exclusion Criteria:

          -  Refractory to any proteasome inhibitor therapy (bortezomib, ixazomib, etc.) Refractory
             disease is defined as failure to respond to the proteasome inhibitor, initial response
             followed by progression while on a proteasome inhibitor, or relapse within 60 days of
             stopping proteasome inhibitor therapy.

          -  Prior carfilzomib treatment.

          -  POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and
             skin changes)

          -  Waldenström's macroglobulinemia or IgM myeloma

          -  Current or previous Plasma cell leukemia defined as (> 2.0 × 10^9/L circulating plasma
             cells by standard differential)

          -  Chemotherapy or investigational agent within 3 weeks prior to registration or antibody
             therapy within 6 weeks prior to registration

          -  Radiotherapy to multiple sites within 28 days prior to registration; localized
             radiotherapy to a single site within 7 days prior to registration

          -  Plasmapheresisis within 14 days of registration.

          -  Pregnant or lactating females.

          -  Major surgery within 21 days prior to registration.

          -  Active, uncontrolled bacterial, fungal, or viral infection.

          -  Concurrent amyloidosis

          -  Known human immunodeficiency virus infection.

          -  Active hepatitis B or C infection.

          -  Myocardial infarction within 4 months prior to registration, NYHA Class III or IV
             heart failure, uncontrolled angina, history of severe coronary artery disease, severe
             uncontrolled ventricular arrhythmias, sick sinus syndrome, or electrocardiographic
             evidence of acute ischemia or grade 3 conduction system abnormalities unless subject
             has a pacemaker.

          -  Uncontrolled hypertension or uncontrolled diabetes within 14 days prior to
             registration.

          -  Other malignancy, including MDS, within the past 3 years with the exception of
             adequately treated basal cell carcinoma, squamous cell skin cancer, or thyroid cancer;
             carcinoma in situ of the cervix or breast; prostate cancer of Gleason Score 6 or less
             with stable prostate-specific antigen levels; or cancer considered cured by surgical
             resection or unlikely to impact survival during the duration of the study, such as
             localized transitional cell carcinoma of the bladder or benign tumours of the adrenal
             or pancreas.

          -  Significant neuropathy (≥ grade 3, or grade 2 with pain) within 14 days prior to
             registration.

          -  Known history of allergy to Captisol® (a cyclodextrin derivative used to solubilize
             carfilzomib).

          -  Contraindication to any of the required concomitant drugs or supportive treatments,
             including hypersensitivity antiviral drugs, or intolerance to hydration due to
             preexisting pulmonary or cardiac impairment.

          -  Ongoing graft-versus-host disease.

          -  Subjects with pleural effusions requiring thoracentesis or ascites requiring
             paracentesis within 14 days prior to registration.

          -  Any other clinically significant medical disease or condition that, in the
             Investigator's opinion, may interfere with protocol adherence or a subject's ability
             to give informed consent.