Carfilzomib, Lenalidomide, and Dexamethasone Before and After Stem Cell Transplant in Treating Patients With Newly Diagnosed Multiple Myeloma
Condition: Stage I Multiple Myeloma; Stage II Multiple Myeloma; Stage III Multiple Myeloma
MeSH terms: Multiple Myeloma; Neoplasms, Plasma Cell
Intervention: dexamethasone; carfilzomib; lenalidomide; autologous hematopoietic stem cell transplantation; laboratory biomarker analysis
Intervention description: Given IV or PO; Given IV; Given PO; Undergo autologous hematopoietic stem cell transplant; Correlative studies
Intervention MeSH terms: Dexamethasone; Lenalidomide
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:

      This phase II trial studies how well carfilzomib, lenalidomide, and dexamethasone before and
      after stem cell transplant works in treating patients with newly diagnosed multiple myeloma.
      Carfilzomib may stop the growth of cancer cells by blocking some of the enzymes needed for
      cell growth. Biological therapies, such as lenalidomide, may stimulate the immune system in
      different ways and stop cancer cells from growing. Drugs used in chemotherapy, such as
      dexamethasone, work in different ways to stop the growth of cancer cells, either by killing
      the cells or by stopping them from diving. Giving carfilzomib, lenalidomide, and
      dexamethasone before and after stem cell transplant may kill more cancer cells
    

Eligibility criteria:

        Inclusion Criteria:

          -  Newly diagnosed, myeloma requiring systemic chemotherapy as per International Myeloma
             Working Group (IMWG) uniform criteria:

               -  Prior treatment of hypercalcemia or spinal cord compression or active and/or
                  aggressively progressing myeloma with corticosteroids or lenalidomide or
                  bortezomib-based regimens does not disqualify the patient (the treatment dose
                  should not exceed the equivalent of 160 mg of dexamethasone in a 4 week period or
                  not more than 1 cycle)

               -  Bisphosphonates are permitted

          -  Suitable and interested to proceed to ASCT

          -  Measurable disease, prior to initial treatment as indicated by one or more of the
             following:

               -  Serum monoclonal (M)-protein >= 0.5 g/dL

               -  Urine M-protein >= 200 mg/24 hours

               -  If serum protein electrophoresis is felt to be unreliable for routine M-protein
                  measurement, then quantitative immunoglobulin levels are acceptable

          -  Life expectancy of more than 3 months

          -  Eastern Cooperative Oncology Group (ECOG) performance status 0-2

          -  Bilirubin < 1.5 times the upper limit of normal (ULN)

          -  Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 2.5 times ULN

          -  Absolute neutrophil count (ANC) >= 1.0 x 10^9/L

          -  Hemoglobin >= 8 g/dL

          -  Platelet count >= 75 x 10^9/L; subjects may receive red blood cell (RBC) transfusions
             or platelet transfusions, if clinically indicated in accordance with institutional
             guidelines; however, screening platelet count should be independent of platelet
             transfusions for at least 2 weeks

          -  Calculated or measured creatinine clearance of >= 50 mL/minute, calculated using the
             formula of Cockcroft and Gault

          -  Written informed consent in accordance with federal, local, and institutional
             guidelines

          -  Females of childbearing potential (FCBP) (defined as sexually mature females who: have
             not undergone a hysterectomy or bilateral oophorectomy; or have not been naturally
             postmenopausal for at least 24 consecutive months [ie, has had menses at any time in
             the preceding 24 consecutive months]) must agree to ongoing pregnancy testing

          -  FCBP must have 2 negative pregnancy tests (sensitivity of at least 50 mIU/mL) prior to
             initiating lenalidomide; the first pregnancy test must be performed within 10-14 days
             before day 1 cycle 1 and the second pregnancy test must be performed within 24 hours
             of day 1 cycle 1; the subject may not receive lenalidomide until the treating
             investigator has verified that the results of these pregnancy tests are negative, and
             must agree to ongoing pregnancy tests as outlined in the protocol

          -  FCBP must agree to use 2 reliable forms of contraception simultaneously or to practice
             complete abstinence from heterosexual intercourse during the following time periods
             related to this study:

               -  For at least 28 days before starting lenalidomide

               -  While participating in the study; and

               -  For at least 28 days after discontinuation from the study; the 2 methods of
                  reliable contraception must include a highly effective method (ie, intrauterine
                  device (IUD), hormonal [birth control pills, injections, or implants], tubal
                  ligation, partner's vasectomy) and an additional effective (barrier) method (ie,
                  latex condom, diaphragm, cervical cap); FCBP must be referred to a qualified
                  provider of contraceptive methods if needed

          -  Male subjects must agree to use a latex condom during sexual contact with females of
             childbearing potential while participating in the study and for at least 28 days
             following discontinuation from the study even if he has undergone a successful
             vasectomy

          -  Male subjects must agree to inform his physician if he has had unprotected sexual
             contact with a female who can become pregnant or if he thinks for any reason that his
             sexual partner may be pregnant

          -  Male subjects must agree not to donate semen or sperm while taking lenalidomide

          -  All study participants must be registered into the mandatory Rev Assist program and be
             willing and able to comply with the requirements of Rev Assist

          -  The ability to take aspirin or other appropriate venous thromboembolism (VTE)
             prophylaxis

          -  Subjects must agree to adhere to all study requirements, including birth control
             measures and pregnancy testing, visit schedule, outpatient treatment, required
             concomitant medications, and laboratory monitoring

        Exclusion Criteria:

          -  Non-secretory or hyposecretory multiple myeloma, prior to initial treatment defined as
             < 0.5 g/dL M-protein in serum, < 200 mg/24 hr urine M-protein, or disease only
             measured by serum free light chain

          -  POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and
             skin changes)

          -  Waldenstrom's macroglobulinemia or immunoglobin (Ig)M myeloma

          -  Radiotherapy to multiple sites or immunotherapy within 4 weeks before start of
             protocol treatment (localized radiotherapy to a single site at least 1 week before
             start is permissible)

          -  Participation in an investigational therapeutic study within 3 weeks or within 5 drug
             half-lives (t1/2) prior to first dose, whichever time is greater

          -  Pregnant or lactating females

          -  History of allergy to mannitol

          -  Major surgery within 3 weeks prior to first dose

          -  Myocardial infarction within 6 months prior to enrollment, New York Heart Association
             (NYHA) class III or IV heart failure, uncontrolled angina, severe uncontrolled
             ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active
             conduction system abnormalities

          -  Uncontrolled hypertension or diabetes

          -  Acute active infection requiring systemic antibiotics, antivirals, or antifungals
             within two weeks prior to first dose

          -  Known or suspected human immunodeficiency virus (HIV) infection, known HIV
             seropositivity

          -  Active hepatitis A, B, or C infection

          -  Non-hematologic malignancy within the past 3 years except adequately treated basal
             cell, squamous cell skin cancer, thyroid cancer, carcinoma in situ of the cervix, or
             prostate cancer < Gleason grade 6 with stable prostate specific antigen levels or
             cancer considered cured by surgical resection alone

          -  Any 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

          -  Significant neuropathy (grades 3-4, or grade 2 with pain) at the time of the first
             dose and/or within 14 days before enrollment

          -  Contraindication to any of the required concomitant drugs, including proton-pump
             inhibitor (eg, lansoprazole), enteric-coated aspirin, allopurinol or if a history of
             prior thrombotic disease, warfarin or low molecular weight heparin

          -  Subjects in whom the required program of PO and IV fluid hydration is contraindicated,
             eg, due to pre-existing pulmonary, cardiac, or renal impairment

          -  Subjects with known or suspected amyloidosis of any organ

          -  Subjects with pleural effusions requiring thoracentesis or ascites requiring
             paracentesis

          -  No coverage or not-acceptable by patient co-pay for lenalidomide