A Multicenter, Single-Arm, Open-Label Expanded Access Program for Lenalidomide Plus Dexamethasone in Previously Treated Subjects With Multiple Myeloma
Condition: Relapsed or Refractory Multiple Myeloma
MeSH terms: Multiple Myeloma; Neoplasms, Plasma Cell
Intervention: Lenalidomide; dexamethasone
Intervention description: Oral lenalidomide at a dose of 25 mg daily for 21 days every 28 days. Treatment as tolerated until disease progression.; Oral pulse dexamethasone at a dose of 40 mg daily on days 1-4, 9-12, and 17-20 for each 28-day-cycle for cycles 1 through 4 (approximately months 1-4). Beginning cycle 5 (approximately month 5) dexamethasone is reduced to 40 mg daily for days 1-4 every 28 days.
Intervention MeSH terms: Dexamethasone; Lenalidomide
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 150.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: CC-5013; Revlimid; Lenalidomide; Celgene; Multiple Myeloma

Summary:

      This was a multicenter, open-label, single-arm phase 3B study of the combination lenalidomide
      plus pulse high-dose dexamethasone.

      This study (CC-5013-MM-019) was set up and executed primarily as an expanded access program
      in Germany.

      Screening procedures were to take place within 28 days prior to Cycle 1 Day 1 (baseline) with
      the exception of hematology assessments that were to be performed within 14 days prior to
      Cycle 1 Day 1. Randomization, blinding, and stratification were not applied in this
      open-label single-arm study.

      Eligible subjects given open-label treatment and received treatment with lenalidomide plus
      high-dose dexamethasone in 28-day cycles.

      Lenalidomide (hard capsules) was to be administered orally (PO) at a dose of 25 mg daily (QD)
      for the first 21 days of each 28-day cycle. According to the protocol, accrual of subjects to
      the study was to be terminated within 2 months of commercial availability of lenalidomide for
      this indication in Germany.

      Upon discontinuation from study, minimal information was collected in order to identify when
      disease progressed.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Must understand and voluntarily sign an informed consent form.

          -  Must be ≥18 years of age at the time of signing the informed consent form.

          -  Must be able to adhere to the study visit schedule and other protocol requirements.

          -  Must be diagnosed with multiple myeloma that is progressing after at least 2 cycles of
             anti-myeloma treatment or that has relapsed with progressive disease after treatment.

          -  Subjects may have been previously treated with thalidomide and/or radiation therapy.
             In addition, radiation therapy initiated prior to or at baseline (Day 1) may be given
             concurrently with study therapy, provided that all other eligibility criteria are
             satisfied.

          -  Subjects must discontinue all anti-myeloma drug or non-drug therapy prior to the first
             dose of study drug with the exception of radiation therapy initiated prior to or at
             baseline (Day 1).

          -  Measurable levels of myeloma paraprotein in serum (>0.5 g/dL) or urine (>0.2 g
             excreted in a 24-hour collection sample).

          -  Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1, or 2.

          -  Females of childbearing potential (FCBP) must agree to use two reliable forms of
             contraception simultaneously or to practice complete abstinence from heterosexual
             intercourse during the following time periods related to this study: 1) for at least
             28 days before starting study drug; 2) while participating in the study; and 3) for at
             least 28 days after discontinuation from the study.

        Exclusion Criteria:

          -  The presence of any of the following will exclude a subject from study enrollment:

          -  Any serious medical condition, laboratory abnormality, or psychiatric illness that
             would prevent the subject from signing the informed consent form.

          -  Pregnant or lactating females.

          -  Any condition, including the presence of laboratory abnormalities, which places the
             subject at unacceptable risk if he/she were to participate in the study or confounds
             the ability to interpret data from the study.

          -  Any of the following laboratory abnormalities:

               -  Absolute neutrophil count (ANC) <1,000 cells/mm^3 (1.0 x 10^9/L)

               -  Platelet count <75,000/mm^3 (75 x 109/L) for subjects in whom <50% of the bone
                  marrow nucleated cells are plasma cells.

               -  Platelet count <30,000/mm^3 (30x10^9/L) for subjects in whom ≥50% of bone marrow
                  nucleated cells are plasma cells.

               -  Serum creatinine >2.5 mg/dL (221 µmol/L)

               -  Serum SGOT/AST or SGPT/ALT >3.0 x upper limit of normal (ULN)

               -  Serum total bilirubin >2.0 mg/dL (34 µmol/L)

          -  Prior history of malignancies other than multiple myeloma (except for basal cell or
             squamous cell carcinoma of the skin or carcinoma in situ of the cervix or breast)
             unless the subject has been free of the disease for ≥1 year.

          -  Prior history of stroke and/or thromboembolic event

          -  Known hypersensitivity to thalidomide or dexamethasone.

          -  Prior history of uncontrollable side effects to dexamethasone therapy.

          -  The development of a desquamating rash while taking thalidomide.

          -  Neuropathy ≥ Grade 2.