Clinical trial NCT06758375: Low Dose Teclistamab in Newly Diagnosed Multiple Myeloma Patients
Official title: Low-dose Teclistamab As Consolidation in the First-line Treatment of Patients with Newly Diagnosed Multiple Myeloma.
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
Conditions: Multiple Myeloma, Newly Diagnosed
Keywords: Multiple myeloma
Teclistamab
Newly diagnosed multiple myeloma
Low-dose teclistamab
Lead sponsor: Hospital Universitario Dr. Jose E. Gonzalez
Sponsor class: OTHER
First posted: 2025-01-03
Enrollment: 10
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: One arm, open-label, phase 2 study
Primary purpose: TREATMENT

Brief summary: This single-arm, open-label study aims to determine the efficacy and safety of low-dose, limited-duration teclistamab as a consolidation scheme in newly diagnosed multiple myeloma (NDMM) patients.

Detailed description: This single-arm, open-label study aims to determine the efficacy and safety of low-dose (1.0 mg/kg), limited-duration teclistamab as a consolidation scheme in newly diagnosed multiple myeloma (NDMM) patients after 3 (three) VRd cycles as induction therapy.

Patients with MMND who meet the established inclusion criteria will be invited to participate. A single-arm phase 2 study will be conducted in the Hematology Department of the University Hospital, where an induction schedule of 3 cycles of bortezomib, lenalidomide, and dexamethasone (VRd) will be administered followed by consolidation with 4 therapeutic doses of teclistamab at 1.0 mg/kg subcutaneously. Four weeks after the last dose of teclistamab, the clinical response will be assessed according to standard International Myeloma Working Group (IMWG) criteria. Those with a complete response (CR) or better will be assessed for measurable residual disease (MRD) with multiparametric flow cytometry with a sensitivity of 10\^6. Patients with CR and negative MRD will be kept under active surveillance for 18 months, while those with positive MRD or high cytogenetic risk will be offered biweekly bortezomib as maintenance. On the other hand, patients with very good partial response (VGPR) or worse will be offered 1-2 additional therapeutic doses of teclistamab and reevaluated 4 weeks after the last dose. Finally, patients who do not achieve CR will exit the study and will continue their management according to the standard of care recommended by their treating physician.

Eligibility criteria: Inclusion Criteria:

* ≥18 years of age.
* Newly diagnosed multiple myeloma.
* Eastern Cooperative Oncology Group (ECOG) Performance Status Score of 0 or 1.
* Women of childbearing potential must have a negative serum pregnancy test prior to starting treatment and agree to use a highly effective method of contraception, such as a hormonal method that inhibits ovulation, an intrauterine device, or a vasectomy partner.
* Males: agree to use a highly effective contraceptive method, such as a male condom or vasectomy.

Exclusion Criteria:

* History of previous treatment for MM.
* Active central nervous system (CNS) involvement or clinical signs of meningeal involvement of multiple myeloma.
* Plasma cell leukemia, Waldenström's macroglobulinemia, POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes) or AL amyloidosis.
* Severe active infection secondary to viruses, bacteria or fungi.
* Pulmonary disease requiring supplemental oxygen.
* History of allogeneic or autologous hematopoietic cell transplantation.
* Vaccination with live attenuated virus in the 4 weeks prior to teclistamab administration.
* Major surgery during the 2 weeks prior to the first dose or absence of complete recovery from surgery.
* Presence of other concomitant malignancy.
* Hepatitis B and C virus infection or human immunodeficiency virus (HIV) infection.
* Cerebrovascular events or seizures in the last 6 months.
* Congestive heart failure class III-IV according to NYHA (New York Heart Association Stage).
* Acute myocardial infarction or history of coronary revascularization surgery in the last 6 months.
* Women of childbearing age: active pregnancy prior to the first administration of treatment.

Primary outcomes:
measure: To determine general response
timeFrame: 18 months after last teclistamab dose
Secondary outcomes:
measure: To determine response duration
timeFrame: Up to 18 months after last teclistamab dose
measure: Adverse events
timeFrame: Through the study completion and up to 18 months after last teclistamab dose
Other outcomes:
Locations:
city: Monterrey
country: Mexico
facility: Hospital Universitario Dr. Jose E. Gonzalez
state: Nuevo León
Study officials:
References:
citation: Girgis S, Lin SXW, Pillarisetti K, Banerjee A, Stephenson T, Ma X, Shetty S, Yang TY, Hilder BW, Jiao Q, Hanna B, Adams HC 3rd, Sun YN, Sharma A, Smit J, Infante JR, Goldberg JD, Elsayed Y. Translational Modeling Predicts Efficacious Therapeutic Dosing Range of Teclistamab for Multiple Myeloma. Target Oncol. 2022 Jul;17(4):433-439. doi: 10.1007/s11523-022-00893-y. Epub 2022 Jun 24.
citation: Usmani SZ, Garfall AL, van de Donk NWCJ, Nahi H, San-Miguel JF, Oriol A, Rosinol L, Chari A, Bhutani M, Karlin L, Benboubker L, Pei L, Verona R, Girgis S, Stephenson T, Elsayed Y, Infante J, Goldberg JD, Banerjee A, Mateos MV, Krishnan A. Teclistamab, a B-cell maturation antigen x CD3 bispecific antibody, in patients with relapsed or refractory multiple myeloma (MajesTEC-1): a multicentre, open-label, single-arm, phase 1 study. Lancet. 2021 Aug 21;398(10301):665-674. doi: 10.1016/S0140-6736(21)01338-6. Epub 2021 Aug 10.