Efficacy of Panobinostat in Patients With Relapsed and Bortezomib-refractory Multiple Myeloma (MACS1271)

A Phase II, Multi-center, Single Arm, Open Label Study of Panobinostat in Combination With Bortezomib and Dexamethasone in Patients With Relapsed and Bortezomib-refractory Multiple Myeloma

This study is designed to assess the effectiveness of the combination of Panobinostat plus Bortezomib and Dexamethasone in patients with relapsed and bortezomib refractory Multiple Myeloma.

Study Overview

• Status: Completed
• Conditions: Refractory Multiple Myeloma; Multiple Myeloma in Relapse; Relapsed and Bortezomib Refractory Multiple Myeloma
• Intervention / Treatment: Drug: dexamethasone; Drug: bortezomib; Drug: panobinostat

Detailed Description

This is a phase II, two stage, single arm, open label, multi-center study of oral PAN in combination with BTZ/Dex in patients with relapsed and refractory multiple myeloma, who are bortezomib-refractory and have received at least 2 prior lines of therapy. Patients must have been exposed to an iMID (lenalidomide or thalidomide) and progressed on or within 60 days of their last BTZ-containing line of therapy.

• Study Type: Interventional
• Enrollment (Actual): 55
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90095
      • University of California at Los Angeles
    • Stanford, California, United States, 94305-5826
      • Stanford University Medical Center Division of Hematology
  • Florida
    • Tampa, Florida, United States, 33612
      • H. Lee Moffitt Cancer Center & Research Institute
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • Emory University School of Medicine/Winship Cancer Institute Dept. of Winship Cancer Inst.
    • Augusta, Georgia, United States, 30912
      • Georgia Regents University MedCollege of GA Cancer Ctr 2
  • Illinois
    • Skokie, Illinois, United States, 60076
      • Hematology/Oncology of the North Shore Orchard Healthcare Res. Inc.
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Dana Farber Cancer Institute
  • New Jersey
    • Somerset, New Jersey, United States, 08873
      • Somerset Hematology Oncology Associates Somerset Hema Oncol Assoc (2)
  • New York
    • Bronx, New York, United States, 10467
      • Montefiore Medical Center
  • North Carolina
    • Durham, North Carolina, United States, 27710
      • Duke University Medical Center Dept. of DUMC (4)
  • Tennessee
    • Nashville, Tennessee, United States, 37212
      • Vanderbilt University Medical Center, Clinical Trials Center Vanderbilt UMC
  • Texas
    • Houston, Texas, United States, 77030
      • MD Anderson Cancer Center/University of Texas MD Anderson CC
  • Wisconsin
    • Milwaukee, Wisconsin, United States, 53226
      • Medical College of Wisconsin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Patient has a previous diagnosis of multiple myeloma, based on IMWG 2003 definitions. All three of the following criteria must have been met:

   • Monoclonal immunoglobulin (M component) on electrophoresis, and on immunofixation on serum or on total 24 hour urine
   • Bone marrow (clonal) plasma cells ≥ 10% or biopsy proven plasmacytoma
   • Related organ or tissue impairment (CRAB symptoms: anemia, hypercalcemia, lytic bone lesions, renal insufficiency, hyperviscosity, amyloidosis or recurrent infections)
2. Patient must have relapsed and refractory MM and must require treatment for the relapsed disease
3. Patients must have received at least 2 prior lines of therapy which include an IMiD (thalidomide or lenalidomide)

4. Patient must be refractory to the last bortezomib containing line of therapy given in the relapsed and refractory setting defined as:

   • having progressed on or within 60 days of the last bortezomib-containing line of therapy

5. Patient has measurable disease on M protein at study screening defined by at least one of the following measurements as per thresholds clarified in IMWG 2003 disease definitions (Kyle, et al 2003):

   • Serum M-protein ≥ 1 g/dL (≥ 10 g/L)
   • Urine M-protein ≥ 200 mg/24 h
6. Patients treated with local radiotherapy with or without concomitant exposure to steroids for pain control or management of cord/nerve root compression, are eligible. Two weeks must have lapsed since last date of radiotherapy, which is recommended to be a limited field. Patients who require concurrent radiotherapy should have entry to the protocol deferred until the radiotherapy is completed and 2 weeks have passed since the last date of therapy
7. Patient's age is ≥ 18 years at time of signing the informed consent
8. Patient has an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of ≤ 2

9. Patient has the following laboratory values within 3 weeks before starting study drug (lab tests may be repeated, as clinically indicated, to obtain acceptable values before screen fail is concluded but supportive therapies are not to be administered within the week prior to screening tests for absolute neutrophil count or platelet counts)

   • Absolute neutrophil count (ANC) ≥ 1.0 x 109 /L
   • Platelet count ≥ 70 x 109 /L
   • Serum potassium, magnesium, phosphorus, within normal limits (WNL) for institution
   • Total calcium (corrected for serum albumin) or ionized calcium ≥ LLN, and not higher than CTCAE grade 1 in case of elevated value

   Note: Potassium, calcium, magnesium, and/or phosphorus supplements may be given to correct values that are < LLN:

   • AST/SGOT and ALT/SGPT ≤ 2.5 x ULN
   • Serum total bilirubin ≤ 1.5 ULN (or ≤ 3.0 x ULN if patient has Gilbert syndrome)
   • Serum creatinine levels ≤ 2.5 x ULN, or calculated creatinine clearance ≥ 40 ml/min
10. Patient has provided written informed consent prior to any screening procedures
11. Patient is able to swallow capsules
12. Patient must be able to adhere to the study visit schedule and other protocol requirements
13. Women of childbearing potential (WOCBP) must have a negative serum pregnancy test at within 7 days prior to start of study treatment

Exclusion Criteria:

1. Primary refractory disease (patients that never reached at least an MR for over 60 days under any prior therapy)
2. Patients who have a history of prior MM treatment with a DAC inhibitor including panobinostat
3. Patients who have had prior allogeneic stem cell transplantation and show evidence of active graft-versus-host disease that requires immunosuppressive therapy
4. Peripheral neuropathy ≥ CTCAE grade 2
5. Patients who will need valproic acid for any medical condition during the study or within 5 days prior to the first administration of study drug / treatment or who cannot be switch to safely to alternative anti-epileptic medication

6. Patients who have impaired cardiac function including any of the following:

   • Congenital long QT syndrome, complete left bundle branch block or use of a permanent cardiac pacemaker, history or presence of ventricular tachyarrhythmias, clinically significant resting bradycardia (< 50 beats per minute). Right bundle branch block + left anterior hemiblock (bifascicular block)
   • QTcF > 450 msec on screening ECG
   • Presence of unstable atrial fibrillation. Patients with stable atrial fibrillation are allowed in the study provided they do not meet other cardiac or prohibited drug exclusion criteria
   • Previous history of angina pectoris or acute MI within 6 months
   • Congestive heart failure (New York Heart Association functional classification III-IV)
   • Patient has any other clinically significant cardiovascular disease (e.g. uncontrolled hypertension)
7. Patient has an impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of panobinostat (e.g., ulcerative disease, uncontrolled nausea, vomiting, malabsorption syndrome, obstruction, or significant small bowel resection)
8. Patient has unresolved diarrhea ≥ CTCAE grade 2
9. Patients who have any other concurrent severe and/or uncontrolled medical condition(s) including, but not limited to: uncontrolled diabetes mellitus, active or uncontrolled infection, chronic obstructive or chronic restrictive pulmonary disease (e.g. dyspnea at rest from any cause), symptomatic thyroid dysfunction, significant bleeding tendency, that could cause unacceptable safety risks or compromise compliance with the protocol
10. Patients who are using medications that have a known relative risk of prolonging the QT interval or of inducing Torsade de Pointes, where such treatment cannot be discontinued or switched to a different medication prior to starting study drug
11. Women who are pregnant or breast feeding
12. Patients with evidence of another malignancy not in remission or history of such a malignancy within the last 5 years (except for treated basal or squamous cell carcinoma, or in situ cancer of the cervix)
13. Patients who have received prior to starting study treatment either radiation therapy to > 30% of marrow-bearing bone within 4 weeks; myelotoxic chemotherapy within 4 weeks; or immunotherapy within 8 weeks; or who have not yet recovered from side effects of such therapies
14. Patients with any significant history of non-compliance to medical regimens or unwilling or unable to comply with the instructions given to him/her by the study staff
15. Use of chemo-, biologic or immunologic therapy and/or other investigational agents while the patient is on study treatment.
16. Patient taking any anti-cancer therapy concomitantly (bisphosphonates are permitted only if commenced prior to the start of screening period)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: panobinostat + bortezomib & dexamethasone; panobinostat in combination with bortezomib and dexamethasone in patients with relapsed and bortezomib-refractory multiple myeloma	Drug: dexamethasone; Other Names: DEX; Drug: bortezomib; Other Names: BTZ; Drug: panobinostat; PAN 20 mg PO given TIW, weeks 1&2 of each 3-week cycle;• BTZ 1.3 mg/m2 IV push given BIW weeks 1&2 of each 3 week cycle (days 1,4,8 and 11);• Dex 20 mg PO given QIW, weeks 1&2 of each 3-week cycle (days 1,2,4,5,8,9,11 and 12); Other Names: LBH589; PAN

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Response Rate (PR+nCR+CR)	Overall response rate=(PR+nCR+CR) CR= < 5% plasma cells in bone marrow. No confirmation on bone marrow plasma cell (additional assessment) is needed to document CR except patients with non-secretory myeloma where the bone marrow examination must be repeated after an interval of at least 6 weeks, Absence of M-protein in serum and urine by immunofixation,nCR same as CR without out Absence of M-protein in serum and urine by immunofixation,PR+ 50% reduction of serum M-protein and sofft tissue Plasmacytomas all for more than 6 weeks.	after eight cycyles of treatment (24 weeks)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Responders to Treatment	The primary endpoint for this phase II study of patients with bortezomib-refractory MM is response after a maximum of 8 cycles of therapy as defined by the modified EBMT criteria.	after eight cycyles of treatment (24 weeks)
Time to Response (Greater Than or Equal to PR) Based on Investigator Assessment	Time to response is defined as the time from the date of first administration of study treatment to the date of first documented evidence of CR or nCR or PR (whichever status is recorded first). Patients who do not have a response of PR or better by the data cut-off date are censored.	after eight cycyles of treatment (24 weeks)
Progression-free Survival	Progression-free survival (PFS) was defined as the time from the date of first study treatment to first occurrence of documented progressive disease /relapse or death. Time from randomization until disease progression or death by Kaplan-Meier estimates	24 weeks
Time to Progression	Time from randomization until objective tumor progression; does not include deaths-- Kaplan-Meier estimates	24 weeks
Over All Survival	Kaplan Meier estimates- median time to event	24 weeks

Collaborators and Investigators

• Sponsor: Novartis Pharmaceuticals
• Investigators: Principal Investigator: Steven Young, M.D., Somerset Hematology Oncology

Publications and helpful links

General Publications

• Richardson PG, Schlossman RL, Alsina M, Weber DM, Coutre SE, Gasparetto C, Mukhopadhyay S, Ondovik MS, Khan M, Paley CS, Lonial S. PANORAMA 2: panobinostat in combination with bortezomib and dexamethasone in patients with relapsed and bortezomib-refractory myeloma. Blood. 2013 Oct 3;122(14):2331-7. doi: 10.1182/blood-2013-01-481325. Epub 2013 Aug 15.

Study record dates

Study Major Dates

• Study Start: June 1, 2010
• Primary Completion (Actual): February 1, 2014
• Study Completion (Actual): February 1, 2014

Study Registration Dates

• First Submitted: March 8, 2010
• First Submitted That Met QC Criteria: March 8, 2010
• First Posted (Estimate): March 10, 2010

Study Record Updates

• Last Update Posted (Actual): December 21, 2017
• Last Update Submitted That Met QC Criteria: November 27, 2017
• Last Verified: November 1, 2017

More Information

Terms related to this study

• Keywords: Multiple Myeloma; Refractory Multiple Myeloma; Relapsed Multiple Myeloma
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Immunoproliferative Disorders; Hematologic Diseases; Hemorrhagic Disorders; Hemostatic Disorders; Paraproteinemias; Blood Protein Disorders; Multiple Myeloma; Neoplasms, Plasma Cell; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Autonomic Agents; Peripheral Nervous System Agents; Enzyme Inhibitors; Anti-Inflammatory Agents; Antineoplastic Agents; Antiemetics; Gastrointestinal Agents; Glucocorticoids; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Antineoplastic Agents, Hormonal; Histone Deacetylase Inhibitors; Dexamethasone; Bortezomib; Panobinostat
• Other Study ID Numbers: CLBH589DUS71