Optimising Renal Outcome in Myeloma Renal Failure (OPTIMAL)

January 26, 2022 updated by: Karthik Ramasamy, Oxford University Hospitals NHS Trust

A Study of Thalidomide, Bendamustine and Dexamethasone (BTD) Versus Bortezomib, Bendamustine and Dexamethasone (BBD) in Patients With Renal Failure Defined as a GFR Below 30 Mls/Min

The purpose of this study is to compare the effectiveness of bortezomib versus thalidomide in reducing free light chains in the blood of myeloma patients. In addition participants will receive bendamustine (chemotherapy) and dexamethasone (steroids), which increase the effectiveness of both bortezomib and thalidomide. The trial will also study whether an earlier reduction of free light chains increases the chances of the kidneys recovering.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Renal impairment is a life threatening condition of myeloma. 20-25% of patients will present at diagnosis with renal dysfunction. Outcome is poor due to high early mortality, with 28% of newly diagnosed myeloma patients in myeloma trials with renal failure not surviving beyond 100 days, compared with 10% overall.

This study aims to establish:

  1. Whether proteosomal inhibition (bortezomib) or immunomodulatory (thalidomide) based therapy achieves threshold reduction of serum free light chains (sFLCs) in a significant majority of patients.
  2. Whether sFLC response to the first 2 cycles (early responder) predicts haematological and renal response to the next 2 cycles of therapy.
  3. An early time point for assessment of sFLC reduction as a biomarker for response.

Participants will be stratified by age and chronic kidney disease (CKD) stage to receive either bortezomib, bendamustine and dexamethasone (BBD) or thalidomide, bendamustine and dexamethasone (BTD).

Study Type

Interventional

Enrollment (Actual)

31

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United Kingdom
      • Basingstoke, United Kingdom
        • Basingstoke & North Hampshire Hospital
      • Birmingham, United Kingdom
        • Heartlands Hospitals
      • Canterbury, United Kingdom, CT1 3NG
        • Kent & Canterbury Hospital
      • Epsom, United Kingdom
        • St Helier Hospital
      • Liverpool, United Kingdom
        • Royal Liverpool Hospital
      • London, United Kingdom
        • Kings College Hospital
      • Oxford, United Kingdom, OX3 7LE
        • Churchill Hospital
      • Portsmouth, United Kingdom
        • Queen Alexandra Hospital
      • Swindon, United Kingdom
        • Great Western Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

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:

  • Participant is willing and able to give informed consent for participation in the trial.
  • Patients attending NHS (National Health Service) Haemato-oncology centres.
  • Patients with newly diagnosed symptomatic myeloma.
  • Glomerular Filtration Rate (GFR) <30 mls/min.
  • Chronic kidney disease (CKD) staging is based on estimated or measured GFR. CKD stage 4 (15-29 ml/min) and CKD stage 5 (<15 ml/min) are eligible to enter the study. It is expected centres will consider use of fluid resuscitation and pulsed dose of steroid therapy in this group of patients to salvage renal function prior to trial screening.
  • A number of patients with newly diagnosed myeloma and renal failure will have a pre-existing medical condition (hypertension, diabetes etc.) causing renal damage. Where there is a medical condition (e.g. hypertension, diabetes) which may cause renal damage, there must have been a further decline (≥15 mls/min GFR) between previous steady state and the study screening.
  • Female participants of childbearing potential and male patients whose partner is a woman of childbearing potential must be prepared to use contraception in accordance with (and consent to) the Celgene-approved process for thalidomide and lenalidomide Risk Management and Pregnancy Prevention Programme.
  • Women of childbearing potential must have a negative pregnancy test performed by a healthcare professional in accordance with the Celgene-approved process for thalidomide and lenalidomide Risk Management and Pregnancy Prevention.
  • Free of prior malignancies for ≥ 2 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, localised prostate cancer or carcinoma "in-situ" of the cervix or breast.
  • In the Investigator's opinion, is able and willing to comply with all trial requirements.
  • Willing to allow his or her General Practitioner and consultant, if appropriate, to be notified of participation in the trial.

Exclusion Criteria:

  • Female participant who is pregnant, lactating or planning pregnancy during the course of the trial or the female partner of a male participant planning a pregnancy during the course of the trial.
  • Known allergy to investigational drugs.
  • Any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the trial, or may influence the result of the trial, or the participant's ability to participate in the trial.
  • Any of the following laboratory abnormalities:
  • Absolute neutrophil count (ANC) < 1.0 x10^9/L
  • Platelet count <75 x 10^9/L
  • Serum SGOT/AST or SGPT/ALT (serum glutamic oxaloacetic transaminase/aspartate aminotransferase or serum glutamic pyruvic transaminase/alanine aminotransferase) >3 x upper limit of normal.
  • Use of any standard/experimental anti-myeloma drug therapy excluding dexamethasone 14 days prior to trial entry.
  • CKD stages < 4.
  • Intention to use a physical method of serum free light chain removal such as plasma exchange or high cut off dialysis.
  • Grade 2 neuropathy or more (National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v 4.0) will preclude use of thalidomide and bortezomib.
  • Participants who have participated in another research trial involving an investigational product in the past 12 weeks.
  • Contraindicated to receive either one of the study drugs, thalidomide, bortezomib, bendamustine based on the respective summary of product characteristics.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
ACTIVE_COMPARATOR: Arm A (BBD)
Bortezomib, Bendamustine and Dexamethasone
Drug: Bortezomib

1.3 mg/m2 subcutaneously* days 1, 4, 8 and 11 of each cycle. Number of cycles: Four 21 day cycles (participants not suitable for ASCT (autologous stem cell transplant) will continue up to 6 cycles on the treatment regimen to which they were randomised).

*intravenous infusion available in case of patient intolerance to subcutaneous bortezomib

Other Names:
  • Velcade
Drug: Bendamustine
60 mg/m2 i.v. days 1 and 8 of each cycle. Four 21 day cycles (participants not suitable for ASCT will continue up to 6 cycles on the treatment regimen to which they were randomised)
Drug: Dexamethasone
40mg orally days 1-2, 4-5, 8-9 and 11-12 of each cycle
ACTIVE_COMPARATOR: Arm B (BTD)
Thalidomide, Bendamustine and Dexamethasone
Drug: Bendamustine
60 mg/m2 i.v. days 1 and 8 of each cycle. Four 21 day cycles (participants not suitable for ASCT will continue up to 6 cycles on the treatment regimen to which they were randomised)
Drug: Dexamethasone
40mg orally days 1-2, 4-5, 8-9 and 11-12 of each cycle
Drug: Thalidomide
100 mg daily orally, preferably at night, days 1-21 of each cycle. Four 21 day cycles (participants not suitable for ASCT will continue up to 6 cycles on the treatment regimen to which they were randomised)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Number of Participants With >50% Reduction From Baseline in Serum Free Light Chain
Time Frame: End of week 6 (after receiving two cycles of therapy)
End of week 6 (after receiving two cycles of therapy)
Number of Participants With Different Renal Responses to Treatment
Time Frame: End of week 12 (after receiving 4 cycles of therapy)
End of week 12 (after receiving 4 cycles of therapy)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Haematological and Non-haematological Toxicity in Both Treatment Arms
Time Frame: End of weeks 3, 6, 9, 12 (after receiving 4 cycles of therapy), 30 days after final treatment and 12 months after randomisation
End of weeks 3, 6, 9, 12 (after receiving 4 cycles of therapy), 30 days after final treatment and 12 months after randomisation
Overall Survival
Time Frame: 1 month post end of treatment and 1 year post randomisation
1 month post end of treatment and 1 year post randomisation
Renal Response After Two Cycles of Trial Treatment
Time Frame: End of 2nd treatment cycle, week 6
End of 2nd treatment cycle, week 6
Quality of Life Measured by the EQ-5D-3L Questionnaire at Baseline and 1 Month Follow up
Time Frame: Baseline and 1 month follow up

The EQ-5D-3L descriptive system comprises the following five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension is scored on a scale of 1 to 3: 1 (no problems), 2 (some problems), and 3 (extreme problems). Higher score equates to a worse outcome.

As stated in the official EQ-5D user guide, patient responses to the 5 questions were converted into a single index value as per Dolan P (1997). Modeling valuations for EuroQol health states. Med Care 35(11):1095-108. These index values, with country specific value sets, facilitate the calculation of quality-adjusted life years (QALYs) that are used to inform economic evaluations of health care interventions. In the UK, the values range from -0.594 to +1.
Baseline and 1 month follow up

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Oxford University Hospitals NHS Trust

Collaborators

University of Warwick
University of Birmingham
Janssen-Cilag Ltd.
Bloodwise

Investigators

  • Principal Investigator: Karthik Ramasamy, National Health Service, United Kingdom

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2014

Primary Completion (ACTUAL)

April 20, 2020

Study Completion (ACTUAL)

April 20, 2020

Study Registration Dates

First Submitted

March 10, 2015

First Submitted That Met QC Criteria

April 22, 2015

First Posted (ESTIMATE)

April 23, 2015

Study Record Updates

Last Update Posted (ACTUAL)

January 27, 2022

Last Update Submitted That Met QC Criteria

January 26, 2022

Last Verified

January 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 26866138-MMY2070
  • 2012-003947-31 (EUDRACT_NUMBER)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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