Effects of Daratumumab Monotherapy on Bone Parameters in Patients With Relapsed and /or Refractory Multiple Myeloma (REBUILD)

A Prospective, Multicenter, Non-comparative, Open-label, Phase II Study to Evaluate the Effects of Daratumumab Monotherapy on Bone Parameters in Patients With Relapsed and /or Refractory Multiple Myeloma Who Have Received at Least 2 Prior Lines of Therapy, Including Lenalidomide and a Proteasome Inhibitor

The purpose of this study is to evaluate the effects of daratumumab monotherapy on bone disease in patients with relapsed/refractory MM who have received at least 2 prior lines of therapy, including lenalidomide and a PI.

Study Overview

• Status: Unknown
• Conditions: Multiple Myeloma
• Intervention / Treatment: Drug: Daratumumab

Detailed Description

This is a prospective, multicenter, non-comparative, open-label Phase II study. Daratumumab will be administered according to approved label. Approximately 57 subjects located in Greece will be enrolled in the study.

Patients shall receive treatment until disease progression, physician decision, unacceptable toxicity, withdrawal of consent, or death (whichever occurs first). Survival status and data of subsequent anti-myeloma treatment will be collected post-treatment.

Primary and secondary variables related to bone disease markers will be evaluated every other cycle of therapy. Disease evaluations will occur monthly and consist mainly of measurements of myeloma proteins. Other parameters may include bone marrow examinations, skeletal surveys, assessment of extramedullary plasmacytomas, and measurements of serum calcium corrected for albumin, and β2- microglobulin and albumin. Assessment of myeloma response and disease progression will be conducted in accordance with the modified IMWG response criteria

• Study Type: Interventional
• Enrollment (Anticipated): 57
• Phase: Phase 2

Contacts and Locations

Study Locations

• Greece
  • Attica
    • Athens, Attica, Greece, 11528
      • Recruiting
      • General Hospital of Athens "Alexandra"
      • Contact: Evangelos Terpos, Assoc Prof; Phone Number: +30210 3381512

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. Males and females at least 18 years of age.
2. Voluntary written informed consent.

3. Subject must have documented relapsed or refractory multiple myeloma as defined by the criteria below:

   a. Measurable disease as defined by any of the following:

   • Serum monoclonal paraprotein (M-protein) level ≥ 1.0 g/dL (except for IgA subtype: ≥ 0.5 g/dL) or urine M-protein level ≥ 200 mg/24 hours; or
   • Light chain multiple myeloma for subjects without measurable disease in the serum or urine by SPEP/UPEP: Serum immunoglobulin free light chain ≥ 10 mg/dL and abnormal serum immunoglobulin kappa lambda free-light-chain ratio.
4. Prior treatment with at least two lines of therapy including lenalidomide and a PI for MM (induction followed by any planned high dose therapy or consolidation or maintenance would be considered as one regimen).
5. Documented evidence of progressive disease as defined by the IMWG 2014 on or after the last regimen.
6. Karnofsky Performance Status score of ≥ 70.

7. All of the following laboratory test results during screening:

   • Absolute neutrophil count (ANC) of ≥1.0 x 109/L.
   • Platelet count of ≥ 75 x 109/L in patients in whom <50% of bone marrow nucleated cells are plasma cells and ≥50 x 109/L in patients in whom more than 50% of bone marrow nucleated cells are plasma cells.
   • Hemoglobin value (> 7.5 g/dL).
   • Alanine aminotransferase level ≤2.5 times the upper limit of normal (ULN).
8. Adequate renal function (CrCl ≥ 30 mL/min by CKD-EPI).
9. Willingness and ability to participate in study procedures.

10. Reproductive Status:

    1. Women of childbearing potential (WOCBP) must have two negative serum or urine pregnancy tests, one 10-14 days prior to start of the study drug and one within 24 hours prior to the start of study drug.
    2. Women must not be breastfeeding.
    3. WOCBP must agree to follow instructions for effective methods of contraception for 4 weeks before the start of treatment with study drugs, for the duration of treatment with study drugs, and for 3 months after cessation of study treatment.

Male patients must use a latex or synthetic condom during any sexual contact with females of reproductive potential, even if they have undergone a successful vasectomy. They must also agree to follow instructions for methods of contraception for 4 weeks before the start of treatment with study drugs, for the duration of treatment with study drugs, and for a total of 3 months post-treatment completion.

Exclusion Criteria:

1. Patient has received any of the following therapies:

   • Radiotherapy or systemic therapy within 2 weeks of baseline.
   • Prior Allogeneic hematopoietic stem cell transplantation within 12 weeks of baseline.
   • Prior Treatment with any CD38-antibody (i.e. isatuximab).

2. Clinically significant cardiac disease, including:

   1. Myocardial infarction within 6 months, or unstable or uncontrolled condition (e.g., unstable angina, congestive heart failure, New York Heart Association Class III-IV).
   2. Cardiac arrhythmia (CTCAE Grade 3 or higher) or clinically significant ECG abnormalities.
   3. ECG showing a baseline QT interval as corrected >470 msec.
3. Chronic obstructive pulmonary disease (COPD) with a Forced Expiratory Volume in 1 second (FEV1) <50% of predicted normal. Note that FEV1 testing is required for subjects suspected of having COPD and subjects must be excluded if FEV1 <50% of predicted normal.
4. Known active hepatitis A, B, or C.
5. Known HIV infection.
6. Significant neuropathy (Grades 3-4, or Grade 2 with pain) within 14 days prior to enrolment.
7. Hypersensitivity to the active substance or to any of the excipients.
8. Any concurrent medical or psychiatric condition or disease (e.g., active systemic infection, uncontrolled diabetes, acute diffuse infiltrative pulmonary disease) that is likely to interfere with subject's ability to give informed consent, the study procedures or results, or that in the opinion of the investigator, would constitute a hazard for participating in this study.
9. Pregnant or breastfeeding women.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

EXPERIMENTAL: Daratumumab; Daratumumab at a dose of 16 mg/kg administered as an IV infusion at weekly intervals (QW) for 8 weeks, then every 2 weeks (Q2W) for an additional 16 weeks, then every 4 weeks (Q4W) thereafter.

Drug: Daratumumab; Daratumumab will be given at a dose of 16 mg/kg administered as an IV infusion at weekly intervals (QW) for 8 weeks, then every 2 weeks (Q2W) for an additional 16 weeks, then every 4 weeks (Q4W) thereafter. Subjects will receive pre-infusion medications prior to Daratumumab infusion to mitigate potential IRRs and post- infusion medications after Daratumumab infusion for the prevention of delayed IRRs

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
changes in bone resorption marker, C-telopeptide of collagen type 1 (CTX), after 4 months of daratumumab monotherapy	The evaluation of the changes in bone resorption marker after 4 months of daratumumab monotherapy. CTX (measured in pg/ml) will be evaluated at baseline and then every 2 months of therapy.	assessed on baseline and after 4 months from initiation of daratumumab monotherapy
changes in bone resorption marker, namely, tartrate-resistant acid phosphatase-5b (TRACP-5b) after 4 months of daratumumab monotherapy	The evaluation of the changes in bone resorption marker after 4 months of daratumumab monotherapy. TRACP-5b (measured in mU/dL) will be evaluated at baseline and then every 2 months of therapy	assessed on baseline and after 4 months from initiation of daratumumab monotherapy

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in bone formation marker, bALP.	Change from baseline in bone formation marker bALP (measured in U/L) after 4, 8 and 12 months of daratumumab monotherapy (or at the end of therapy)	from baseline up to 12 months of daratumumab monotherapy or at end of treatment
Changes in bone formation marker, OC.	Change from baseline in bone formation marker OC (measured in ng/ml) after 4, 8 and 12 months of daratumumab monotherapy (or at the end of therapy)	from baseline up to 12 months of daratumumab monotherapy or at end of treatment
Changes in bone formation marker, PINP.	Change from baseline in bone formation marker PINP (measured in ng/ml) after 4, 8 and 12 months of daratumumab monotherapy (or at the end of therapy)	from baseline up to 12 months of daratumumab monotherapy or at end of treatment
Changes in bone resorption marker, CTX.	Change from baseline in bone resorption marker CTX (measured in pg/ml) after 8 and 12 months of daratumumab monotherapy	from baseline up to12 months of daratumumab monotherapy or at end of treatment
Changes in bone resorption marker, TRACP-5b.	Change from baseline in bone resorption marker TRACP-5b (measured in mU/dL) after 8 and 12 months of daratumumab monotherapy	from baseline up to12 months of daratumumab monotherapy or at end of treatment
Changes in bone marker RANKL	Change from baseline in RANKL (measured in pg/ml) after 4, 8 and 12 months of daratumumab monotherapy	from baseline up to 12 months of daratumumab monotherapy or at end of treatment
Changes in bone marker ratio,RANKL/OPG ratio.	Change from baseline in RANKL/OPG ratio after 4, 8 and 12 months of daratumumab monotherapy	from baseline up to 12 months of daratumumab monotherapy or at end of treatment
Changes in bone marker CCL3	Change from baseline in CCL3 (measured in pg/ml) after 4, 8 and 12 months of daratumumab monotherapy	from baseline up to 12 months of daratumumab monotherapy or at end of treatment
Changes in bone marker Dkk1	Change from baseline in Dkk1 (measured in ng/ml) after 4, 8 and 12 months of daratumumab monotherapy	from baseline up to 12 months of daratumumab monotherapy or at end of treatment
Changes in bone marker SOST	Change from baseline in SOST (measured in pmol/L) after 4, 8 and 12 months of daratumumab monotherapy	from baseline up to 12 months of daratumumab monotherapy or at end of treatment
Changes in bone marker activin-A	Change from baseline in activin-A (measured in μg/L) after 4, 8 and 12 months of daratumumab monotherapy	from baseline up to 12 months of daratumumab monotherapy or at end of treatment
Change in Bone Mineral Density (BMD) of lumbar spine	Change in Bone Mineral Density (BMD) of lumbar spine measured by DXA after 6 and 12 months of daratumumab monotherapy	measured at baseline and after 6 and 12 months after initiation of daratumumab monotherapy
Immunomodulatory effects of daratumumab on T cells by comprehensive molecular and phenotypic studies and correlations with bone markers	Immunomodulatory effects of daratumumab on T cells by comprehensive molecular and phenotypic studies and correlations with bone markers	: measured at baseline and after 3 and 6 months after initiation of daratumumab monotherapy
Progression free survival (PFS)	Progression free survival is defined as the time, in months, from recruitment to the date of the first documented PD or death due to any cause, whichever comes first. PD will be assessed by the investigator based on the analysis of serum and urine protein electrophoresis (sPEP and uPEP), serum free light chain protein (sFLC), Corrected serum calcium assessment, imaging and bone marrow assessments as per modified IMWG guidelines.	from recruitment to the date of the first documented PD or death due to any cause, whichever comes first (approximately up to 2 years).
Overall survival	Overall survival is defined as the time, in months	Time from first dose of study treatment to death (approximately up to 2 years)
Time to next treatment	Time to next therapy will be defined as the time, in months.	From first dose until the date to next anti-neoplastic therapy or death from any cause, whichever comes first (approximately up to 2 years)
Spinal cord compression (Skeletal surveys-Skeletal related events)	Spinal cord compression will be evaluated in terms of number (and percentage) of patients with events and number of events per patient	From baseline to 24 months (up to 2 years)
The incidence of pathological fractures (Skeletal surveys-Skeletal related events)	The incidence of pathological fractures will be evaluated in terms of number (and percentage) of patients with events and number of events per patient	From baseline to 24 months (up to 2 years)
Need for radiotherapy or surgery to the bones (Skeletal surveys-Skeletal related events)	Need for radiotherapy or surgery to the bones will be evaluated in terms of number (and percentage) of patients with events and number of events per patient	From baseline to 24 months (up to 2 years)
Safety (adverse events)	The incidence of Adverse Events will be assessed according to the common Terminology Criteria for Adverse Events.	Continuously throughout the study, starting from informed consent until 30 days after last study treatment (approximately up to 30 months)

Collaborators and Investigators

• Sponsor: Hellenic Society of Hematology
• Collaborators: Janssen Pharmaceuticals
• Investigators: Principal Investigator: Evangelos Terpos, Assoc Prof, Department of Clinical therapeutics, National and Kapodistrian University of Athens, School of medicine, Athens, Greece

Study record dates

Study Major Dates

• Study Start (ACTUAL): February 21, 2018
• Primary Completion (ANTICIPATED): June 20, 2019
• Study Completion (ANTICIPATED): February 20, 2020

Study Registration Dates

• First Submitted: February 22, 2018
• First Submitted That Met QC Criteria: March 22, 2018
• First Posted (ACTUAL): March 23, 2018

Study Record Updates

• Last Update Posted (ACTUAL): March 23, 2018
• Last Update Submitted That Met QC Criteria: March 22, 2018
• Last Verified: March 1, 2018

More Information

Terms related to this study

• 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; Antineoplastic Agents; Daratumumab
• Other Study ID Numbers: EAE-2017/MM01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No