Study to Evaluate Safety Tolerability & Efficacy of Kyprolis (Carfilzomib) in Relapsed or Refractory Multiple Myeloma

Post-marketing Phase 4 Study to Evaluate Safety, Tolerability, and Efficacy of Kyprolis® (Carfilzomib) in Indian Patients With Relapsed or Refractory Multiple Myeloma: A Prospective, Open-label, Non-comparative, Multicenter Study

To characterize safety associated with the use of Kyprolis under the locally approved label.

Study Overview

• Status: Active, not recruiting
• Conditions: Relapsed Refractory Multiple Myeloma
• Intervention / Treatment: Drug: Drug: Carfilzomib + Dexamethasone; Drug: Drug: Carfilzomib + Lenalidomide + Dexamethasone

Detailed Description

Kyprolis® (K; carfilzomib) was approved in India on 17 January 2017 as a prescription medication in combination with dexamethasone (Kd) or with lenalidomide (Revlimid®) plus dexamethasone (KRd) for the treatment of patients with relapsed or refractory multiple myeloma (RRMM) following 1 to 3 prior lines of therapy.

This non-comparative, interventional phase 4 study is designed to fulfil the post-marketing requirement to assess safety, tolerability, and efficacy of Kyprolis on Indian subjects with RRMM as per the locally approved label.

• Study Type: Interventional
• Enrollment (Actual): 101
• Phase: Phase 4

Contacts and Locations

Study Locations

• India
  • Andhra Pradesh
    • Hyderabad, Andhra Pradesh, India, 500033
      • Apollo Hospital
    • Hyderabad, Andhra Pradesh, India, 500 082
      • Yashoda Hospital
  • Karnataka
    • Bangalore, Karnataka, India, 560054
      • M S Ramaiah Memorial Hospital
    • Belagavi, Karnataka, India, 590010
      • K L E S Dr Prabhakar Kore Hospital and Medical Research Centre
    • Bengaluru, Karnataka, India, 560064
      • Cytecare Cancer Hospitals
  • Kerala
    • Kochi, Kerala, India, 682027
      • Aster Medcity
    • Kozhikode, Kerala, India, 673008
      • Government Medical College
  • Maharashtra
    • Mumbai, Maharashtra, India, 400 012
      • Tata Memorial Hospital
    • Mumbai, Maharashtra, India, 400 056
      • Mumbai Oncocare Center
    • Nashik, Maharashtra, India, 422 002
      • Navsanjeevani Hospital
    • Nashik, Maharashtra, India, 422 004
      • Heath Care Group Manavata Cancer Centre
    • Pune, Maharashtra, India, 411004
      • Deenanath Mangeshkar Hospital and Research Centre
  • Pondicherry
    • Puducherry, Pondicherry, India, 605 006
      • Jawaharlal Institute of Postgraduate Medical Education and Research
  • Tamil Nadu
    • Chennai, Tamil Nadu, India, 600020
      • Cancer Institute WIA
    • Namakkal, Tamil Nadu, India, 637001
      • Thangam Cancer Centre
  • Uttar Pradesh
    • Meerut, Uttar Pradesh, India, 250001
      • Valentis Cancer Hospital
  • West Bengal
    • Kolkata, West Bengal, India, 700 094
      • Netaji Subhash Chandra Bose Cancer Research Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Documented RRMM after last treatment. Refractory is defined as meeting 1 or more of the following: Nonresponsive to most recent therapy (stable disease [SD] or progressive disease [PD]) while on treatment, or Disease progression within 60 days of discontinuation from the most recent therapy.
• Eligible to receive Kyprolis per the locally approved label.
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2.
• Adequate hepatic function within 28 days prior to enrollment: bilirubin < 1.5 times the upper limit of normal (ULN); aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 2.5 times the ULN.
• Absolute neutrophil count (ANC) ≥ 1.0 x 10^9 /L within 28 days prior to enrollment. (Screening ANC should be independent of granulocyte- and granulocyte macrophage-colony stimulating factor support for at least 1 week and of pegylated granulocyte stimulating factor for ≥ 2 weeks).
• Hemoglobin ≥ 80 g/L within 28 days prior to enrollment. Subjects should not have received red blood cell (RBC) transfusions for at least 7 days prior to obtaining the screening hemoglobin.
• Platelet count ≥ 75 x 10^9/L (≥ 50 x 10^9/L if myeloma involvement in the bone marrow is ≥ 50%) within 28 days prior to enrollment. Subjects should not have received platelet transfusions for at least 7 days prior to obtaining the screening platelet count.
• Adequate renal function within 28 days prior to enrollment (either measured or calculated using a standard formula such as the Cockcroft and Gault): calculated or measured creatinine clearance (CrCl) of ≥ 50 mL/min for subjects receiving KRd; calculated or measured CrCl of ≥ 15 mL/min for subjects receiving Kd.
• Left ventricular ejection fraction ≥ 40% as assessed by transthoracic echocardiogram (TTE) or multigated acquisition scan (MUGA).
• Females of childbearing potential (FCBP) must have a negative serum pregnancy test within the 10 to 14 days prior to enrollment and a negative urine pregnancy test within the 24 hours prior to day 1 of each cycle prior to dosing.
• Subject or legally acceptable representative has provided informed consent/assent prior to initiation of any study specific activities/procedures.

Exclusion Criteria:

• Waldenström macroglobulinemia.
• Plasma cell leukemia (> 2.0 x 10^9/L circulating plasma cells by standard differentials).
• POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes)
• Myelodysplastic síndrome.
• Primary amyloidosis (subjects with multiple myeloma with asymptomatic deposition of amyloid plaques found on biopsy would be eligible if all other criteria are met).
• History of other malignancy within the past 5 years, with the following exception[s]: Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease. Adequately treated cervical carcinoma in situ without evidence of disease. Adequately treated breast ductal carcinoma in situ without evidence of disease. Prostatic intraepithelial neoplasia without evidence of prostate cáncer. Adequately treated urothelial papillary noninvasive carcinoma or carcinoma in situ.
• Known immediate or delayed hypersensitivity reaction to Captisol (a cyclodextrin derivative used to solubilize Kyprolis).
• Contraindication to any of the required concomitant drugs or supportive treatments, including hypersensitivity to antiviral drugs.
• Intolerance to hydration.
• Active congestive heart failure (New York Heart Association [NYHA] Class III to IV), symptomatic ischemia, uncontrolled arrhythmias, clinically significant echocardiogram (ECHO) abnormalities, screening ECG with corrected QT interval (QTc) of > 470 msec, pericardial disease, or myocardial infarction within 4 months prior to enrollment.
• Infiltrative pulmonary disease and/or known pulmonary hypertension.
• Active infection within 14 days prior to enrollment requiring systemic antibiotics, antiviral (except antiviral therapy directed at hepatitis B) or antifungal agents. Such infections must be fully resolved prior to initiating study treatment.
• Pleural effusions requiring thoracentesis within 14 days prior to enrollment.
• Ascites requiring paracentesis within 14 days prior to enrollment.
• Uncontrolled hypertension, defined as an average systolic blood pressure > 159 mmHg or diastolic > 99 mm/Hg despite optimal treatment (measured following European Society of Hypertension/European Society of Cardiology [ESH/ESC] 2013 guidelines.
• Active hepatitis B virus (HBV) infection. Subjects with positive hepatitis B surface antigen (HBsAg) or core antibody (anti-HBc) that achieve sustained virologic response with antiviral therapy directed at hepatitis B are allowed. Subjects with known history or resolved infection (negative for HBsAg but positive for antibodies to surface antigen, and/or core antigen) must be screened with HBV DNA levels. EXCEPTION: Subjects with serologic findings suggestive of HBV vaccination (hepatitis B surface antibody [anti-HBs] positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA.
• Known human immunodeficiency virus (HIV) infection, hepatitis C infection (subjects with hepatitis C that achieve a sustained virologic response following antiviral therapy are allowed).
• Ongoing graft-versus-host disease.
• Subjects with grade 3 or worse neuropathy within 14 days prior to enrollment.
• Antitumor therapy (eg, chemotherapy, immunotherapy, antibody therapy) or investigational agent within 28 days before enrollment or not recovered from any acute toxicity.
• Subjects on immunosuppressive therapy for graft versus host disease, even if it has resolved.
• Glucocorticoid therapy within 14 days before first dose that exceeds a cumulative dose of 160 mg or dexamethasone or equivalent dose of other corticosteroids.
• Focal radiation therapy within 7 days before enrollment. Radiation therapy to an extended field involving significant volume of bone marrow within 28 days prior to enrollment (ie, prior radiation must have been to less than 30% of the bone marrow).
• Autologous stem cell transplant less than 100 days prior to enrollment.
• Prior treatment with Kyprolis (carfilzomib).
• Currently receiving treatment in another investigational device or drug study, or less than 30 days since ending treatment on another investigational device or drug study. Other investigational procedures while participating in this study are excluded.
• Female subject is pregnant or breastfeeding or planning to become pregnant or breastfeed during treatment, during any breaks (interruptions) in the treatment, and for an additional 30 days after the last dose of Kyprolis. Females of childbearing potential should only be included in the study after a confirmed menstrual period and a negative highly sensitive urine or serum pregnancy test.
• Female subjects of childbearing potential unwilling to use 1 highly effective method of contraception during treatment, during any breaks (interruptions) in the treatment, and for an additional 30 days after the last dose of Kyprolis.

NOTE: Female subjects of childbearing potential being treated with lenalidomide must agree to use 2 methods of contraception for at least 28 days before starting treatment, during treatment, during any breaks (interruptions) in the treatment, and for an additional 30 days after the last dose of treatment.

• Male subjects with a female partner of childbearing potential who are unwilling to practice sexual abstinence (refrain from heterosexual intercourse) or use contraception during treatment and for an additional 90 days after the last dose of Kyprolis.

NOTE: Male subjects being treated with lenalidomide must agree to use a male condom with spermicide even if they have undergone a successful vasectomy.

• Male subjects with a pregnant partner who are unwilling to practice abstinence or use a condom during treatment and for an additional 90 days after the last dose of Kyprolis.
• Male subjects unwilling to abstain from donating sperm during treatment and for an additional 90 days after the last dose of Kyprolis.
• Subject likely to not be available to complete all protocol required study visits or procedures, and/or to comply with all required study procedures to the best of the subject and investigator's knowledge.
• History or evidence of any other clinically significant disorder, condition or disease (with the exception of those outlined above) that, in the opinion of the investigator or Amgen physician, if consulted, would pose a risk to subject safety or interfere with the study evaluation, procedures or completion.
• Active hepatitis B virus (HBV) infection. Subjects with positive hepatitis B surface antigen (HBsAg) or core antibody (anti-HBc) that achieve sustained virologic response with antiviral therapy directed at hepatitis B are allowed. Subjects with known history or resolved infection (negative for HBsAg but positive for antibodies to surface antigen, and/or core antigen) must be screened with HBV DNA levels. EXCEPTION: Subjects with serologic findings suggestive of HBV vaccination (hepatitis B surface antibody [anti-HBs] positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Carfilzomib + Dexamethasone; Drug: Carfilzomib + Dexamethasone; Carfilzomib 20 mg/m2 on days 1 and 2, and if tolerated, escalated to a target dose of 56 mg/m2 starting on day 8 of cycle 1 and thereafter.; Dexamethasone 20 mg taken by mouth or intravenously on days 1, 2, 8, 9, 15, 16, 22, and 23 of each 28-day cycle. An individual subject will receive study treatment for a maximum of 3 years if the subject has not yet experienced disease progression	Drug: Drug: Carfilzomib + Dexamethasone; Drug: Carfilzomib + Dexamethasone; Carfilzomib will be administered as a 30-minute infusion.; Dexamethasone will be taken by mouth or intravenously.; Other Names: Kyprolis
Experimental: Carfilzomib+Lenalidomide+Dexamethasone; Drug: Carfilzomib + Lenalidomide + Dexamethasone; Carfilzomib is 20 mg/m2 on days 1 and 2, and if tolerated, escalated to a target dose of 27 mg/m2 starting on day 8 of cycle 1 and thereafter. From cycle 13, the day 8 and day 9 doses of Carfilzomib will be omitted.; Lenalidomide 25 mg is taken orally on days 1 to 21.; Dexamethasone 40 mg on days 1, 8, 15, and 22 of the 28-day cycles. An individual subject will receive study treatment for a maximum of 18 months consistent with the approved use in this combination.	Drug: Drug: Carfilzomib + Lenalidomide + Dexamethasone; Drug: Carfilzomib + Lenalidomide + Dexamethasone; Carfilzomib will be administered as a 10 minute infusion.; Lenalidomide will be taken orally.; Dexamethasone will be taken by mouth or intravenously.; Other Names: Kyprolis

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants Who Experienced Treatment-emergent Adverse Events (TEAEs)	A TEAE is any untoward medical occurrence in a clinical study participant after first dose irrespective of a causal relationship with the study treatment(s). TEAEs were graded using National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v.4.03. Any clinically significant laboratory changes over time were recorded as TEAEs.	From the first dose date of any study drug until the end of study or cutoff date, whichever occurred earlier (median [min, max] time on treatment was 43.14 [4.4, 73.4] weeks for the KRd group and 28.79 [0.3, 107.3] weeks for the Kd group)
Number of Participants Who Experienced Serious TEAEs	A serious TEAE is any untoward medical occurrence in a clinical study participant after first dose irrespective of a causal relationship with the study treatment(s) that resulted in death, was immediately life threatening, required in-patient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, a congenital anomaly/birth defect, or another medically important serious event.	From the first dose date of any study drug until the end of study or cutoff date, whichever occurred earlier (median [min, max] time on treatment was 43.14 [4.4, 73.4] weeks for the KRd group and 28.79 [0.3, 107.3] weeks for the Kd group)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression Free Survival	Progression Free Survival is defined as the time from first dose of study treatment until the earliest date of disease progression or death due to any cause	From enrollment up to the post treatment follow-up visit, which is 19 months for Carfilzomib + Lenolidamide + Dexamethasone arm or until disease progression or a maximum of 3 years for the Carfilzomib + Dexamethasone arm.
Overall Response Rate	Overall Response Rate is defined as the proportion of subjects with either a best overall response of the stringent complete response (sCR), complete response (CR), very good partial response (VGPR), or partial response (PR) CBR is defined as the proportion of subjects with either a best overall response of sCR, CR, VGPR, PR, and minimal response (MR)	From enrollment up to the post treatment follow-up visit, which is 19 months for Carfilzomib + Lenolidamide + Dexamethasone arm or until disease progression or a maximum of 3 years for the Carfilzomib + Dexamethasone arm.
Clinical Benefit Rate	Clinical Benefit Rate is defined as the proportion of subjects with either a best overall response of sCR, CR, VGPR, PR, and minimal response (MR)	From enrollment up to the post treatment follow-up visit, which is 19 months for Carfilzomib + Lenolidamide + Dexamethasone arm or until disease progression or a maximum of 3 years for the Carfilzomib + Dexamethasone arm.
Time to Response	Time To Response is calculated only for subjects who achieve a best overall response of PR or better and is defined as the time from first dose of study treatment to the earliest date a response of PR or better is first achieved and subsequently confirmed	From enrollment up to the post treatment follow-up visit, which is 19 months for Carfilzomib + Lenolidamide + Dexamethasone arm or until disease progression or a maximum of 3 years for the Carfilzomib + Dexamethasone arm.
Duration of Response	Duration of Response is defined as the time from initial response (sCR, CR, VGPR, or PR) to date of disease progression	From enrollment up to the post treatment follow-up visit, which is 19 months for Carfilzomib + Lenolidamide + Dexamethasone arm or until disease progression or a maximum of 3 years for the Carfilzomib + Dexamethasone arm.

Collaborators and Investigators

• Sponsor: Amgen
• Investigators: Study Director: MD, Amgen

Publications and helpful links

Helpful Links

• AmgenTrials clinical trials website

Study record dates

Study Major Dates

• Study Start (Actual): September 16, 2019
• Primary Completion (Actual): March 23, 2023
• Study Completion (Estimated): June 24, 2025

Study Registration Dates

• First Submitted: April 16, 2019
• First Submitted That Met QC Criteria: April 29, 2019
• First Posted (Actual): May 2, 2019

Study Record Updates

• Last Update Posted (Estimated): January 1, 2024
• Last Update Submitted That Met QC Criteria: December 14, 2023
• Last Verified: November 1, 2023

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; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Autonomic Agents; Peripheral Nervous System Agents; Enzyme Inhibitors; Anti-Inflammatory Agents; Antineoplastic Agents; Immunologic Factors; Antiemetics; Gastrointestinal Agents; Glucocorticoids; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Antineoplastic Agents, Hormonal; Protease Inhibitors; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; Dexamethasone; Dexamethasone acetate; BB 1101; Lenalidomide
• Other Study ID Numbers: 20160372

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual patient data for variables necessary to address the specific research question in an approved data sharing request
• IPD Sharing Time Frame: Data sharing requests relating to this study will be considered beginning 18 months after the study has ended and either 1) the product and indication (or other new use) have been granted marketing authorization in both the US and Europe or 2) clinical development for the product and/or indication discontinues and the data will not be submitted to regulatory authorities. There is no end date for eligibility to submit a data sharing request for this study.
• IPD Sharing Access Criteria: Qualified researchers may submit a request containing the research objectives, the Amgen product(s) and Amgen study/studies in scope, endpoints/outcomes of interest, statistical analysis plan, data requirements, publication plan, and qualifications of the researcher(s). In general, Amgen does not grant external requests for individual patient data for the purpose of re-evaluating safety and efficacy issues already addressed in the product labelling. Requests are reviewed by a committee of internal advisors, and if not approved, may be further arbitrated by a Data Sharing Independent Review Panel. Upon approval, information necessary to address the research question will be provided under the terms of a data sharing agreement. This may include anonymized individual patient data and/or available supporting documents, containing fragments of analysis code where provided in analysis specifications. Further details are available at the link below.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes