Trial Studying Maintenance Treatment With Lenalidomide and Dexamethasone Versus Lenalidomide, Dexamethasone and MLN9708 After Autologous Hematopoietic Stem Cell Transplantation in Patients With Newly-diagnosed Symptomatic Multiple Myeloma

NCT ID: NCT02406144

Last Updated: 2017-11-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

316 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-11-30

Study Completion Date

2017-11-30

Brief Summary

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This protocol is a randomized, open-label, national, multicenter trial studying maintenance treatment with lenalidomide and dexamethasone versus lenalidomide, dexamethasone and MLN9708 after autologous hematopoietic stem cell transplantation in patients with newly-diagnosed symptomatic multiple myeloma.

A total of 316 patients, from the study GEM2012MENOS65, will be enrolled in the study.

The pre-treatment period includes the screening visit in which participants provide informed consent in writing in order to take part in the study. The patient is then assessed to determine his/her eligibility. The selection process will begin 21 days before the first dose of medication is administered (days -21 to 0). All procedures during the pre-treatment period will be carried out after completion of the two cycles of post-transplant consolidation with VRD which coincide with the end-of-study visit of clinical trial GEM2012MENOS65.

During the treatment period, eligible patients will be included in the study and receive maintenance treatment with lenalidomide/dexamethasone versus lenalidomide/dexamethasone/MLN9708. Each cycle will last 28 days. Treatment arm A will consist of oral administration of 15 mg/day of oral lenalidomide on days 1-21, and 20 mg/day of dexamethasone administered orally on days 1-4 and 9-12 for a period of two years. Arm B of the maintenance treatment will be the same as arm A, with the addition of MLN9708 during the two year maintenance period, at a dose of 4 mg/day on days 1, 8 and 15 of the cycle.

At two years, patients with negative MRD will finish maintenance treatment. Patients with positive MRD will continue treatment with lenalidomide/dexamethasone until they have completed five years of maintenance treatment. In this case, 20 mg/day of dexamethasone will only be administered on days 1-4 of the cycle. The dose of lenalidomide will not be adjusted. (unless necessary to treat adverse events)

Once this phase of active treatment is complete, patients will begin the long-term follow-up phase, during which they will be visited every three months to evaluate progression and survival.

Detailed Description

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The primary trial objectives are:

• Impact on progression-free survival (PFS) when adding MLN9708 to post-transplant maintenance treatment with lenalidomide/dexamethasone in patients with multiple myeloma.

The secondary trial objectives are:

* Evaluate development and clinical significance of minimal residual disease (MRD) from the time maintenance treatment is initiated, yearly over five years.
* Overall survival (OS).
* Evaluate the safety and tolerability of the maintenance treatment.

Conditions

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Multiple Myeloma

Keywords

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Multiple Myeloma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Lenalidomide

Oral administration of 15 mg/day of oral lenalidomide on days 1-21, and 20 mg/day of dexamethasone administered orally on days 1-4 and 9-12 for a period of two years

Group Type ACTIVE_COMPARATOR

Lenalidomide

Intervention Type DRUG

Dexamethasone

Intervention Type DRUG

MLN9708 plus Lenalidomide

MLN9708 during the two year maintenance period, at a dose of 4 mg/day on days 1, 8 and 15 of the cycle.

Group Type EXPERIMENTAL

MLN9708

Intervention Type DRUG

Lenalidomide

Intervention Type DRUG

Dexamethasone

Intervention Type DRUG

Interventions

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MLN9708

Intervention Type DRUG

Lenalidomide

Intervention Type DRUG

Dexamethasone

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* The patient must, in the opinion of the investigator, be capable of complying with all requirements of the trial.
* Have signed the informed consent form
* Be between 18 and 67 years of age
* Have an ECOG Performance Status \<= 2 (or 3 if the ECOG is due to myeloma, e.g. pathological fracture)
* Multiple myeloma patient who was included in the GEM2012MENOS65 trial, and who is found to have, at a minimum, minimal response after consolidation
* Life expectancy \> 3 months
* The patient must have the following laboratory values in the 21 days prior to initiation of treatment (day 1, cycle 1):

1. Platelet count ≥ 100 x 109/L and absolute neutrophil count of ≥ 1.0 x 109/L. - Platelet transfusions to help patients meet eligibility criteria are not allowed.
2. Corrected serum calcium \< 14 mg/dL.
3. Aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 2.5 x the upper limit of normal (ULN)
4. Total bilirubin within normal range
5. Calculated creatinine clearance \> 30 mL/min
* Female patients who:

1. Are postmenopausal for at least 1 year before the screening visit, OR
2. Are surgically sterile, OR
3. If they are of childbearing potential, agree to practice 2 effective methods of contraception, at the same time, from the time of signing the informed consent form through 90 days after the last dose of study drug, AND
4. Must also adhere to the guidelines of any treatment-specific pregnancy prevention program, if applicable, OR
5. Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence \[eg, calendar, ovulation, symptothermal, post-ovulation methods\] and withdrawal are not acceptable methods of contraception.)
* Male patients, even if surgically sterilized (ie, status post-vasectomy), must agree to one of the following:

1. Agree to practice effective barrier contraception during the entire study treatment period and through 90 days after the last dose of study drug, OR
2. Must also adhere to the guidelines of any treatment-specific pregnancy prevention program, if applicable, OR 30 Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence (eg, calendar, ovulation, symptothermal, post-ovulation methods\] and withdrawal are not acceptable methods of contraception.)

Exclusion Criteria

* Patients not included in clinical trial GEM2012MENOS65
* Patients included in GEM2012MENOS65 who are not found to have a least minimal response after consolidation
* Patients included in GEM2012MENOS65 who were discontinued prematurely due to toxicity or disease progression
* Female patients who are lactating or have a positive serum pregnancy test during the screening period.
* Central nervous system involvement
* Infection requiring systemic antibiotic therapy or other serious infection within 14 days before study enrollment.
* Systemic treatment, within 14 days before the first dose of MLN9708, with strong inhibitors of CYP1A2 (fluvoxamine, enoxacin, ciprofloxacin), strong inhibitors of CYP3A (clarithromycin, telithromycin, itraconazole, voriconazole, ketoconazole, nefazodone, posaconazole) or strong CYP3A inducers (rifampin, rifapentine, rifabutin, carbamazepine, phenytoin, phenobarbital), or use of Ginkgo biloba or St. John's wort.
* Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol.
* Known GI disease or GI procedure that could interfere with the oral absorption or tolerance of MLN9708 including difficulty swallowing.
* Diagnosed or treated for another malignancy within 2 years before study enrollment or previously diagnosed with another malignancy and have any evidence of residual disease. Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection.
* Peripheral neuropathy ≥ grade 2 in the 21 days prior to inclusion.
* Known hypersensitivity to lenalidomide or to MLN9708, their analogues, or excipients in the various formulations of any agent.
* Patients who have had a myocardial infarction in the six months prior to inclusion in the clinical trial, or who are class III or IV according to the New York Heart Association (NYHA), heart failure unstable angina, uncontrolled ventricular arrhythmias or acute ischemia detected by electrocardiogram, or conduction disorders.
* Patients who are currently participating in another clinical trial or receiving any other investigational product.
* Seropositive for HVB, HVC or HIV.
Minimum Eligible Age

18 Years

Maximum Eligible Age

67 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Celgene

INDUSTRY

Sponsor Role collaborator

Millennium Pharmaceuticals, Inc.

INDUSTRY

Sponsor Role collaborator

PETHEMA Foundation

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Complejo Hospitalario Universitario de Santiago

A Coruña, , Spain

Site Status

Hospital Txagorritxu

Alava, , Spain

Site Status

Hospital General de Albacete

Albacete, , Spain

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Hospital Del Vinalopo

Alicante, , Spain

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Hospital General Universitario de Alicante

Alicante, , Spain

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Hospital de Cabueñes

Asturias, , Spain

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Hospital Universitario Central de Asturias

Asturias, , Spain

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Hospital Clinic

Barcelona, , Spain

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H.Universitari Germans Trias I Pujol de Badalona

Barcelona, , Spain

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Hospital de La Santa Creu I Sant Pau

Barcelona, , Spain

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Hospital de Sabadell (Parc Taulí)

Barcelona, , Spain

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Hospital de Sant Joan de Déu

Barcelona, , Spain

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Hospital Del Mar

Barcelona, , Spain

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Hospital Universitari Mútua de Terrasa

Barcelona, , Spain

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Hospital Vall D'Hebron

Barcelona, , Spain

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Ico L'Hospitalet

Barcelona, , Spain

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Hospital Universitario de Burgos

Burgos, , Spain

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Hospital de Especialidades de Jerez de La Frontera

Cadiz, , Spain

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Hospital Universitario Marqués de Valdecilla

Cantabria, , Spain

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Hospital General de Castellón

Castelló, , Spain

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Complejo Hospitalario de Cáceres

Cáceres, , Spain

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Hospital General de Ciudad Real

Ciudad Real, , Spain

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Hospital Universitari Dr. Josep Trueta de Girona

Girona, , Spain

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Hospital de Gran Canaria Doctor Negrín

GRAN Canaria, , Spain

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Hospital Universitario Virgen de Las Nieves

Granada, , Spain

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Hospital Universitario Guadalajara

Guadalajara, , Spain

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Hospital Universitario Donostia

Guipúzcoa, , Spain

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Hospital Son Llatzer

Illes Balears, , Spain

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Hospital Universitari Son Espases

Illes Balears, , Spain

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Hospital San Pedro

La Rioja, , Spain

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Hospital de León

León, , Spain

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Hospital Universitari Arnau de Vilanova de Lleida

Lleida, , Spain

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Centro Oncológico Md Anderson International España

Madrid, , Spain

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Fundación Jiménez Díaz-Ute

Madrid, , Spain

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Hm Universitario San Chinarro

Madrid, , Spain

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Hospital Clínico San Carlos

Madrid, , Spain

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Hospital de Fuenlabrada

Madrid, , Spain

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Hospital Del Tajo

Madrid, , Spain

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Hospital General Universitario Gregorio Marañón

Madrid, , Spain

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Hospital Infanta Leonor

Madrid, , Spain

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Hospital Infanta Sofía

Madrid, , Spain

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Hospital Ramón Y Cajal

Madrid, , Spain

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Hospital Severo Ochoa

Madrid, , Spain

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Hospital Universitario 12 de Octubre

Madrid, , Spain

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Hospital Universitario de La Princesa

Madrid, , Spain

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Hospital Universitario Fundación Alcorcón

Madrid, , Spain

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Hospital Universitario Infanta Cristina

Madrid, , Spain

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Hospital Universitario La Paz

Madrid, , Spain

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Hospital Universitario Puerta de Hierro Majadahonda

Madrid, , Spain

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Complejo Hospital Costa Del Sol (Ivcs)

Málaga, , Spain

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Hospital General Universitario Santa Lucia

Murcia, , Spain

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Hospital J.M. Morales Meseguer

Murcia, , Spain

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Hospital Universitario Virgen de La Arrixaca

Murcia, , Spain

Site Status

Clinica Universidad de Navarra

Navarra, , Spain

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Complejo Hospitalario de Navarra

Navarra, , Spain

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Complejo Hospitalario de Ourense

Ourense, , Spain

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Complejo Hospitalario de Pontevedra

Pontevedra, , Spain

Site Status

Hospital Universitario de Salamanca

Salamanca, , Spain

Site Status

Hospital Universitario de Canarias

Santa Cruz de Tenerife, , Spain

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Hospital General de Segovia

Segovia, , Spain

Site Status

Hospital Nuestra Señora de Valme

Seville, , Spain

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Hospital Virgen del Rocío

Seville, , Spain

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Hospital Santa Bárbara

Soria, , Spain

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Hospital Universitari Joan Xxiii de Tarragona

Tarragona, , Spain

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Complejo Hospitalario de Toledo

Toledo, , Spain

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Hospital Nuestra Señora Del Prado

Toledo, , Spain

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Hospital Clínico Universitario Valencia

Valencia, , Spain

Site Status

Hospital Universitario Dr. Peset

Valencia, , Spain

Site Status

Hospital Universitario La Fe

Valencia, , Spain

Site Status

HOSPITAL CLíNICO UNIVERSITARIO DE VALLADOLID

Valladolid, , Spain

Site Status

Hospital Universitario Del Rio Hortega

Valladolid, , Spain

Site Status

Hospital de Cruces

Vizcaya, , Spain

Site Status

Hospital Clínico Universitario Lozano Blesa

Zaragoza, , Spain

Site Status

Hospital Universitario Miguel Servet

Zaragoza, , Spain

Site Status

Countries

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Spain

References

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Puig N, Agullo C, Contreras T, Cedena MT, Martinez-Lopez J, Oriol A, Blanchard MJ, Rios R, Inigo MB, Sureda A, Lakhwani S, de la Rubia J, Gonzalez-Calle V, Cabanas V, Palomera L, Moraleda JM, Bargay J, Castro S, Rosinol L, Blade J, San-Miguel JF, Lahuerta JJ, Paiva B, Mateos MV. Measurable residual disease by mass spectrometry and next-generation flow to assess treatment response in myeloma. Blood. 2024 Dec 5;144(23):2432-2438. doi: 10.1182/blood.2024024995.

Reference Type DERIVED
PMID: 39293025 (View on PubMed)

Guerrero C, Puig N, Cedena MT, Calasanz MJ, Gutierrez NC, Fernandez M, Oriol A, Rios-Tamayo R, Hernandez MT, Martinez-Martinez R, Bargay J, de Arriba F, Palomera L, Gonzalez-Rodriguez AP, Gonzalez Perez MS, Orfao A, Mateos MV, Martinez-Lopez J, Rosinol L, Blade J, Lahuerta JJ, San-Miguel JF, Paiva B. Predictors of unsustained measurable residual disease negativity in transplant-eligible patients with multiple myeloma. Blood. 2024 Feb 15;143(7):597-603. doi: 10.1182/blood.2023022083.

Reference Type DERIVED
PMID: 38048552 (View on PubMed)

Lakhwani S, Rosinol L, Puig N, Pico-Picos MA, Medina-Gonzalez L, Martinez-Lopez J, Paiva B, Cedena MT, Oriol A, Rios-Tamayo R, Blanchard MJ, Jarque I, Bargay J, Moraleda JM, Carrillo-Cruz E, Sureda A, Krsnik I, Gonzalez E, Casado LF, Marti JM, Encinas C, De Arriba F, Palomera L, Sampol A, Gonzalez-Montes Y, Motllo C, De La Cruz J, Alonso R, Mateos MV, Blade J, Lahuerta JJ, San-Miguel J, Hernandez MT. Recovery of uninvolved heavy/light chain pair immunoparesis in newly diagnosed transplant-eligible myeloma patients complements the prognostic value of minimal residual disease detection. Haematologica. 2024 Jun 1;109(6):1909-1917. doi: 10.3324/haematol.2023.284154.

Reference Type DERIVED
PMID: 38031761 (View on PubMed)

Rosinol L, Oriol A, Rios R, Blanchard MJ, Jarque I, Bargay J, Hernandez MT, Cabanas V, Carrillo-Cruz E, Sureda A, Martinez-Lopez J, Krsnik I, Gonzalez ME, Casado LF, Marti JM, Encinas C, de Arriba F, Palomera L, Sampol A, Gonzalez-Montes Y, Cabezudo E, Paiva B, Puig N, Cedena MT, de la Cruz J, Mateos MV, San Miguel J, Lahuerta JJ, Blade J. Lenalidomide and dexamethasone maintenance with or without ixazomib, tailored by residual disease status in myeloma. Blood. 2023 Nov 2;142(18):1518-1528. doi: 10.1182/blood.2022019531.

Reference Type DERIVED
PMID: 37506339 (View on PubMed)

Botta C, Maia C, Garces JJ, Termini R, Perez C, Manrique I, Burgos L, Zabaleta A, Alignani D, Sarvide S, Merino J, Puig N, Cedena MT, Rossi M, Tassone P, Gentile M, Correale P, Borrello I, Terpos E, Jelinek T, Paiva A, Roccaro A, Goldschmidt H, Avet-Loiseau H, Rosinol L, Mateos MV, Martinez-Lopez J, Lahuerta JJ, Blade J, San-Miguel JF, Paiva B. FlowCT for the analysis of large immunophenotypic data sets and biomarker discovery in cancer immunology. Blood Adv. 2022 Jan 25;6(2):690-703. doi: 10.1182/bloodadvances.2021005198.

Reference Type DERIVED
PMID: 34587246 (View on PubMed)

Other Identifiers

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GEM2014MAIN

Identifier Type: -

Identifier Source: org_study_id