Outpatient and Intermittent Dosing of Elranatamab in Relapsed/Refractory Multiple Myeloma

NCT ID: NCT06421675

Last Updated: 2025-11-14

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE2
• Total Enrollment: 40 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-03-28
• Study Completion Date: 2028-12-31

Brief Summary

A phase II study of single agent elranatamab in patients with relapsed and/or refractory multiple myeloma (MM) who have previously received at least three classes of therapeutic agents and are refractory to the last line of treatment. The primary objective of this study is to improve the tolerability and safety of elranatamab in patients with relapsed and/or refractory multiple myeloma by evaluating an outpatient and intermittent dosing strategy.

Detailed Description

This is a multi-centre, single arm, phase II study of single agent elranatamab in patients with relapsed and/or refractory multiple myeloma (MM) who have previously received at least three classes of therapeutic agents and are refractory to the last line of treatment. Potential study participants must have documented evidence of refractory or progressive disease during or within 60 days (measured from the end of the last cycle) of completing treatment with the last anti-myeloma drug regimen used just prior to study entry. Study participants will receive SC administration of elranatamab until disease progression, unacceptable toxicity or death. The primary short term outcome is hospitalization rate within the first 2 weeks of Cycle 1 of treatment; the primary long term outcome is rate of grade 3+ infections within the first 24 months of treatment. Study participants will be followed for survival for 36 months from the date of enrollment. A total of 40 study participants will be enrolled across approximately 5 Canadian clinical trial sites.

Conditions

Refractory Multiple Myeloma

Keywords

relapsed; refractory; multiple myeloma; elranatamab; cytokine release syndrome; immune effector-cell associated neurotoxicity

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Elranatamab injection

The administration of two step-up elranatamab doses (12 mg and 32 mg) and full dose 76 mg. The dosing interval for the first Cycle (each cycle q28 days) is every week. Cycles 2-3, the dosing interval increases to q2weeks. Cycles 4-12, the dosing interval increases to q4weeks. Cycles 13+, further dosing interval increases to q8weeks will be scheduled if a participant meets criteria for IMWG complete response (CR) in Cycle 12 (bone marrow required at Cycle 12 to confirm). If a participant does not meet CR criteria at Cycle 12, they will be continued on Q4W dosing.

Group Type: EXPERIMENTAL

Elranatamab injection

Intervention Type: DRUG

Elranatamab (Elrexfio) is a humanized bispecific antibody that targets both BCMA-expressing multiple myeloma (MM) cells and CD3-expressing T cells.

Interventions

Elranatamab injection

Elranatamab (Elrexfio) is a humanized bispecific antibody that targets both BCMA-expressing multiple myeloma (MM) cells and CD3-expressing T cells.

Intervention Type: DRUG

Other Intervention Names

Elrexio

Eligibility Criteria

Inclusion Criteria

1. Relapsed and/or refractory MM defined as:

1. Documented evidence of progressive disease (PD) after achieving at least minimal response (MR) for ≥ 1 cycle during a previous MM treatment (i.e., relapsed MM).

2. Disease progression during or within 60 days from the end of the most recent MM treatment (i.e., refractory MM).

2. Measurable disease based on IMWG criteria, defined as at least one of the following, documented within 28 days before enrollment:

1. Serum M-protein ≥ 0.5 g/dl.

2. Urine M-protein excretion ≥ 200 mg/24 h.

3. Serum-free light chains (FLC) assay: Involved FLC level ≥ 10 mg/dl (≥ 100 mg/l) AND an abnormal serum-free light chain ratio (< 0.26 or > 1.65) only for patients without measurable serum or urine M protein.

3. Receipt of at least three prior classes of drugs either in separate regimens or as combinations.

The three classes are defined as:

An immunomodulatory drug (lenalidomide or pomalidomide), a proteasome inhibitor (bortezomib, ixazomib, carfilzomib), and an anti-CD38 drug (daratumumab or isatuximab).

4. At least 18 years of age.

5. Eastern Cooperative Oncology Group (ECOG) performance status score of ≤2.

Exclusion Criteria

Medical conditions

1. Active plasma cell leukemia (either 20% of peripheral white blood cells or > 2.0 × 109/L circulating plasma cells by standard differential).

2. Amyloidosis.

3. POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder, Skin Changes).

4. Monoclonal gammopathy of unknown significance or smoldering multiple myeloma.

5. Solitary plasmacytoma.

6. Stem cell transplant within 12 weeks prior to enrollment or active graft versus host disease.

7. History of prior treatment with a BCMA targeting agent.

Laboratory Parameters

8. Laboratory results within 28 days as per below prior to enrollment:

• Absolute neutrophil count (ANC) ≤ 1.0 x 109 /L) (use of growth factor is permitted if completed at least 7 days prior to enrollment).
• Platelet count ≤ 25 x 109 /L (transfusion support permitted if completed at least 7 days prior to enrollment).
• Hemoglobin ≤ 8.0 g/dL (transfusion support permitted if completed at least 7 days prior to enrollment, concurrent erythropoietin stimulating agents allowed).
• Serum AST and ALT > 2.5 x upper limit of normal (ULN).
• Creatinine clearance < 30 mL/min (according to the Cockcroft Gault formula, by 24-hour urine collection for creatinine clearance, or according to local institutional standard method).
• Total bilirubin > 2.0 x ULN (≥ 3.0 unless known to have Gilbert's disease).

Support Requirement

9. As this protocol requires outpatient administration, the patient will be excluded if they cannot agree to the following for the first 9 days post-first dose of drug administration:

1. Staying within 60 minutes of travel distance to their trial-based hospital.

2. Must have a caregiver/support person who will stay with the patient.

3. Patient and/or their caregiver/support person agree to monitor and record oral temperature q8 hours.

4. Patients must agree that if they have an oral temperature of (≥38°C), they must report to the study team within 1 hour and can come to the hospital for admission within 2 hours.

Other co-morbidities

10. Impaired cardiovascular function or clinically significant cardiovascular diseases, defined as any of the following within 6 months before enrollment:

• Acute myocardial infarction or acute coronary syndromes (eg, unstable angina, coronary artery bypass graft, coronary angioplasty or stenting, symptomatic pericardial effusion).
• Clinically significant cardiac arrhythmias (eg, uncontrolled atrial fibrillation or uncontrolled paroxysmal supraventricular tachycardia).
• Thromboembolic or cerebrovascular events (eg, transient ischemic attack, cerebrovascular accident, deep vein thrombosis [unless associated with a central venous access complication], or pulmonary embolism).
• Prolonged QT syndrome (or triplicate average QTcF >470 msec at screening).

11. Ongoing Grade ≥2 peripheral sensory or motor neuropathy.

12. History of Guillain-Barre Syndrome (GBS) or GBS variants, or history of any Grade ≥3 peripheral motor polyneuropathy.

13. Unresolved acute effects of any prior therapy for MM in the last three months to either baseline severity or NCI CTCAE ≤Grade 1.

14. Active HBV, HCV, SARS-CoV2, HIV, or any active, uncontrolled bacterial, fungal, or viral infection.

15. Any other active malignancy within 2 years prior to enrollment, except for adequately treated basal cell or squamous cell skin cancer, or carcinoma in situ.

16. Any serious and/or unstable pre-existing medical, psychiatric disorder, or other conditions (including lab abnormalities), or surgical (major surgery within 14 days prior to enrollment) that could interfere with the patient's safety, obtaining informed consent or compliance to the study procedures.

17. Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to elranatamab or any of the components of the study treatment.

Concomitant Medications

18. Treatment with a chemotherapeutic or anti-MM drug within the last 28 days or 5 half-lives (whichever is shorter) prior to enrollment or are currently enrolled in another interventional clinical study.

19. Receipt of any other therapy to treat cancer (including radiation, biologics, cellular therapies, and/or steroids at doses > 20 mg dexamethasone or equivalent) within 14 days prior to the enrollment.

20. Receipt of any live vaccine within 30 days prior to enrollment or expected need of live vaccination during study participation. (Administration of locally approved non-live vaccine can be done as per local guidelines during the screening and/or treatment period including the COVID-19 mRNA vaccine. Elranatamab should be administered ± 7 days from the SARS-CoV-2 vaccine administration).

Pregnancy and Contraception

21. Pregnancy or lactating female or inability of female patients of childbearing potential (FCBP) to meet contraception requirements (see Section 5.1.3.).

Informed Consent

22. Inability to provide signed, informed consent.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Ontario Clinical Oncology Group (OCOG)

OTHER

Sponsor Role: lead

Pfizer

INDUSTRY

Sponsor Role: collaborator

McMaster University

OTHER

Sponsor Role: collaborator

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Hira Mian, MD

Role: PRINCIPAL_INVESTIGATOR

McMaster University

Jim Wright, MD

Role: STUDY_DIRECTOR

OCOG - McMaster University

Locations

Vancouver Cancer Center

Vancouver, British Columbia, Canada

Site Status: RECRUITING

Juravinski Cancer Center

Hamilton, Ontario, Canada

Site Status: RECRUITING

London Health Science Centre - Victoria Hospital

London, Ontario, Canada

Site Status: NOT_YET_RECRUITING

Ottawa Hospital

Ottawa, Ontario, Canada

Site Status: RECRUITING

Countries

Canada

Central Contacts

Emilio Aguirre, CRA,HIT,CHIM

Role: CONTACT

Phone: 905-527-2299

Email: aguirre@mcmaster.ca

Daryl Solomon

Role: CONTACT

Phone: 905-527-2299

Email: solomd5@mcmaster.ca

Facility Contacts

Christopher Venner, MD

Role: primary

Hira Mian, MD

Role: primary

Arleigh Robertson McCurdy, MD

Role: primary

Other Identifiers

OCOG-2023-EMBRACE

Identifier Type: -

Identifier Source: org_study_id