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Bevacizumab, Lenalidomide, and Dexamethasone in Treating Patients With Relapsed or Refractory Stage II or Stage III Multiple Myeloma
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), December 2008
Sponsors and Collaborators: University of Wisconsin, Madison
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00410605
  Purpose

RATIONALE: Monoclonal antibodies, such as bevacizumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Bevacizumab and lenalidomide may stop the growth of multiple myeloma by blocking blood flow to the cancer. Dexamethasone may stimulate the immune system in different ways and stop cancer cells from growing. Giving bevacizumab together with lenalidomide and dexamethasone may kill more cancer cells.

PURPOSE: This phase II trial is studying how well giving bevacizumab together with lenalidomide and dexamethasone works in treating patients with relapsed or refractory stage II or stage III multiple myeloma.


Condition Intervention Phase
Multiple Myeloma and Plasma Cell Neoplasm
Drug: bevacizumab
Drug: dexamethasone
Drug: lenalidomide
Procedure: fluorescence in situ hybridization
Procedure: immunoenzyme technique
Procedure: immunohistochemistry staining method
Procedure: laboratory biomarker analysis
Procedure: polymorphism analysis
Phase II

Genetics Home Reference related topics: aceruloplasminemia hemophilia
MedlinePlus related topics: Cancer Multiple Myeloma
Drug Information available for: Dexamethasone Dexamethasone acetate Dexamethasone Sodium Phosphate Doxiproct plus Bevacizumab Lenalidomide CC 5013
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: Phase II Trial of Bevacizumab Combined With Lenalidomide and Dexamethasone (BEV/REV/DEX) in Relapsed or Refractory Multiple Myeloma

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Overall response rate (complete response and partial response) [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Time to progression [ Designated as safety issue: No ]
  • Toxicity and tolerability [ Designated as safety issue: Yes ]
  • Effect of bevacizumab and lenalidomide on markers of myeloma activity in myeloma cells and stromal cells, including interleukin-6, macrophage inflammatory protein-1α, vascular endothelial growth factor, and STAT3 [ Designated as safety issue: No ]

Estimated Enrollment: 33
Study Start Date: November 2006
Estimated Primary Completion Date: April 2009 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine the overall response rate (complete response and partial response) in patients with relapsed or refractory stage II or III multiple myeloma treated with bevacizumab, lenalidomide, and dexamethasone.

Secondary

  • Determine time to progression in these patients.
  • Determine the toxicity and tolerability of this regimen.
  • Determine the effect of bevacizumab and lenalidomide on markers of myeloma activity in myeloma cells and stromal cells, including interleukin-6, macrophage inflammatory protein-1α, vascular endothelial growth factor, and STAT3.
  • Assess local cytokine milieu using tissue microarrays of bone marrow biopsy specimens.

OUTLINE: This is a multicenter, open-label study.

Patients receive bevacizumab IV over 30-90 minutes on days 1 and 15, oral lenalidomide on days 1-21, and oral dexamethasone on days 1, 8, 15, and 22. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.

Blood samples are collected at baseline and before courses 2 and 4. Blood samples are examined for vascular endothelial growth factor (VEGF) and VEGF receptor (VEGFR) polymorphisms by pyrosequencing and VEGF, VEGFR1, VEGFR2, interleukin-6, and macrophage inflammatory protein 1 by immunoenzyme techniques. Relationships between plasma cell myeloma and stroma and the effect of study treatment on these relationships are examined in tissue sections of bone marrow before and after treatment utilizing microvessel density measurements, VEGF staining, and STAT3 staining (by immunohistochemistry and fluorescent in situ hybridization [FISH]).

After completion of study treatment, patients are followed periodically for at least 5 years.

PROJECTED ACCRUAL: A total of 33 patients will be accrued for this study

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed symptomatic multiple myeloma

    • Stage II or III disease
    • Relapsed or refractory disease after ≥ 2 courses of prior chemotherapy
  • Measurable levels of monoclonal protein (M protein) > 1.0 g/dL by serum protein electrophoresis OR > 200 mg of monoclonal light chain by 24-hour urine protein electrophoresis
  • Measurable bone disease, defined as ≥ 1 unidimensionally measurable lesion (longest diameter to be recorded) ≥ 20 mm with conventional techniques OR ≥ 10 mm with spiral CT scan (for patients with lytic bone disease)
  • No known brain metastases

PATIENT CHARACTERISTICS:

  • ECOG performance status (PS) 0-2 OR Karnofsky PS 70-100%

    • Patients with PS of 3 are eligible if it is due to pain that is likely to improve with treatment
  • Life expectancy > 6 months
  • No known HIV positivity
  • No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months
  • No active infections requiring oral or intravenous antibiotics within the past week
  • No proteinuria (i.e., albuminuria) > 1,000 mg/24 hours unless related to the diagnosis of multiple myeloma

    • Patients with light chain (i.e., "Bence-Jones") proteinuria are still eligible if the non-light chain component of protein is < 1,000 mg/24 hours
  • No serious nonhealing wound or ulcer
  • No blood pressure > 150/90 mm Hg (even with medication)
  • No significant traumatic injury within the past 28 days
  • No clinically significant peripheral vascular disease
  • No evidence of bleeding diathesis or coagulopathy
  • No unstable angina or myocardial infarction within the past 6 months
  • No stroke within the past 6 months
  • No New York Heart Association class III or IV heart failure
  • No secondary malignancy within the past 2 years except squamous cell or basal cell carcinoma of the skin or carcinoma in situ of the cervix
  • Hemoglobin > 9 g/dL (may be supported by transfusion or growth factors)
  • WBC ≥ 2,000/mm³
  • Absolute neutrophil count ≥ 1,000/mm³
  • Platelet count ≥ 75,000/mm³
  • Bilirubin ≤ 2.5 mg/dL
  • AST and ALT ≤ 5 times upper limit of normal
  • Creatinine < 2.5 mg/dL
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use 2 methods of effective contraception 4 weeks before, during, and 4 weeks after completion of study treatment
  • No history of allergic reactions attributed to compounds of similar chemical or biological composition to lenalidomide and/or bevacizumab or other agents used in the study

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • At least 4 weeks since prior chemotherapy or radiotherapy and recovered
  • More than 7 days since prior minor surgical procedures, fine-needle aspirations, or core biopsies

    • More than 24 hours since prior bone marrow biopsy or central veinous access placement
  • More than 28 days since prior major surgical procedure or open biopsy
  • At least 4 weeks since prior and no concurrent participation in another experimental drug study
  • Prior autologous peripheral blood stem cell transplantation allowed
  • No prior lenalidomide
  • Concurrent full-dose anticoagulants allowed provided all of the following criteria are met:

    • No active bleeding or pathological condition that carries a high risk of bleeding (e.g., tumor involving major vessels or known varices)
    • No thrombocytopenia requiring transfusion
    • Platelet count > 75,000/mm³
    • INR 2-3 and stable
  • No concurrent major surgery
  • No concurrent sargramostim (GM-CSF)
  • No other concurrent investigational agents
  • No other concurrent anticancer agents or therapies
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00410605

Locations
United States, Pennsylvania
Veterans Affairs Medical Center - Pittsburgh Recruiting
Pittsburgh, Pennsylvania, United States, 15240
Contact: Clinical Trials Office - Veterans Affairs Medical Center - Pit     412-688-6104        
United States, Wisconsin
Aurora Sinai Medical Center Recruiting
Milwaukee, Wisconsin, United States, 53201-0342
Contact: Nancy Briggs     414-219-6591        
Gundersen Lutheran Center for Cancer and Blood Recruiting
La Crosse, Wisconsin, United States, 54601
Contact: Clinical Trials Office - Gundersen Lutheran Cancer Center     608-775-2385     cancerctr@gundluth.org    
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center Recruiting
Madison, Wisconsin, United States, 53792-6164
Contact: Clinical Trials Office - University of Wisconsin Paul P. Carbo     608-262-5223        
St. Vincent Hospital Regional Cancer Center Recruiting
Green Bay, Wisconsin, United States, 54307-3508
Contact: Clinical Trials Office - St. Vincent Hospital Regional Cancer     920-433-8889        
University of Wisconcin Cancer Center at Aspirus Wausau Hospital Recruiting
Wausau, Wisconsin, United States, 54401
Contact: Clinical Trials Office - University of Wisconsin Cancer Center     608-262-5223        
Medical Consultants, Limited Recruiting
Milwaukee, Wisconsin, United States, 53215-3690
Contact: Nancy Briggs     414-385-3086        
Sponsors and Collaborators
University of Wisconsin, Madison
Investigators
Study Chair: Natalie S. Callander, MD University of Wisconsin, Madison
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Study ID Numbers: CDR0000521546, WCCC-HO06401
Study First Received: December 11, 2006
Last Updated: December 25, 2008
ClinicalTrials.gov Identifier: NCT00410605  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
refractory multiple myeloma
stage II multiple myeloma
stage III multiple myeloma

Study placed in the following topic categories:
Dexamethasone
Immunoproliferative Disorders
Blood Protein Disorders
Hematologic Diseases
Blood Coagulation Disorders
Lenalidomide
Vascular Diseases
Paraproteinemias
Bevacizumab
Hemostatic Disorders
Multiple Myeloma
Hemorrhagic Disorders
Multiple myeloma
Lymphoproliferative Disorders
Dexamethasone acetate
Neoplasms, Plasma Cell

Additional relevant MeSH terms:
Anti-Inflammatory Agents
Neoplasms by Histologic Type
Antineoplastic Agents, Hormonal
Immune System Diseases
Antineoplastic Agents
Growth Substances
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists
Gastrointestinal Agents
Antiemetics
Angiogenesis Inhibitors
Hormones
Glucocorticoids
Pharmacologic Actions
Neoplasms
Autonomic Agents
Therapeutic Uses
Cardiovascular Diseases
Growth Inhibitors
Angiogenesis Modulating Agents
Peripheral Nervous System Agents
Central Nervous System Agents

ClinicalTrials.gov processed this record on January 16, 2009