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Hydroxychloroquine and Bortezomib in Treating Patients With Relapsed or Refractory Multiple Myeloma
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), November 2008
Sponsors and Collaborators: University of Pennsylvania
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00568880
  Purpose

RATIONALE: Drugs used in chemotherapy, such as hydroxychloroquine, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving hydroxychloroquine together with bortezomib may kill more cancer cells.

PURPOSE: This phase I/II trial is studying the side effects and best dose of hydroxychloroquine when given together with bortezomib and to see how well it works in treating patients with relapsed or refractory multiple myeloma.


Condition Intervention Phase
Multiple Myeloma and Plasma Cell Neoplasm
Drug: bortezomib
Drug: hydroxychloroquine
Procedure: biopsy
Procedure: immunologic technique
Procedure: laboratory biomarker analysis
Procedure: mass spectrometry
Procedure: pharmacological study
Phase I
Phase II

Genetics Home Reference related topics: aceruloplasminemia hemophilia
MedlinePlus related topics: Cancer Multiple Myeloma
Drug Information available for: Bortezomib Hydroxychloroquine Hydroxychloroquine sulfate
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: A Phase I/II Trial of Hydroxychloroquine Added to Bortezomib for Relapsed/Refractory Myeloma

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

Primary Outcome Measures:
  • Dose-limiting toxicity [ Designated as safety issue: Yes ]
  • Maximum tolerated dose of hydroxychloroquine [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Myeloma response (stringent complete response [sCR], CR, very good partial response [VGPR], PR, stable disease, and progressive disease) [ Designated as safety issue: No ]
  • Overall survival [ Designated as safety issue: No ]
  • Time to treatment failure [ Designated as safety issue: No ]
  • Progression-free survival [ Designated as safety issue: No ]
  • Time to response [ Designated as safety issue: No ]
  • Duration of overall response [ Designated as safety issue: No ]
  • Correlation of hydroxychloroquine and its metabolites blood levels with efficacy by mass spectrometry [ Designated as safety issue: No ]
  • Pre- and post-bortezomib proteasome inhibition assays [ Designated as safety issue: No ]
  • Bone marrow aspirate and peripheral blood mononuclear cell analysis for aggresome formation, autophagy inhibition, and apoptosis [ Designated as safety issue: No ]
  • Rate of overall adverse events and serious adverse events [ Designated as safety issue: Yes ]

Estimated Enrollment: 50
Study Start Date: November 2007
Estimated Primary Completion Date: November 2009 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • To establish the dose-limiting toxicities and maximum tolerated dose of hydroxychloroquine when added to a standard-dose regimen of bortezomib for treatment of patients with relapsed or refractory multiple myeloma.

Secondary

  • To obtain a preliminary estimate of the toxicity rate and response rate of this combination at the maximum tolerated dose.
  • To confirm preclinical evidence showing synergistic effects of hydroxychloroquine and bortezomib by correlating response rate with blood levels of hydroxychloroquine and degree of autophagy inhibition in repeated bone marrow samples.

OUTLINE: This is a phase I dose-escalation study of hydroxychloroquine followed by a phase II study.

  • Phase I: Patients receive oral hydroxychloroquine every other day for 2 weeks. Patients then receive oral hydroxychloroquine 1-3 times daily or every other day and bortezomib IV twice a week for 2 weeks. Treatment with hydroxychloroquine and bortezomib repeats every 3 weeks for at least 2 courses in the absence of disease progression or unacceptable toxicity. Once the maximum tolerated dose (MTD) for hydroxychloroquine is determined, additional patients are accrued to the phase II portion of the study.
  • Phase II: Patients receive hydroxychloroquine (at the MTD determined in phase I) and bortezomib as in phase I.

Blood and bone marrow samples are collected periodically during the study for correlative studies by mass spectrometry, proteasome inhibition assays, pharmacokinetic analysis and assessment of aggresome formation, autophagy inhibition, and apoptosis by protein electrophoresis and serum free light-chain analysis.

After completion of study treatment, patients are followed periodically.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Histologically confirmed multiple myeloma
  • Must meet 1 of the following criteria:

    • Relapsed disease documented
    • Disease refractory to at least one prior treatment regimen (may include autologous and allogeneic bone marrow transplantation)
    • In need of further therapy for myeloma, as determined by the patient's treating physician
  • No known CNS involvement

    • Calvarial lytic lesions or plasmacytomas are not exclusion criteria if there is no CNS involvement

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Life expectancy ≥ 3 months
  • Absolute neutrophil count ≥ 500/μL
  • Hemoglobin ≥ 7 g/dL (with or without transfusion support)
  • Platelets ≥ 25,000/μL (with or without transfusion support)
  • Total bilirubin ≤ 2 x upper limit of normal (ULN)
  • AST/ALT ≤ 2.5 x ULN
  • Creatinine ≤ 2 times ULN
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception prior to and during study treatment
  • No baseline peripheral neuropathy ≥ grade 2
  • No history of allergic reactions to compounds of similar chemical or biological composition to bortezomib or hydroxychloroquine
  • No known macular degeneration or retinopathy (diabetic or otherwise), porphyria, or psoriasis

    • Well-controlled psoriasis allowed provided under the care of a specialist who agrees to monitor the patient for exacerbations
  • No other conditions that would require therapy with hydroxychloroquine, including but not limited to, any of the following:

    • Systemic lupus
    • Rheumatoid arthritis
    • Porphyria cutanea tarda
    • Malaria treatment or prophylaxis
  • No concurrent or prior malignancy except for the following:

    • Basal cell or squamous cell carcinoma of the skin
    • Treated carcinoma in situ
    • Localized prostate adenocarcinoma (stage T1a or T1b) with a stable PSA for a period of at least 4 months allowed
    • Patients with a prior malignancy treated with chemotherapy, biologic agents, and/or radiation are eligible for this study if they have completed therapy ≥ 4 years previously with no evidence of recurrent disease
    • Patients with a prior malignancy treated with surgery alone are eligible for this study if they have completed therapy ≥ 2 years previously with no evidence of recurrent disease
  • No uncontrolled intercurrent illness including, but not limited to, any of the following:

    • Uncontrolled ongoing infection
    • Symptomatic congestive heart failure
    • Unstable angina pectoris
    • Cardiac arrhythmia
    • Psychiatric illness or social situations that would limit compliance with study requirements
  • No prior dose-limiting toxicity due to bortezomib administration
  • No inability to understand or unwillingness to sign the informed consent document

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • At least 7 days since prior corticosteroids
  • At least 14 days since prior antimyeloma agents, including thalidomide or lenalidomide
  • Concurrent therapy with bisphosphonates allowed at the discretion of the treating physician
  • Concurrent hematopoietic growth factors allowed, including filgrastim (G-CSF) or pegfilgrastim, epoetin alpha, and darbepoetin alpha
  • Concurrent participation in non-treatment studies allowed, if it will not interfere with participation in this study
  • No concurrent radiotherapy except local radiotherapy during the treatment phase of this study for palliation of pain or prevention of fracture
  • No concurrent treatment with a different investigational regimen
  • No concurrent therapy with other anticancer agents
  • No concurrent participation in other investigational trials that involve novel therapies
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00568880

Locations
United States, Pennsylvania
Abramson Cancer Center of the University of Pennsylvania Recruiting
Philadelphia, Pennsylvania, United States, 19104-4283
Contact: Clinical Trials Office - Abramson Cancer Center of the Univers     800-474-9892        
Sponsors and Collaborators
University of Pennsylvania
Investigators
Study Chair: Dan Vogl, MD University of Pennsylvania
  More Information

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

Responsible Party: Abramson Cancer Center of the University of Pennsylvania ( Dan Vogl )
Study ID Numbers: CDR0000577505, UPCC-01407, UPCC-IRB-806149
Study First Received: December 5, 2007
Last Updated: December 9, 2008
ClinicalTrials.gov Identifier: NCT00568880  
Health Authority: Unspecified

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

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

Additional relevant MeSH terms:
Anti-Infective Agents
Antiprotozoal Agents
Neoplasms by Histologic Type
Immune System Diseases
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Enzyme Inhibitors
Pharmacologic Actions
Protease Inhibitors
Antimalarials
Neoplasms
Antiparasitic Agents
Therapeutic Uses
Cardiovascular Diseases
Antirheumatic Agents

ClinicalTrials.gov processed this record on January 15, 2009