Aggressive Smoldering Curative Approach Evaluating Novel Therapies (ASCENT): A Phase 2 Trial of Induction, Consolidation, and Maintenance in Subjects With High Risk Smoldering Multiple Myeloma (SMM)
This study evaluates the use of carfilzomib, lenalidomide, daratumumab, and dexamethasone in subjects with high-risk smoldering multiple myeloma (SMM). Subjects will receive treatment in 3 phases - induction (6 cycles), consolidation (6 cycles), and maintenance (12 cycles). Each cycle is 28 days.
18 Years and up
Accepting Healthy Volunteers?
- Age 18 years and ≤ 80 years
- High risk smoldering myeloma, which is untreated, as defined by: Serum M spike > 3 gm/dL AND an involved to uninvolved free light chain (FLC) ratio > 8 AND bone marrow PC% > 10%
- The following laboratory values obtained 14 days prior to registration.
- Calculated creatinine clearance (using Cockcroft-Gault equation below)* ≥ 30 mL/min
- Absolute neutrophil count (ANC) ≥ 1000/mm3
- Platelet count ≥ 75000/mm3
- Hemoglobin ≥8.0 g/dL
- Total bilirubin ≤ 1.5 x upper limit of normal (ULN)
- alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 x ULN
- left ventricular ejection fraction (LVEF) ≥ 40%
- Prior therapy for the treatment of solitary plasmacytoma is permitted, but >7 days should have elapsed from the last day of radiation. Note: Prior therapy with clarithromycin, dehydroepiandrosterone (DHEA), anakinra, pamidronate or zoledronic acid is permitted. Any additional agents not listed must be approved by the Principal Investigator.
- Measurable disease as defined by at least one of the following:
- Serum monoclonal protein ≥ 1.0 g/dL (see Section 11.1 for definition)
- >200 mg of monoclonal protein in the urine on 24 hour electrophoresis
- Serum immunoglobulin free light chain ≥ 10 mg/dL AND abnormal serum immunoglobulin kappa to lambda free light chain ratio.
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1 (Appendix VII)
- Previously untreated.
- Provide informed written consent.
- Negative pregnancy test done ≤7 days prior to cycle 1 day 1, for women of childbearing potential only.
- All study participants must be registered into the mandatory Revlimid Risk Evaluation and Mitigation Strategy (REMS®) program and be willing and able to comply with the requirements of the REMS® program.
- Females of reproductive potential must adhere to the scheduled pregnancy testing as required in the Revlimid REMS® program.
- Willing to follow strict birth control measures as outlined in the protocol.
Female subjects: If they are of childbearing potential, agree to one of the following:
- 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 trial drug, AND must also adhere to the guidelines of any treatment-specific pregnancy prevention program, if applicable, OR
- Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g., calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.)
Male subjects: even if surgically sterilized (i.e., status post-vasectomy), must agree to one of the following:
- Agree to practice effective barrier contraception during the entire trial treatment period and through 90 days after the last dose of trial drug, OR
- Must also adhere to the guidelines of any treatment-specific pregnancy prevention program, if applicable, OR
- Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception).
- Willing to return to enrolling institution for follow-up during the Active Treatment Phase of the trial.
- Male subjects must agree not to donate sperm for at least 90 days after the last dose of study treatment.
- Willing to provide samples for planned research
- Life expectancy > 6 months
- Able to take aspirin (325 mg) daily as prophylactic anticoagulation. Subjects intolerant to aspirin may use warfarin or low dose molecular weight heparin.
- monoclonal gammopathy of undetermined significance (MGUS), standard risk smoldering myeloma, symptomatic myeloma, or light chain amyloidosis with organ involvement.
- Diagnosed or treated for another malignancy ≤ 2 years before trial enrollment or previously diagnosed with another malignancy and have any evidence of residual disease. NOTE: Subjects with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection.
- If any of the following exist at screening, subject will not be eligible for trial because this trial involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:
- Pregnant women
- Nursing women
- Men or women of childbearing potential who are unwilling to employ adequate contraception (per protocol)
- Other co-morbidity which would interfere with subject's ability to participate in trial, e.g. uncontrolled infection, uncompensated heart or lung disease.
- Other concurrent chemotherapy, or any ancillary therapy considered investigational. NOTE: Bisphosphonates are considered to be supportive care rather than therapy, and are thus allowed while on protocol treatment.
- Peripheral neuropathy ≥ Grade 3 on clinical examination or grade 2 with pain within 30 days prior to C1D1.
- Major surgery ≤14 days prior to C1D1.
- Evidence of current uncontrolled cardiovascular conditions, including hypertension, cardiac arrhythmias, congestive heart failure, unstable angina, or myocardial infarction within the past 6 months. Note: Prior to trial entry, any ECG abnormality at screening must be documented by the investigator as not medically relevant.
- New York Heart Association (NYHA) II, III, IV heart failure
- Known human immunodeficiency virus (HIV) positive.
- Known hepatitis B surface antigen-positive status, or known or suspected active hepatitis C infection.
- Any medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol.
- Known allergies, hypersensitivity, or intolerance to corticosteroids, monoclonal antibodies or human proteins, or their excipients (refer to respective package inserts or Investigator's Brochure), or known sensitivity to mammalian-derived products. Known allergies, hypersensitivity, or intolerance to trial drugs.
- Inability to comply with protocol/procedures.