Overview
Pembrolizumab (MK-3475) in MM Patients With Residual Disease
Status:
Completed
Completed
Trial end date:
2020-02-20
2020-02-20
Target enrollment:
0
0
Participant gender:
All
All
Summary
This is a national, multicenter, open label single-arm, non-comparative study that will determine the efficacy, safety and the changes in selected pharmacodynamics markers of MK-3475 monotherapy administered as consolidation therapy in MM patients who have achieved a response with a previous treatment but who still display some residual disease. For this purpose, 20 MM patients, who have received any treatment of limited duration either at diagnosis or at first relapse, and that have achieved a good response (≥VGPR) but with persistent residual disease (that is patients in VGPR, non-stringent CR, or MRD+ sCR), will be treated with MK-3475 monotherapy administered iv at a dose of 200 mg every three weeks for 1 year, with a potential expansion of 1 additional year of treatment in case of clinical benefit and patient agreement. Efficacy, safety and pharmacodynamic parameters will be evaluated to understand the role of this monoclonal antibody in this setting.Phase:
Phase 2Accepts Healthy Volunteers?
NoDetails
Lead Sponsor:
PETHEMA FoundationCollaborators:
Adknoma Health Research
Merck Sharp & Dohme Corp.Treatments:
Pembrolizumab
Criteria
Inclusion Criteria:- Age ≥18 years
- Performance status (ECOG) ≤ 2.
- Patient is, in the Investigator's opinion, willing and able to comply with the
protocol requirements.
- Patient has given voluntary written informed consent before performance of any
study-related procedure not part of normal medical care, with the understanding that
consent may be withdrawn by the patient at any time without prejudice to their future
medical care.
- Patients previously diagnosed with MM according to the IMWG Criteria (Blood 2011) who
are in good response (≥VGPR) but with persistent residual disease after the end of any
therapy administered for a limited duration of time either at 1st or 2nd line of
therapy.
Persistent disease is defined by either the presence of an M-Component by electrophoresis,
positive immunofixation, abnormal FLC ratio or identification of pathological plasma cells
by flow cytometry.
- At least 2 months for any non-transplant therapy or 3 months after ASCT, must relapse
from the last dose of the previous treatment before being eligible to be included in
the trial.
- Response must be confirmed to be stable between the end of the previous therapy and
the initiation of the trial (see the time that must elapse in the previous criteria).
Stable is defined as: No change in response according to the IMWG Criteria between these
determinations; No evidence of increase or decrease (> 25%) in M-component, provided the
variation is > 0.5 mg/dl; No evidence of increase or decrease (> 25%) of the involved FLC,
provided the ratio is abnormal and the absolute change is > 10 mg/dL; No evidence of
increase or decrease (> 50%) of the percentage of pathological plasma cells by flow
cytometry in the bone marrow provided the variation is > 0.5%; No positivization or
negativization of the electrophoresis or IFE between these determinations.
In case of doubt, another determination separated at least 1 month after the last one is
required to confirm the stability of the response, and this must be discussed with the DMC,
prior to be eligible.
Exclusion Criteria:
- Prior therapy with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-Cytotoxic
T-lymphocyte-associated antigen-4 (CTLA-4) antibody (including ipilimumab or other
antibody or drug specifically targeting T cell co-stimulation).
- Known hypersensitivity to pembrolizumab or any of its excipients.
- Non-adequate hematological or biochemical parameters as specified below:
Hemoglobin < 8.0 g/dl. Platelets count < 75 x109/L without previous platelet transfusions
in the last 7 days.
Neutrophils (ANC) <1 × 109/L without growth factor support (defined as no growth factor
administration for at least 14 days prior to observation).
Aspartate transaminase (AST): > 2.5 x the upper limit range. Alanine transaminase (ALT): >
2.5 x the upper limit range. Total bilirubin: > 2 x the upper limit range. Creatinine
clearance: < 30 mL/min (measured or calculated with the Cockcroft and Gault formula).
- Absence of recovery from any significant non-hematological toxicity derived from
previous treatments. The presence of alopecia and NCI CTCAE grade < 2 symptomatic
peripheral neuropathy is allowed.
- Pregnant or lactating women or expecting to conceive or father children within the
projected duration of the trial, starting with the pre-screening or screening visit
through 120 days after the last dose of trial treatment. Female subjects of
childbearing potential should have a negative urine or serum pregnancy prior to study
registration and re-tested within 72 hours prior to receiving the first dose of study
medication.
- Men and women of reproductive potential who are not using effective contraceptive
methods (double barrier method, intrauterine device, oral contraception). Male
subjects should agree to use an adequate method of contraception starting with the
first dose of study therapy through 120 days after the last dose of study therapy
- Previous history of any other malignancy in the last 5 years (except basal cell
carcinoma, skin epithelioma or carcinoma in situ of any site).
- More than 2 prior lines of therapy for MM.
- Previous allogeneic stem cell transplantation.
- Other relevant diseases or adverse clinical conditions:
Congestive heart failure or angina pectoris, myocardial infarction within 12 months before
inclusion in the study.
Uncontrolled arterial hypertension or cardiac arrhythmias (i.e. requiring a change in
medication within the last 3 months or a hospital admission within the past 6 months).
History of significant neurological or psychiatric disorders. Active infection. Significant
non-neoplastic liver disease (e.g., cirrhosis, active chronic hepatitis).
Uncontrolled endocrine diseases (e.g. diabetes mellitus, hypothyroidism or hyperthyroidism)
(i.e. requiring relevant changes in medication within the last month, or hospital admission
within the last 3 months).
Active autoimmune disease or a documented history of autoimmune disease, or a syndrome that
requires systemic steroids or immunosuppressive agents. Subjects with vitiligo or resolved
childhood asthma/atopy would be an exception to this rule. Subjects that require
intermittent use of bronchodilators or local steroid injections would not be excluded from
the study. Subjects with hypothyroidism stable on hormone replacement or Sjogren's syndrome
will not be excluded from the trial.
- Patient is known to be HIV positive, Hepatitis B surface antigen-positive, has active
hepatitis C infection or has active tuberculosis.
- Limitation of the patient's ability to comply with the treatment or follow-up
protocol.