Sunitinib in Treating Patients With Relapsed Multiple Myeloma

A Phase II Trial of Sunitinib (SU11248) in Multiple Myeloma

This phase II trial is studying how well sunitinib works in treating patients with relapsed multiple myeloma. Sunitinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the cancer

PRIMARY OBJECTIVES:

I. To assess the number of responses in patients with relapsed multiple myeloma treated with sunitinib (sunitinib malate).

SECONDARY OBJECTIVES:

I. To assess the toxicity of sunitinib malate in patients with relapsed multiple myeloma.

II. To assess time to progression after initial response to sunitinib malate.

OUTLINE:

Patients receive oral sunitinib malate once daily on days 1-42. Treatment repeats every 42 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 3-6 months for up to 3 years.

Inclusion Criteria:

• Diagnosis of relapsed multiple myeloma

• Measurable disease as defined by at least one of the following:

  • Serum monoclonal protein ≥ 1.0 g by protein electrophoresis
  • Urine monoclonal protein > 200 mg by 24-hour electrophoresis
  • Serum immunoglobulin free light chain ≥ 10 mg/dL AND abnormal serum immunoglobulin kappa to lambda free light chain ratio
  • Monoclonal bone marrow plasmacytosis ≥ 30%

• Not a candidate for stem cell transplantation OR have undergone prior stem cell collection

• Eastern Cooperative Oncology Group (ECOG) performance status 0-2

• Life expectancy ≥ 3 months

• Absolute neutrophil count ≥ 1,000/microliter (mcL)

• Platelets ≥ 75,000/mcL

• Hemoglobin ≥ 8 g/dL

• Total serum bilirubin normal

• aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 x upper limit of normal

• Creatinine < 2.5 mg/dL

• Negative pregnancy test for women of childbearing potential

• No more than 4 prior therapies

  • Stem cell transplantation and preceding induction therapy will be considered 1 therapy

• Prior anthracycline exposure or central thoracic radiotherapy that included the heart in the radiotherapy port allowed provided patient has a New York Heart Association (NYHA) class II or better cardiac function on baseline ECHO or multiple gated acquisition scan (MUGA)

• Concurrent bisphosphonates allowed

• At least 7 days since prior and no concurrent cytochrome P450 3A4 (CYP3A4) inhibitors

• At least 12 days since prior and no concurrent CYP3A4 inducers

Exclusion Criteria:

• Pregnant or nursing women

• History of allergic reactions attributed to compounds of similar chemical or biologic composition to sunitinib malate

• History of serious ventricular arrhythmia or corrected QT interval (QTc) prolongation

• Poorly controlled hypertension

• Any condition that impairs the ability to swallow and retain sunitinib malate tablets

• Patients with a preexisting thyroid abnormality who are unable to maintain thyroid function in the normal range with medication

• Other active malignancy except nonmelanoma skin cancer or carcinoma in situ of the cervix or breast

• Concurrent uncontrolled illness including, but not limited to, ongoing or active infections or psychiatric illness/social situations that would limit compliance with study requirements

• Patients who have not recovered from adverse events of prior therapy

• Chemotherapy or radiotherapy ≤ 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to study entry

• Any major surgery ≤ 4 weeks prior to study entry

• Nonmyelosuppressive agents ≤ 2 weeks prior to study entry

• Any other prior antiangiogenic agents

• Concurrent high-dose corticosteroids

  • Concurrent chronic steroids (up to 20 mg/day prednisone equivalent) allowed for disorders other than amyloid; NOTE: Bisphosphonates are considered to be supportive care rather than therapy, and are thus allowed while on protocol treatment

• Concurrent therapeutic doses of coumarin-derivative anticoagulants

• Concurrent agents with proarrhythmic potential

• Concurrent combination antiretroviral therapy for HIV-positive patients

• Any other concurrent investigational agents or anticancer therapy