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| Name | Class |
|---|---|
| Janssen Pharmaceutica | INDUSTRY |
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This is Phase 2, open-label, multicentre, non-randomised study evaluating participants with newly diagnosed MM eligible for high-dose therapy. The goal of the study is to determine if consolidation with T-cell redirectors - Talquetamab and Teclistamab in sequence will improve the response depth: increase MRD negative CR rate.
A total of 50 transplant-eligible patients with newly diagnosed multiple myeloma in need of treatment will be enrolled.
The study consists of three phases: Induction, Consolidation, and Follow-up. Induction will consist of Dara-VRd and consolidation Part I will include talquetamab and Part II will include teclistamab.
Follow-up Phase After consolidation, treatment continues upon physician's choice: the options are ASCT with maintenance or only maintenance with lenalidomide.
Efficacy will be evaluated by serum/urine electrophoresis monthly; by serum/urine immunofixation, bone marrow morphology and flow cytometry when CR/sCR is suspected;
MRD will be evaluated by NGS ( at the level of 10-6) and FDG PET-CT ( by Deauville score) at various timepoints during induction, consolidation and follow-up.
Participants quality of life, symptoms, functional and general well-being will be captured using 3 PRO measures ( PRO-CTCAE, EORTC QLQ-C30, FACT-Cog).
The safety of study drugs will be assessed by physical examinations, vital signs, ECGs, clinical laboratory tests, neurologic examinations (including ICE scores), ECOG performance status, and AE monitoring according to NCI-CTCAE Version 5.0), grading of CRS and ICANS will be assessed based on ASTCT guidelines.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Induction with Dara -VRd + Consolidation with Talquetamab and Teclistamab as monotherapy in sequence | Experimental | Induction with Daratumumab-VRd; Consolidation part I with Talquetamab; Consolidation part II with Teclistamab. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Daratumumab | Drug | Daratumumab will be administered by SC injection |
|
| Measure | Description | Time Frame |
|---|---|---|
| Evaluate efficacy in terms of Minimal Residual Disease (MRD) negative Complete Remission rate by next generation sequencing ( NGS) after completing consolidation with talquetamab and teclistamab. | MRD measured by NGS with a sensitivity level of 10-6. | 18 months approximately |
| Evaluate efficacy in terms of Minimal Residual Disease (MRD) negative Complete Remission rate by Fluorodeoxyglucose Positron Emission Tomography-Computerized Tomography (FDG PET-CT) scan after completing consolidation with talquetamab and teclistamab. | MRD assessed by FDG PET-CT scan using Deauville score. | 18 months approximately |
| Measure | Description | Time Frame |
|---|---|---|
| Evaluate efficacy in terms of Minimal Residual Disease (MRD) negative Complete Remission rate by next generation sequencing ( NGS) after completing induction treatment with Daratumumab-VRd | MRD measured by NGS with a sensitivity level of 10-6. | 6 months approximately |
| Evaluate efficacy in terms of Minimal Residual Disease (MRD) negative Complete Remission rate by Fluorodeoxyglucose Positron Emission Tomography-Computerized Tomography (FDG PET-CT) scan after completing induction treatment with Daratumumab-VRd. |
| Measure | Description | Time Frame |
|---|---|---|
| To capture specific proteomic signatures from MRD positive and negative patients by mass-spectrometry based proteomic profiling. | 42 months approximately |
Inclusion Criteria:
Participant must have documented MM satisfying the IMWG criteria.
Newly diagnosed patients eligible for high dose therapy and ASCT.
ECOG performance status score ≤2.
HIV-positive participants are eligible if they meet all of the following
Must sign an ICF indicating that the participant understands the purpose of, and procedures required for, the study and is willing to participate in the study.
Willing and able to adhere to the lifestyle restrictions specified in this protocol.
A female participant of childbearing potential must have a negative highly sensitive serum (β hCG) pregnancy test at screening
A female participant must be
A female participant must agree not to donate eggs or freeze for future use during the study and for 6 months after receiving the last dose of study treatment.
A male participant must wear a condom when engaging any sexual activity that allows for passage of ejaculate to another person during the study and for a minimum of 100 days after receiving the last dose of study treatment.
A male participant must agree not to donate sperm for the purpose of reproduction during the study and for a minimum of 100 days after receiving the last dose of study treatment.
Have clinical laboratory values meeting the following criteria
Exclusion Criteria:
Waldenström's macroglobulinemia, POEMS syndrome, or primary amyloid light chain amyloidosis.
Known active CNS involvement or exhibits clinical signs of meningeal involvement of MM. If either is suspected, negative whole brain MRI and lumbar cytology are required.
Peripheral neuropathy or neuropathic pain Grade 2 or higher
Excluded for any of the following:
Any ongoing myelodysplastic syndrome or B cell malignancy (other than MM).
Any history of malignancy, other than MM, which is considered at high risk of recurrence requiring systemic therapy.
Any active malignancy (ie, progressing or requiring treatment change in the last 24 months) other than MM. The only allowed exceptions are malignancies treated within the last 24 months that are considered cured:
Stroke within 6 months prior to signing ICF.
Presence of the following cardiac conditions:
Concurrent medical or psychiatric condition or disease that is likely to interfere with study procedures or results, or that in the opinion of the investigator would constitute a hazard for participating in this study, such as:
Any other issue that would impair the ability of the participant to receive or tolerate the planned treatment at the investigational site, to understand informed consent or any condition for which, in the opinion of the investigator, participation would not be in the best interest of the participant (eg, compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments
Contraindications or life-threatening allergies, hypersensitivity, or intolerance to any study drug or its excipients
Any of the following:
Prior or current systemic therapy or stem cell transplantation for any plasma cell dyscrasia, with the exception of emergency use of a short course (equivalent of dexamethasone 40 mg/day for a maximum 4 days) of corticosteroids before treatment.
Major surgery within 2 weeks prior to the start of administration of study treatment, or will not have fully recovered from surgery, or has major surgery planned during the time the participant is expected to be treated in the study or within 2 weeks after administration of the last dose of study treatment.
Contraindications to the use of Dara-VRd per SmPC.
Prior or concurrent exposure to any of the following, in the specified time frame prior to first dose of study treatment:
Participant is pregnant, breastfeeding, or planning to become pregnant while enrolled in this study or within 6 months after the last dose of study treatment.
Participant plans to father a child while enrolled in this study or within 100 days after the last dose of study treatment.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Diana Loigom, MD | Contact | +372 6172173 | diana.loigom@regionaalhaigla.ee |
| Name | Affiliation | Role |
|---|---|---|
| Diana Loigom, MD | North Estonia Medical Centre | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Copenhagen University Hospital (Rigshospitalet) | Not yet recruiting | Copenhagen | 2100 | Denmark |
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|
| Bortezomib | Drug | Bortezomib will be administered by SC injection |
|
|
| Lenalidomide | Drug | Lenalidomide will be administered by oral route |
|
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| Dexamethasone | Drug | Dexamethasone will be administered by oral route |
|
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| Talquetamab | Drug | Talquetamab will be administered by SC injection |
|
|
| Teclistamab | Drug | Teclistamab will be administered by SC injection |
|
|
MRD assessed by FDG PET-CT scan using Deauville score. |
| 6 months approximately |
| Evaluate efficacy in terms of Minimal Residual Disease (MRD) negative Complete Remission conversion by next generation sequencing ( NGS) after completing consolidation treatment with talquetamab. | MRD measured by NGS with a sensitivity level of 10-6. | 12 months approximately |
| Evaluate efficacy in terms of Minimal Residual Disease (MRD) negative Complete Remission conversion by Fluorodeoxyglucose Positron Emission Tomography-Computerized Tomography (FDG PET-CT) scan after completing consolidation treatment with talquetamab. | MRD assessed by FDG PET-CT scan using Deauville score. | 12 months approximately |
| Evaluate efficacy in terms of Minimal Residual Disease (MRD) negative Complete Remission conversion by next generation sequencing ( NGS) after completing consolidation treatment with teclistamab. | MRD measured by NGS with a sensitivity level of 10-6. | 18 months approximately |
| Evaluate efficacy in terms of Minimal Residual Disease (MRD) negative Complete Remission conversion by Fluorodeoxyglucose Positron Emission Tomography-Computerized Tomography (FDG PET-CT) scan after completing consolidation treatment with teclistamab. | MRD assessed by FDG PET-CT scan using Deauville score. | 18 months approximately |
| Evaluate efficacy in terms of Sustained Minimal Residual Disease (MRD) negative Complete Remission rate by next generation sequencing ( NGS). | MRD measured by NGS with a sensitivity level of 10-6. | 42 months approximately |
| Evaluate efficacy in terms of Sustained Minimal Residual Disease (MRD) negative Complete Remission rate by Fluorodeoxyglucose Positron Emission Tomography-Computerized Tomography (FDG PET-CT) scan. | MRD assessed by FDG PET-CT scan using Deauville score. | 42 months approximately |
| To assess Overall Response Rate (ORR) | ORR is defined as proportion of patients achieveing documentation of a response (Partial Response or better) from the first dose of study drug on treatment. Response to treatment is defined according to the International Myeloma Working Group (IMWG) criteria. | 42 months approximately |
| To assess Overall Survival (OS). | OS is defined as the time from the date of first dose of study drug to the date of the subject's death. If the subject is alive or the vital status is unknown, then the subject's data will be censored at the date the subject was last known to be alive. OS is measured in months. | 42 months approximately |
| To assess Progression free Survival (PFS). | PFS is defined as the time from the date of first dose of study drug to the date of first documented disease progression, as defined in the International Myeloma Working Group (IMWG) criteria, or death due to any cause, whichever occurs first. For subjects who have not progressed and are alive, data will be censored at the last disease evaluation before the start of any subsequent anti-myeloma therapy. PFS is measured in months. | 42 months approximately |
| To assess Duration of Response ( DoR). | DoR is the date of initial documentation of a response (Partial Response or better) to the date of first documented evidence of progressive disease, as defined in the International Myeloma Working Group (IMWG) criteria. Relapse from complete response is not considered as disease progression. For subjects who have not progressed, data will be censored at the last disease evaluation before the start of any subsequent anti-myeloma therapy. DoR is measured in months. | 42 months approximately |
| To assess Time to Next anti-myeloma Treatment (TNT). | TNT is defined as the time between date of first dose of study drug and the first dose of the next treatment received. TNT is measured in months. | 42 months approximately |
| To assess the safety and tolerability of the treatment described in the protocol. | Incidence of treatment-emergent adverse events. AE monitoring according to NCI-CTCAE Version 5.0), grading of CRS and ICANS will be assessed based on ASTCT guidelines. | 42 months approximately |
| To assess quality of life on the treatment described in the protocol. | Quality of life in general is assessed using PRO questionnaire, such as EORTC QLQ-C30. | 42 months approximately |
| To assess incidence of participant -recorded side effects on the treatment described in the protocol. | Participant - recorded side effects are assessed using PRO questionnaire, such as PRO-CTCAE. | 42 months approximately |
| Odense University Hospital | Not yet recruiting | Odense | 5000 | Denmark |
|
| Vejle hospital | Not yet recruiting | Vejle | 7100 | Denmark |
|
| North Estonia Medical Centre | Recruiting | Tallinn | 13419 | Estonia |
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| Oslo University Hospital, Oslo Myeloma Centre | Not yet recruiting | Oslo | 0450 | Norway |
|
| Stavanger University Hospital | Not yet recruiting | Stavanger | 4068 | Norway |
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| St. Olavs Hospital | Not yet recruiting | Trondheim | 7030 | Norway |
|
| ID | Term |
|---|---|
| D009101 | Multiple Myeloma |
| ID | Term |
|---|---|
| D054219 | Neoplasms, Plasma Cell |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D020141 | Hemostatic Disorders |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D010265 | Paraproteinemias |
| D001796 | Blood Protein Disorders |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D006474 | Hemorrhagic Disorders |
| D008232 | Lymphoproliferative Disorders |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |
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| ID | Term |
|---|---|
| C556306 | daratumumab |
| D000069286 | Bortezomib |
| D000077269 | Lenalidomide |
| D003907 | Dexamethasone |
| C000730985 | talquetamab |
| ID | Term |
|---|---|
| D001897 | Boronic Acids |
| D000148 | Acids, Noncarboxylic |
| D000143 | Acids |
| D007287 | Inorganic Chemicals |
| D001896 | Boron Compounds |
| D009930 | Organic Chemicals |
| D011719 | Pyrazines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D010797 | Phthalimides |
| D010795 | Phthalic Acids |
| D000146 | Acids, Carbocyclic |
| D002264 | Carboxylic Acids |
| D010881 | Piperidones |
| D010880 | Piperidines |
| D054833 | Isoindoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D011246 | Pregnadienetriols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D013259 | Steroids, Fluorinated |
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