Minimal Residual Disease Guided Maintenance Therapy With Belantamab Mafodotin and Lenalidomide After Autologous Hematopoietic Cell Transplantation in Patients With Newly Diagnosed Multiple Myeloma

Study Purpose

To increase the conversion rate from MRD-positive to MRD-negative CR in patients with newly diagnosed multiple myeloma (NDMM) receiving post-transplant maintenance therapy with belantamab mafodotin plus lenalidomide.

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

Yes
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Interventional
Eligible Ages 18 Years and Over
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

  • - Patients with newly diagnosed multiple myeloma status post 1st auto-HCT (day 60 - 180 post-transplant).
  • - Disease status (MRD positive or negative), partial response, or better.
  • - Age > 18-year and 75-year.
  • - Karnofsky performance status 70 (Appendix A.
).
  • - Adequate organ function (Please see Table 2.
below). Participant agrees to not donate blood while taking lenalidomide and for 28 days after stopping lenalidomide.
  • - Patient agrees to enroll in the lenalidomide REMS program.
  • - Woman of child-bearing potential (WOCPB) must abstain from hetersosexual sexual contact or agrees to use a contraceptive method that is highly effective (with a failure rate of <1% per year), preferably with low user dependency (as described in Appendix C), plus one additional effective method at least 28 days before starting therapy (for lenalidomide), during the intervention period, at least 28 days after the last dose of lenalidomide and at least 4 months after the last dose of belantamab mafodotin, and agrees not to donate eggs (ova, oocytes) for reproduction during this period.
The investigator should evaluate the effectiveness of the contraceptive method in relation to the first dose of the study intervention. A WOCBP must have a negative highly sensitive serum pregnancy test (as required by local regulations) within 10-14 days and also within 24 hours before the first dose of the study intervention. Nonchildbearing potential is defined as follows (by other than medical reasons):
  • - ≥ 45 years of age and has not had menses for >1 year.
  • - Patients who have been amenorrhoeic for <2 years without a history of a hysterectomy and oophorectomy must have a follicle-stimulating hormone value in the postmenopausal range upon screening evaluation.
  • - Post-hysterectomy, post-bilateral oophorectomy, or post-tubal ligation.
9. Male participant agrees to contraceptive use that should be consistent with institutional guidelines regarding the methods of contraception for those participating in clinical studies. Male participants are eligible to participate if they agree to the following during the intervention period and for 6 months after the last dose of study treatment to allow for clearance of any altered sperm: • Refrain from donating sperm during treatment (including dose interruptions) and for 4 weeks after their last dose of lenalidomide. PLUS, either: • Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent. OR Must agree to use contraception/barrier as detailed in Appendix C.

Exclusion Criteria:

  • - History of progressive disease at any time before starting maintenance.
  • - Patients with smoldering MM (IMWG criteria, Appendix F.
).
  • - Patients with plasma cell leukemia.
  • - Patients with non-secretory MM (no measurable disease on electrophoresis and immunofixation).
Patients with a measurable disease on PET scan or bone marrow will be eligible.
  • - Participant must not have current unstable liver or biliary disease defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminemia due to underlying liver disease (serum albumin < 3gm/dL), esophageal or gastric varices, persistent jaundice, or cirrhosis.
  • - Participant must not have presence of active renal condition (infection, requirement for dialysis or any other condition that could affect participant's safety).
Participants with isolated proteinuria resulting from MM are eligible, provided they fulfil inclusion criteria.
  • - Current corneal or epithelial disease (except mild punctate keratopathy; see Appendix E.
).
  • - Participant must not use contact lenses while participating in this study.
  • - Participant must not have used an investigational drug or approved systemic anti-myeloma therapy (including systemic steroids) within 14 days or five half-lives, whichever is shorter, preceding the first dose of study drug.
  • - Participant must not have received prior treatment with a monoclonal antibody within 30 days of receiving the first dose of study drugs.
  • - Participant must not have had major surgery ≤ 4 weeks before initiating study treatment.
  • - The participant must not have any evidence of active mucosal or internal bleeding.
  • - Participant must not have known immediate or delayed hypersensitivity reaction or idiosyncratic reactions to belantamab mafodotin or drugs chemically related to belantamab mafodotin, or any of the components of the study treatment.
  • - Participant must not have an active infection requiring treatment.
  • - Participant must not have evidence of cardiovascular risk, including any of the following: 1.
Evidence of current clinically significant uncontrolled arrhythmias, including clinically significant ECG abnormalities such as 2nd degree (Mobitz Type II) or 3rd degree atrioventricular (AV) block. 2. History of myocardial infarction, acute coronary syndromes (including unstable angina), coronary angioplasty, or stenting or bypass grafting within three
  • (3) months of screening.
3. Class III or IV heart failure as defined by the New York Heart Association functional classification system.16. 4. Uncontrolled hypertension (blood pressure that remains above goal despite the concurrent use of three antihypertensive drug classes).
  • - Participant must not have known HIV infection.
  • - Patients will Hepatitis B will be excluded unless the following criteria can be met (Please, also see Appendix B): Serology Screening HbcAb+, HbsAg- • HBV DNA undetectable HBsAg+ at screen or within 3 months prior to first dose • HBV DNA undetectable.
  • - Highly effective antiviral treatment started at least 4 weeks prior to first dose of study treatment.
  • - Baseline imaging per protocol.
  • - Participants with cirrhosis are excluded.
Note: presence of Hep B surface antibody (HBsAb) indicating previous vaccination will not exclude a participant.
  • - Positive hepatitis C antibody test result or positive hepatitis C RNA test result at screening or within 3 months prior to first dose of study treatment unless the participant can meet the following criteria (Please, also see Appendix B): - RNA test negative.
  • - Successful anti-viral treatment (usually 8 weeks duration) is required, followed by a negative HCV RNA test after a washout period of at least 4 weeks.
  • - Participant must not have invasive malignancies other than disease under study, unless the second malignancy has been medically stable for at least 2 years and, in the opinion of the principal investigators, will not affect the evaluation of the effects of clinical trial treatments on the currently targeted malignancy.
Participants with curatively treated non-melanoma skin cancer may be enrolled without a 2-year restriction.
  • - Participants must not be pregnant or lactating.
  • - Any serious unstable pre-existing medical condition or psychiatric disorder that can interfere with safety or with obtaining informed consent or compliance with study procedures.
  • - All prior treatment-related toxicities (defined by National Cancer Institute- Common Toxicity Criteria for Adverse Events (NCI-CTCAE), version 5 must be ≤ Grade 1 at the time of enrolment except for alopecia.

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT05091372
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

Phase 2
Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

M.D. Anderson Cancer Center
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

Qaiser Bashir
Principal Investigator Affiliation M.D. Anderson Cancer Center
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

Other
Overall Status Not yet recruiting
Countries United States
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

Myeloma Multiple
Study Website: View Trial Website
Additional Details

Primary Objective: -To increase the conversion rate from MRD-positive to MRD-negative CR in patients with newly diagnosed multiple myeloma (NDMM) receiving post-transplant maintenance therapy with belantamab mafodotin plus lenalidomide. Secondary Objectives:

  • - To determine the safety and tolerability of belantamab mafodotin plus lenalidomide maintenance therapy after auto-HCT.
  • - To increase the overall MRD-negative CR rate in patients with NDMM receiving post-auto-HCT maintenance therapy with belantamab mafodotin plus lenalidomide.
  • - To determine the PFS and OS in patients who discontinue maintenance therapy after achieving sustained MRD-negative CR.
Sustained MRD-negative CR is defined as MRD-negative status in two assessments, at least 1-year apart, without any MRD-positive status in between.
  • - To determine the PFS with belantamab mafodotin plus lenalidomide maintenance therapy after auto-HCT in patients with NDMM.
  • - To determine the OS with belantamab mafodotin plus lenalidomide maintenance therapy after auto-HCT in patients with NDMMM.

Arms & Interventions

Arms

Experimental: Belantamab mafodotin

belantamab mafodotin by vein over about 30 minutes on Day 1 of each cycle

Experimental: Lenalidomide

lenalidomide by mouth every day of each cycle

Interventions

Drug: - Belantamab mafodotin

Belantamab Mafodotin Belantamab mafodotin dose levels: Dose level -2 = 1.4 mg/kg IV every 12 weeks Dose level -1 = 1.9 mg/kg IV every 12 weeks Dose level 0 = 1.9 mg/kg IV every 8 weeks Cycles 1 - 6: All patients will start at dose level 0. Cycles 7 and onwards*: Patients previously on dose level 0 (1.9 mg/kg IV every 8 weeks) will change to dose level -1 (1.9 mg/kg IV every 12 weeks) Patients previously on dose level -1 (1.9 mg/kg IV every 12 weeks) will continue at the same dose level. Patients previously on dose level -2 (1.4 mg/kg IV every 12 weeks) will continue at the same dose level. *Reduction to a lower dose level is allowed in case of development of adverse effects or poor tolerance as determined by the treating physician.

Drug: - Lenalidomide

Lenalidomide dose levels: Dose level 0 (starting dose): Lenalidomide 10 mg/day PO continuously. Dose level -1: Lenalidomide 10 mg/day PO. One week off after every three weeks of treatment. Dose level -2: Lenalidomide 5 mg/day PO. One week off after every three weeks of treatment.

Contact a Trial Team

If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.

MD Anderson Cancer Center, Houston, Texas

Status

Address

MD Anderson Cancer Center

Houston, Texas, 77051

Site Contact

Qaiser Bashir

qbashir@mdanderson.org

713-794-4422