A Phase I/II Study of the Safety and Efficacy of Brostallicin (PNU-166196A) in Adult Patients With Multiple Myeloma That Has Progressed on Prior Chemotherapy
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Confirmed diagnosis of multiple myeloma based on prior or current demonstration of
the following criteria*:
- Major criteria:
- Plasmacytoma on tissue biopsy
- Bone marrow plasmacytosis with at least 30% plasma cells
- Monoclonal globulin spike on serum electrophoresis exceeding 3.5 g/dL for
IgG peaks or 2.0 g/dL for IgA peaks; greater than 1,000 mg/24hr of kappa or
gamma light chain excretion on urine electrophoresis in the absence of
amyloidosis
- Minor criteria:
- Bone marrow plasmacytosis with 10% to 30% plasma cells
- Monoclonal globulin spike present but less than levels in major criterion
III above
- Lytic bone lesions
- Residual normal IgM no greater than 0.5 g/dL, IgA no greater than 0.1 g/dL,
or IgG no greater than 0.6 g/dL NOTE: *Diagnosis of multiple myeloma
requires a minimum of 1 major and 1 minor criterion (I and a together is
not sufficient; must be I and b, I and c, I and d; II and b, II and c, II
and d; III and a, III and c, III and d) or 3 minor criteria that must
include a and b (a, b, and c; a, b, and d)
- Measurable disease defined by 1 of the following values:
- Serum myeloma (M) protein (IgG or IgA) level greater than 1.0 g/dL
- Urine M protein (light chain disease) at least 300 mg/24hr
- Soft tissue plasmacytoma with bidimensional measurement at least 20 x 20 mm (10
x 10 mm if spiral CT scan is used)
- Must have progressed during or within 12 months of discontinuing prior
myelosuppressive chemotherapy (e.g., vincristine, doxorubicin, and dexamethasone
[VAD] or melphalan) OR not responded after 2 courses of prior myelosuppressive
chemotherapy
- No indolent or smoldering myeloma or localized plasmacytoma
- No known brain or leptomeningeal disease unless such lesions were previously
irradiated, are currently not being treated with corticosteroids, and are associated
with no clinical symptoms
PATIENT CHARACTERISTICS:
Age
- 18 and over
Performance status
- ECOG 0-2
Life expectancy
- At least 12 weeks
Hematopoietic
- Absolute neutrophil count at least 1,500/mm^3 (at least 1,000/mm^3 if neutropenia due
to replacement of the normal bone marrow cells by myeloma cells)
- Platelet count at least 100,000/mm^3 (at least 50,000/mm^3 if thrombocytopenia due to
replacement of the normal bone marrow cells by myeloma cells)
- Hemoglobin at least 8.0 g/dL (no transfusion allowed)
- No hyperviscosity syndrome
Hepatic
- Bilirubin no greater than 1.5 times upper limit of normal (ULN)
- SGOT no greater than 2.5 times ULN
- Alkaline phosphatase no greater than 2.5 times ULN
Renal
- Creatinine no greater than 3.0 times ULN
- Calcium no greater than 12 mg/dL
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Willing and able to comply with scheduled visits, treatment plan, laboratory tests,
and sampling for study analysis
- HIV negative
- No other malignancy within the past 5 years except adequately treated nonmelanoma
skin cancer or carcinoma in situ of the cervix
- No AIDS-related illness
- No active infectious process or other severe concurrent disease that would make the
patient inappropriate for study entry
- No mental incapacity or psychiatric illness that would preclude giving informed
consent or completing follow-up
PRIOR CONCURRENT THERAPY:
Biologic therapy
- See Chemotherapy
- No concurrent anticancer biological response modifiers
- No concurrent immunotherapy
- No concurrent sargramostim (GM-CSF)
Chemotherapy
- See Disease Characteristics
- More than 2 years since prior high-dose chemotherapy with autologous bone marrow
transplantation or stem cell support
- More than 4 weeks since prior myelosuppressive chemotherapy
- No other concurrent anticancer chemotherapy
Endocrine therapy
- See Disease Characteristics
- No concurrent anticancer hormonal therapy
- No concurrent chronic steroids
- Acute pulse dosing required for treatment of a concurrent medical condition is
allowed, provided treatment duration is no greater than 2 weeks
- No concurrent corticosteroids (e.g., dexamethasone)
Radiotherapy
- More than 14 days since prior radiotherapy
- No prior radiotherapy to more than 25% of bone marrow
- No plans for radiotherapy within the next 6 months
- Concurrent palliative radiotherapy for skeletal pain allowed
Surgery
- More than 14 days since prior surgery
- No plans for surgery within the next 6 months
Other
- Acute toxic effects of prior therapy (except for alopecia and neurotoxicity) must
have resolved to grade 0, 1, or the patient's baseline
- Treatment-related neurotoxicity must have resolved to the patient's baseline,
not to exceed grade 2
- Chronic bisphosphonates for bone pain allowed only for maintenance doses
- More than 2 weeks since prior nonmyelosuppressive antimyeloma therapy
- More than 2 weeks since prior macrolide antibiotics
- No other concurrent investigational agents
- No concurrent macrolide antibiotics
- No concurrent participation in another treatment clinical study