A Phase I/II Study of Oral Melphalan Combined With LBH589 for Patients With Relapsed or Refractory Multiple Myeloma (MM)
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Diagnosis of multiple myeloma, based on the following criteria:
- Major criteria
- Plasmacytomas on tissue biopsy (1)
- Bone marrow plasmacytosis (> 30% plasma cells) (2)
- Monoclonal immunoglobulin spike on serum electrophoresis, IgG > 3.5 g/dL or
IgA > 2.0 g/dL, and kappa or lambda light chain excretion > 1 g/day on
24-hour urine protein electrophoresis (3)
- Minor Criteria
- Bone marrow plasmacytosis (10-30% plasma cells) (a)
- Monoclonal immunoglobulin present but of lesser magnitude than given under
major criteria (b)
- Lytic bone lesions ©)
- Normal IgM < 50 mg/dL, IgA < 100 mg/dL, or IgG < 600 mg/dL (d)
- Meets any of the following sets of multiple myeloma diagnostic criteria:
- Any two of the major criteria
- Major criterion 1 plus minor criterion b, c, or d
- Major criterion 3 plus minor criterion a or c
- Minor criteria a, b, and c, OR a, b, and d
- Measurable disease, defined as a monoclonal immunoglobulin spike on serum
electrophoresis of ≥ 1 g/dL and/or urine monoclonal immunoglobulin spike of ≥ 200
mg/24 hours, or evidence of lytic bone disease
- Nonmeasurable disease (i.e., patients with nonsecretory or oligosecretory
multiple myeloma) not allowed
- Must have received ≥ 1 prior treatment regimen OR refractory to most recent
chemotherapy
- Relapsed following stabilization or response to standard first-line chemotherapy
(e.g., vincristine, doxorubicin hydrochloride, and prednisone or melphalan and
prednisone) or first-line high-dose chemotherapy
- Refractory (i.e., failure to achieve at least complete or partial response or
stable disease) to most recent chemotherapy, whether or not containing systemic
corticosteroids
- Prior treatment with ≤ 4 days of a total of 400 mg of prednisone (or an
equivalent potency of another steroid) for myeloma is not considered a regimen
- No plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy,
monoclonal protein, and skin changes (POEMS syndrome)
- No plasma cell leukemia
PATIENT CHARACTERISTICS:
- ECOG performance status ≤ 2
- Life expectancy > 3 months
- Platelet count ≥ 75 x 10^9/L (≥ 50 x 10^9/L if bone marrow is extensively
infiltrated)
- Absolute neutrophil count ≥ 1.5 x 10^9/L (≥ 1.0 x 10^9/L if bone marrow is
extensively infiltrated)
- AST and ALT ≤ 2.5 times upper limit of normal (ULN)
- Serum bilirubin ≤ 1.5 times ULN
- Creatinine clearance ≥ 30 mL/min
- Creatinine > 10 mL/min and < 30 mL/min due to significant myelomatous
involvement of the kidneys allowed with medical director approval
- Serum potassium ≥ lower limit of normal (LLN)
- Serum magnesium ≥ LLN
- Serum phosphorus ≥ LLN
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- No peripheral neuropathy > grade 2
- No impaired cardiac function or clinically significant cardiac disease, including any
1 of the following:
- Congenital long QT syndrome
- History or presence of sustained ventricular tachyarrhythmia
- History of ventricular fibrillation or Torsade de Pointes
- Bradycardia, defined as heart rate (HR) < 50 beats per minute (bpm)
- Pacemaker allowed provided HR ≥ 50 bpm
- QTc > 450 msec on screening ECG
- LVEF below normal on screening ECHO or MUGA scan
- Right bundle branch block with left anterior hemiblock (bifascicular block)
- Myocardial infarction or unstable angina within the past 6 months
- Other clinically significant heart disease, including any of the following:
- NYHA class III-IV congestive heart failure
- Uncontrolled hypertension
- History of labile hypertension
- History of poor compliance with an antihypertensive regimen
- No impairment of gastrointestinal (GI) function or GI disease that may significantly
alter the absorption of panobinostat
- No prior malignancy within the past 5 years except basal cell or squamous cell
carcinoma or carcinoma in situ of the cervix
- No other concurrent severe and/or uncontrolled medical or psychiatric conditions
(e.g., uncontrolled diabetes or active or uncontrolled infection), including abnormal
laboratory values that could cause unacceptable safety risks or compromise protocol
compliance
- No known positivity for HIV or hepatitis B or C
- No severe hypercalcemia (i.e., serum calcium ≥ 14 mg/dL)
- No significant history of non-compliance to medical regimens or unwillingness or
inability to comply with instructions given by the study staff
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- Recovered from all prior therapy
- Prior localized radiotherapy allowed
- At least 3 weeks since prior chemotherapy (≥ 6 weeks for nitrosoureas)
- At least 3 weeks since prior corticosteroids (> 10 mg/day prednisone or equivalent)
- More than 4 weeks since prior major surgery
- Recent kyphoplasty allowed at investigator's discretion
- More than 8 weeks since prior immunotherapy
- More than 4 weeks since prior antibody therapy
- More than 2 weeks since prior radiotherapy to > 30% of marrow-bearing bone
- No prior panobinostat
- No concurrent medication that risk prolonging the QT interval or inducing Torsades de
Pointes