Phase I/II Study of Combination of Aurora Kinase Inhibitor MLN8237 and Bortezomib in Relapsed or Refractory Multiple Myeloma
Inclusion Criteria
Inclusion
- ANC >= 1500/uL
- AST =< 2.5 x ULN
- Creatinine =< 1.5 x ULN
- Creatinine clearance as calculated by the method of Cockroft and Gault >= 30
mL/minute
- Patients with relapsed or refractory multiple myeloma requiring treatment
- Patients who have received prior bortezomib therapy will be allowed on trial as long
as they did not progress during bortezomib or =< 60 days of therapy discontinuation
- Negative serum pregnancy test done =< 7 days prior to registration, for women of
childbearing potential (WOCBP) only (a WOCBP is a sexually mature woman who: 1) has
not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally
postmenopausal for at least 24 consecutive months)
- Willingness to return to enrolling institution for follow-up
- Life expectancy >= 12 weeks
- Voluntary written informed consent before performance of any study-related procedure
not part of normal medical care, with the understanding that consent may be withdrawn
by the subject at any time without prejudice to future medical care
- Female subject is either post-menopausal or surgically sterilized or willing to use
an acceptable method of birth control (i.e., a hormonal contraceptive, intra-uterine
device, diaphragm with spermicide, condom with spermicide, or abstinence) for the
duration of the study
- Male subject agrees to use an acceptable method for contraception for the duration of
the study
- Patients have a baseline LVEF >= 45% at baseline
- Bisphosphonates are considered to be supportive care rather than therapy, and are
thus allowed while on protocol treatment
- PLT >= 100,000/uL
- Total bilirubin =<1.5 x upper limit of normal (ULN) or if total bilirubin is > 1.5 x
ULN, the direct bilirubin must be =< 2.0 mg/dL
- Measurable disease of multiple myeloma as defined by at least ONE of the following:
- Serum monoclonal protein >= 1.0 g/dL, >= 200 mg of monoclonal protein in the urine on
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% (evaluable disease), or measurable plasmacytoma
- ECOG Performance Status (PS) 0, 1, or 2
- Hgb >= 9 g/dl
Exclusion
- Major surgery, open biopsy (excluding bone marrow) or significant traumatic injury =<
4 weeks prior to registration
- Melphalan or other myelosuppressive agents including lenalidomide and
non-myelosuppressive agents such as thalidomide or high dose corticosteroids =< 2
weeks prior to registration
- Concurrent use of corticosteroids, but patients may be on chronic steroids (maximum
dose 20 mg/day prednisone equivalent) if they are being given for disorders other
than myeloma, i.e., adrenal insufficiency, rheumatoid arthritis, etc
- Uncontrolled infection
- Pregnant women or women of reproductive ability who are unwilling to use effective
contraception
- Nursing women
- Men who are unwilling to use a condom (even if they have undergone a prior vasectomy)
while having intercourse with any woman, while taking the drug and for 4 weeks after
stopping treatment
- Other co-morbidity or psychiatric illness which would interfere with patient's
ability to participate in this trial
- Recent history of myocardial infarction in the six months prior to registration
- Uncontrolled angina or electrocardiographic evidence of acute ischemia
- Severe uncontrolled ventricular arrhythmias or electrocardiographic evidence of
active conduction system abnormalities
- Cardiac amyloidosis with hypotension (systolic BP less than 100mmHg)
- MGUS or smoldering myeloma
- Serious non-healing wound, or ulcer
- Known hypersensitivity to Bortezomib, boron or mannitol
- Patient has >=Grade 2 peripheral neuropathy within 14 days before enrollment
- Patient has received other investigational drugs with 14 days before enrollment
- Diagnosed or treated for another malignancy within 2 years of enrollment, with the
exception of complete resection of basal cell carcinoma or squamous cell carcinoma of
the skin, an in situ malignancy, or low-risk prostate cancer after curative therapy
- Infection requiring systemic antibiotic therapy within 14 days preceding the first
dose of study drug, or other severe infection
- Inability to swallow orally administered medication
- Prior allogeneic bone marrow or organ transplantation
- Patients who are currently receiving digoxin, cyclosporine, tacrolimus or sirolimus
- Severe cardiac comorbidity
- Known positive for HIV or active infectious hepatitis, type A, B or C