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CURATE.AI Optimized Modulation for Multiple Myeloma

N

National University Health System (NUHS)

Status and phase

Enrolling
Phase 3
Phase 2

Conditions

Multiple Myeloma

Treatments

Drug: Dexamethasone
Drug: Thalidomide
Drug: Lenalidomide
Drug: Cyclophosphamide
Other: CURATE.AI-Guided dosage modulation
Drug: Bortezomib

Study type

Interventional

Funder types

Other

Identifiers

NCT03759093
2015/00280

Details and patient eligibility

About

Clinical trial applying CURATE.AI, a Phenotypic Precision Medicine (PPM) platform, to Bortezomib, Thalidomide, Cyclophosphamide and Lenalidomide dosing in multiple myeloma patients to show improvement in response.

Full description

In conventional combination chemotherapy, drug doses are typically determined using dose escalation to reach a maximum tolerated dose (MTD) or via dose expansion to identify suitable regimen administration guideline, and the combinations are subsequently administered at fixed doses. During the course of treatment, the patient's response to therapy evolves and changes due to the time-dependent, dose dependent, and patient-specific nature of drug synergy and resulting efficacy and tolerability. To overcome this challenge, we have developed CURATE.AI, a Phenotypic Precision Medicine (PPM) platform, which has been clinically validated and used to prospectively optimize patient liver transplant immunosuppression, and tuberculosis therapy, among other indications. In this study, CURATE.AI may improve patient response by providing dose recommendations for Bortezomib, Thalidomide, Cyclophosphamide and Lenalidomide to the clinical team over the course of the patient's treatment.

Enrollment

20 estimated patients

Sex

All

Ages

21 to 99 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  1. Multiple myeloma diagnosed according to standard criteria, without prior anti-myeloma treatment at study entry. Both transplant eligible and ineligible patients may be included.

  2. Patients must have evaluable multiple myeloma with at least one of the following (within 21 days of starting treatment)

    1. Serum M-protein ≥ 0.5g/dL, or
    2. In subjects without detectable serum M-protein, Urine M-protein ≥ 200mg/24 hour, or serum free light chai (sFLC) > 100mg/L (involved light chain) and an abnormal kappa/Lambda ratio
  3. Males and females ≥ 18 years of age or > country's legal age for adult consent

  4. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 2

  5. Patients must meet the following clinical laboratory criteria with 21 days of starting treatment:

    1. Absolute neutrophil count (ANC) ≥ 1,000/mm3 and platelet ≥ 50,000/mm3 (≥ 30,000/mm3 if myeloma involvement in the bone marrow is >50%)
    2. Total bilirubin ≤ 1.5 x the upper limit of the normal range (ULN). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 x ULN.
    3. Calculated creatinine clearance ≥ 30mL/min or creatinine < 3mg/dL.
  6. Written informed consent in accordance with federal, local and institutional guidelines

Exclusion criteria

  1. Female patients who are lactating or pregnant

  2. Multiple Myeloma of IgM subtype

  3. Glucocorticoid therapy (prednisolone > 30mg/day or equivalent) within 14 days prior to informed consent obtained

  4. POEMS syndrome

  5. Plasma cell leukaemia or circulating plasma cells ≥ 2 x 109/L

  6. Waldenstrom's Macroglobulinaemia

  7. Patients with known amyloidosis

  8. Chemotherapy with approved or investigation anticancer therapeutics within 21 days prior to starting bortezomib treatment

  9. Focal radiation therapy within 7 days prior to start of treatment. Radiation therapy to an extended field involving a significant volume of bone marrow within 21 days prior to start of treatment

  10. Immunotherapy (excluding steroids) 21 days prior to start of treatment

  11. Major surgery (excluding kyphoplasty) within 28 days prior to start of treatment

  12. Active congestive heart failure (New York Heart Association [NYHA] Class III or IV), symptomatic ischaemia, or conduction abnormalities uncontrolled by conventional intervention. Myocardial infarction within 4 months prior to informed consent obtained

  13. Known HIV seropositive, hepatitis C infection, and/or hepatitis B (except for patients with hepatitis B surface antigen or core antibody receiving and responding to antiviral therapy directed at hepatitis B: these patients are allowed)

  14. Patients with known cirrhosis

  15. Second malignancy within the past 3 years except:

    1. Adequately treated basal cell or squamous cell skin cancer
    2. Carcinoma in situ of the cervix
    3. Breast carcinoma in situ with full surgical resection
  16. Patients with myelodysplastic syndrome

  17. Patients with steroid, cyclophosphamide, bortezomib, lenalidomide or thalidomide hypersensitivity

  18. Patients with a calculated creatinine clearance less than 30ml/min by the Cockroft Galt method.

  19. Prior treatment with Bortezomib

  20. Contraindication to any of the required concomitant drugs or supportive treatments

  21. Any clinically significant medical disease or psychiatric condition that, in the investigator's opinion, may interfere with protocol

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

Single Blind

20 participants in 2 patient groups

Standard of Care
Active Comparator group
Description:
Dosing of VCD(bortezomib, cyclophosphamide,dexamethasone), VTD (bortezomib,thalidomide, dexamethasone), or VRD (Bortezomib, Lenalidomide, Dexamethasone) combinations according to standard of care
Treatment:
Drug: Dexamethasone
Drug: Dexamethasone
Drug: Thalidomide
Drug: Cyclophosphamide
Drug: Lenalidomide
Drug: Bortezomib
Drug: Bortezomib
Drug: Lenalidomide
Drug: Thalidomide
Drug: Cyclophosphamide
CURATE.AI-guided dosing
Experimental group
Description:
CURATE.AI optimized modulation of bortezomib and cyclophosphamide dosages in the VCD (bortezomib, cyclophosphamide, dexamethasone), bortezomib and thalidomide in the VTD (bortezomib, thalidomide, dexamethasone) or bortezomib and lenalidomide in the VRD (bortezomib, lenalidomide, dexamethasone) combinations
Treatment:
Drug: Dexamethasone
Drug: Dexamethasone
Drug: Thalidomide
Other: CURATE.AI-Guided dosage modulation
Drug: Cyclophosphamide
Drug: Lenalidomide
Drug: Bortezomib
Drug: Bortezomib
Drug: Lenalidomide
Drug: Thalidomide
Drug: Cyclophosphamide

Trial contacts and locations

1

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Central trial contact

Wee Joo Chng, Prof; Sanjay de Mel, Dr

Data sourced from clinicaltrials.gov

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