Ensayos clínicos

Inclusion Criteria:

• Male or female patients 18 years of age or older.
• Multiple myeloma diagnosed according to standard criteria either currently or at the time of initial diagnosis
  • NOTE: The initial diagnosis must be symptomatic MM, although the relapsed disease does not need to be symptomatic.
• Patients must have measurable disease defined by at least 1 of the following 3 measurements:
  • Serum M-protein ≥ 1 g/dL ( ≥10 g/L)
  • Urine M-protein ≥ 200 mg/24 hours
  • Serum free light chain assay: involved free light chain level ≥ 10 mg/dL ( ≥ 100 mg/L), provided that the serum free light chain ratio is abnormal
• Patients with relapsed and/or refractory MM who have received 1 to 3 prior therapies
  • NOTE: This patient population includes the following 3 categories of patients:
    • Patients who relapsed from their previous treatment(s) but were not refractory to any previous treatment 
    • Patients who were refractory to all lines of previous treatment(s) (ie, patients who have never responded to any therapies received)
    • Patients who were relapsed from at least 1 previous treatment AND additionally were refractory to at least 1 previous treatment.
  • For the purposes of this study, refractory disease is defined as disease progression on treatment or progression within 60 days after the last dose of a given therapy
  • A line of therapy is defined as 1 or more cycles of a planned treatment program. This may consist of 1 or more planned cycles of single-agent therapy or combination therapy, as well as a sequence of treatments administered in a planned manner. For example, a planned treatment approach of induction therapy followed by autologous stem cell transplantation, followed by maintenance is considered 1 line of therapy
  • Autologous and allogenic transplants are permitted
• Patients must meet the following clinical laboratory criteria: 
  • Absolute neutrophil count (ANC) ≥ 1,000/mm3 
  • Platelet count ≥75,000/mm3
    • Platelet transfusions to help patients meet eligibility criteria are not allowed within 3 days prior to randomization
  • Total bilirubin ≤1.5 times the upper limit of the normal range (ULN)
  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤3 times ULN.
  • Calculated creatinine clearance ≥ 30 mL/min
    • NOTE: Patients with a low creatinine clearance ≤ 60 mL/min (or ≤ 50 mL/min, according to local label/practice) will receive a reduced lenalidomide dose of 10 mg once daily on Days 1 through 21 of a 28-day cycle
    • The lenalidomide dose may be escalated to 15 mg once daily after 2 cycles if the patient is not responding to treatment and is tolerating the treatment
    • If renal function normalizes (ie, creatinine clearance > 60 mL/min or > 50 mL/min, according to local label/practice) and the patient continues to tolerate this treatment, lenalidomide may then be escalated to 25 mg once daily.
• ECOG performance status of 0, 1, or 2.
• Patients who received prior allogenic transplant must have no active graft-versus-host disease (GVHD).
• Female patients who:
  • Are postmenopausal for at least 24 months before the screening visit, OR
  • Are surgically sterile, OR
  • Females of childbearing potential must:
    • Have a negative pregnancy test with a sensitivity of at least 25 mIU/mL within 10 to 14 days and again within 24 hours prior to starting Cycle 1 of lenalidomide 
    • Either agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the patient. (Periodic abstinence [eg, calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.) OR
    • Begin TWO reliable methods of birth control: 1 highly effective method and 1 additional effective method AT THE SAME TIME, at least 28 days before starting study drug through 90 days after the last dose of study treatment
    • Agree to ongoing pregnancy testing 
    • Adhere to the guidelines of the RevAssist program (United States [US] participants), RevAid program (Canadian participants), iAccess program (Australian participants), RevMate program (Japanese participants) or The Lenalidomide Pregnancy Risk Minimisation Plan as outlined in the Study Manual (all other participants who are not using commercial supplies)
  • Male patients, even if surgically sterilized (ie, status postvasectomy), must: 
    • Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the patient. (Periodic abstinence [eg, calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.) OR
    • Agree to practice effective barrier contraception during the entire study treatment period and 90 days after the last dose of study treatment if their partner is of childbearing potential, even if they have had a successful vasectomy, AND
    • Adhere to the guidelines of the RevAssist program (US participants); RevAid program (Canadian participants), iAccess program (Australian participants), RevMate program (Japanese participants) or The Lenalidomide Pregnancy Risk Minimisation Plan as outlined in the study Manual (all other participants who are not using commercial supplies)
• Must be able to take concurrent aspirin 81 to 325 mg daily (or enoxaparin 40 mg subcutaneously daily [or its equivalent] if allergic to aspirin), per published standard or institutional standard of care, as prophylactic anticoagulation.
  • NOTE: For patients with prior history of DVT, low molecular weight heparin (LMWH) is mandatory.
•  Voluntary written consent must be given before performance of any study related procedure not part of standard medical care, with the understanding that consent may be withdrawn by the patient at any time without prejudice to future medical care.
• Patient is willing and able to adhere to the study visit schedule and other protocol requirements.

Exclusion Criteria:

• Patient was refractory to lenalidomide or proteasome inhibitor-based therapy at any line
  • NOTE: Refractory disease defined as disease progression on treatment or progression within 60 days after the last dose of a given therapy.
  • Patients who progress after 60 days from the last dose of a given therapy will be considered relapsed and are eligible for inclusion in the study. Patients who were refractory to thalidomide-based therapy are eligible
• Female patients who are breast feeding or pregnant.
• Failure to have fully recovered (ie, ≤ Grade 1 toxicity) from the effects of prior chemotherapy (except for alopecia) regardless of the interval since last treatment.
• Major surgery within 14 days before randomization.
• Radiotherapy within 14 days before randomization.
• Central nervous system involvement.
• Infection requiring systemic antibiotic therapy or other serious infection within 14 days before randomization.
• Diagnosis of
  • Waldenstrom's macroglobulinemia
  • POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome
  • Plasma cell leukemia
  • Primary amyloidosis
  • Myelodysplastic syndrome
  • Myeloproliferative syndrome.
• Evidence of current uncontrolled cardiovascular conditions, including
  • Uncontrolled hypertension
  • Uncontrolled cardiac arrhythmias
  • Symptomatic congestive heart failure
  • Unstable angina
  • Myocardial infarction within the past 6 months.
• Systemic treatment with
  • strong inhibitors of CYP1A2 (fluvoxamine, enoxacin, ciprofloxacin)
  • strong inhibitors of CYP3A (clarithromycin, telithromycin, itraconazole, voriconazole, ketoconazole, nefazodone, posaconazole) 
  • strong CYP3A inducers (rifampin, rifapentine, rifabutin, carbamazepine, phenytoin, phenobarbital)
  • Ginkgo biloba or St. John's wort within 14 days before randomization in the study.
• Ongoing or active systemic infection, active hepatitis B or C virus infection, or known human immunodeficiency virus (HIV) positive.
• Comorbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens (eg, peripheral neuropathy that is Grade 1 with pain or Grade 2 or higher of any cause).
• Psychiatric illness/social situation that would limit compliance with study requirements.
• Known allergy to any of the study medications, their analogues, or excipients in the various formulations of any agent.
• Inability to swallow oral medication, inability or unwillingness to comply with the drug administration requirements, or gastrointestinal (GI) condition that could interfere with the oral absorption or tolerance of treatment.
• Diagnosed or treated for another malignancy within 2 years before randomization or previously diagnosed with another malignancy and have any evidence of residual disease. Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection.