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NCT01383928

Study of Oral IXAZOMIB in Combination With Lenalidomide and Dexamethasone in Participants With Newly Diagnosed Multiple Myeloma

Completed Phase 1, PHASE2 Results posted Last updated 21 March 2019
What this trial tests

Phase 1, PHASE2 trial testing Ixazomib in Multiple Myeloma in 64 participants. Completed in 27 November 2017.

Timeline
31 October 2011
Primary endpoint
13 October 2014
27 November 2017

Quick facts

Lead sponsorMillennium Pharmaceuticals, Inc.
PhasePhase 1, PHASE2
StatusCompleted
Study typeINTERVENTIONAL
Allocationnon randomized
Designsingle group
Maskingnone
Primary purposetreatment
Enrollment64
Start date31 October 2011
Primary completion13 October 2014
Estimated completion27 November 2017
Sites20 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

Millennium Pharmaceuticals, Inc. — full company profile →

Who can join

18 and older, any sex, with Multiple Myeloma. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Phase 1: Maximum Tolerated Dose (MTD) Primary · Cycle 1 (21 days)

MTD was highest dose of ixazomib given with combination drugs, at which \<=1 of 6 participants experienced dose-limiting toxicity (DLT) during Cycle 1 of Phase 1. DLT defined as any of following considered possibly related to therapy: Grade 4 neutropenia (absolute neutrophil count \[ANC\] \<500 cell per cubic millimeter \[cells/mm\^3\]) for \>7 days; Grade 3 neutropenia with fever or infection; Grade 4 thrombocytopenia for \>7 days; Grade 3 thrombocytopenia with clinically significant bleeding; platelet count \<10,000/mm\^3; Grade 2 peripheral neuropathy with pain or \>=Grade 3 peripheral neur

GroupValue95% CI
Phase 1: All Participants3.7
Phase 1: Recommended Phase 2 Dose (RP2D) Primary · Cycle 1 (21 days)

The RP2D of ixazomib was determined after the evaluation of the available data from the phase 1 portion of the trial which included, but was not limited to analyses of efficacy results, toxicity characterization, all grades peripheral neuropathy, and treatment discontinuation. The maximum number of cycles received was 83 cycles (approximately up to 2037 days).

GroupValue95% CI
Phase 1: All Participants3
Phase 1: Percentage of Participants Experiencing 1 or More Treatment-Emergent Adverse Events (TEAEs) or Serious Adverse Events (SAEs) Primary · Baseline up to 30 days after last dose of study drug (Up to Cycle 83 - approximately 2067 days)

An Adverse Event (AE) is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (example, a clinically significant abnormal laboratory finding), symptom, or disease temporally associated with the use of a drug, whether or not it is considered related to the drug. A SAE is an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospital

Adverse Event
GroupValue95% CI
Phase 1: Ixazomib 3 mg100
Phase 1: Ixazomib 3.7 mg100
Serious Adverse Event
GroupValue95% CI
Phase 1: Ixazomib 3 mg71
Phase 1: Ixazomib 3.7 mg29
Phase 1: Number of Participants With Markedly Abnormal Laboratory Values Reported as Treatment Emergent Adverse Events (TEAEs) Primary · Baseline up to 30 days after last dose of study drug (Up to Cycle 83 - approximately 2067 days)

Laboratory tests included chemistry, hematology and urinalysis. Abnormal laboratory value was assessed as an AE if the value lead to discontinuation or delay in treatment, dose modification, therapeutic intervention, or was considered by the investigator to be a clinically significant change from baseline. A treatment-emergent adverse event (TEAE) is defined as an adverse event with an onset that occurs after receiving study drug.

Alanine aminotransferase increased
GroupValue95% CI
Phase 1: Ixazomib 3 mg0
Phase 1: Ixazomib 3.7 mg3
Aspartate aminotransferase increased
GroupValue95% CI
Phase 1: Ixazomib 3 mg0
Phase 1: Ixazomib 3.7 mg2
Blood creatinine increased
GroupValue95% CI
Phase 1: Ixazomib 3 mg2
Phase 1: Ixazomib 3.7 mg0
Shift to the left
GroupValue95% CI
Phase 1: Ixazomib 3 mg0
Phase 1: Ixazomib 3.7 mg1
Platelet count decreased
GroupValue95% CI
Phase 1: Ixazomib 3 mg1
Phase 1: Ixazomib 3.7 mg0
Blood bicarbonate decreased
GroupValue95% CI
Phase 1: Ixazomib 3 mg1
Phase 1: Ixazomib 3.7 mg0
Anaemia
GroupValue95% CI
Phase 1: Ixazomib 3 mg1
Phase 1: Ixazomib 3.7 mg0
Neutropenia
GroupValue95% CI
Phase 1: Ixazomib 3 mg1
Phase 1: Ixazomib 3.7 mg0
Phase 1: Number of Participants With Treatment-Emergent Adverse Events (TEAE) Related to Neurotoxicity Primary · Baseline up to 30 days after last dose of study drug (Up to Cycle 83 - approximately 2067 days)

TEAE related to neurotoxicity grading based on common terminology criteria for adverse events (CTACE) version 4.03 are reported. Grade 1= mild; Grade 2= moderate; within normal limits, Grade 3= severe or medically significant but not immediately life-threatening; Grade 4= life-threatening consequences; urgent intervention indicated; Grade 5= death. Only TEAEs related to neurotoxicity with values are reported.

Neuropathy Peripheral (Grade 1)
GroupValue95% CI
Phase 1: Ixazomib 3 mg0
Phase 1: Ixazomib 3.7 mg1
Neuropathy Peripheral (Grade 2)
GroupValue95% CI
Phase 1: Ixazomib 3 mg2
Phase 1: Ixazomib 3.7 mg1
Neuropathy Peripheral (Grade 3)
GroupValue95% CI
Phase 1: Ixazomib 3 mg0
Phase 1: Ixazomib 3.7 mg1
Peripheral Sensory Neuropathy (Grade 1)
GroupValue95% CI
Phase 1: Ixazomib 3 mg2
Phase 1: Ixazomib 3.7 mg1
Peripheral Sensory Neuropathy (Grade 2)
GroupValue95% CI
Phase 1: Ixazomib 3 mg0
Phase 1: Ixazomib 3.7 mg1
Peripheral Sensory Neuropathy (Grade 3)
GroupValue95% CI
Phase 1: Ixazomib 3 mg1
Phase 1: Ixazomib 3.7 mg0
Peripheral Motor Neuropathy (Grade 1)
GroupValue95% CI
Phase 1: Ixazomib 3 mg1
Phase 1: Ixazomib 3.7 mg0
Phase 1: Number of Participants With Clinically Significant Change From Baseline in Vital Signs Primary · Baseline up to 30 days after last dose of study drug (Up to Cycle 83 - approximately 2067 days)

Vital signs included body temperature, blood pressure and heart rate.

Pyrexia
GroupValue95% CI
Phase 1: Ixazomib 3 mg1
Phase 1: Ixazomib 3.7 mg3
Bradycardia
GroupValue95% CI
Phase 1: Ixazomib 3 mg1
Phase 1: Ixazomib 3.7 mg0
Orthostatic hypotension
GroupValue95% CI
Phase 1: Ixazomib 3 mg0
Phase 1: Ixazomib 3.7 mg1
Hypotension
GroupValue95% CI
Phase 1: Ixazomib 3 mg1
Phase 1: Ixazomib 3.7 mg1
Phase 2: Percentage of Participants With Complete Response (CR) + Very Good Partial Response (VGPR) Primary · Baseline until end of treatment (Up to treatment Cycle 74 - approximately 1875 days)

CR as per International Myeloma Working Group (IMWG) uniform criteria is defined as negative immunofixation on the serum and urine and disappearance of soft tissue plasmacytomas and \<5% plasma cells in bone marrow. VGPR as per IMWG criteria is defined as serum and urine M-protein detectable by immunofixation but not on electrophoresis or 90% or greater reduction in serum M-protein plus urine M-protein level \<100 mg per 24 hours. VGPR was applicable only to participants who had measurable disease defined by at least 1 of the following 3 measurements: Serum M-protein greater than or equal to (

GroupValue95% CI
Phase 2: Ixazomib 3 mg6550.4 – 78.3
Phase 2: Percentage of Participants With Grade 3 or Higher Adverse Events Primary · Baseline up to 30 days after the last dose of study drug (approximately 1905 days)

An Adverse Event (AE) is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (example, a clinically significant abnormal laboratory finding), symptom, or disease temporally associated with the use of a drug, whether or not it is considered related to the drug. As per Common Terminology Criteria for Adverse Events v4.0 (CTCAE), Grade 3 = AE with severe or medically significant but not immediately life-threa

GroupValue95% CI
Phase 2: Ixazomib 3 mg74
Phase 2: Percentage of Participants Experiencing Serious Adverse Events Primary · Baseline up to 30 days after the last dose of study drug (approximately 1905 days)

A SAE is an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; or congenital anomaly; or a medically important event.

GroupValue95% CI
Phase 2: Ixazomib 3 mg46
Phase 2: Percentage of Participants With Treatment-Emergent Adverse Events Resulting in Study Drug Discontinuation Primary · Baseline up to 30 days after the last dose of study drug (approximately 1905 days)

An Adverse Event (AE) is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (example, a clinically significant abnormal laboratory finding), symptom, or disease temporally associated with the use of a drug, whether or not it is considered related to the drug. A TEAE is defined as an adverse event with an onset that occurs after receiving study drug.

GroupValue95% CI
Phase 2: Ixazomib 3 mg14
Phase 1: Cmax: Maximum Plasma Concentration for Ixazomib Secondary · Cycle 1, Days 1 and 11

Maximum observed plasma concentration (Cmax) is the peak plasma concentration of ixazomib, obtained directly from the plasma concentration-time curve.

Day 1
GroupValue95% CI
Phase 1: Ixazomib 3 mg33.515± 22.9634
Phase 1: Ixazomib 3.7 mg46.946± 26.6436
Day 11
GroupValue95% CI
Phase 1: Ixazomib 3 mg58.674± 19.9559
Phase 1: Ixazomib 3.7 mg51.832± 23.5112
Phase 1: AUC(0-72): Area Under the Plasma Concentration-Time Curve From Time 0 to 72 Hours Postdose for Ixazomib Secondary · Cycle 1, Days 1 and 11

AUC(0-72) is a measure of the area under the plasma concentration time-curve from time zero to 72 hours post-dose for ixazomib.

Day 1
GroupValue95% CI
Phase 1: Ixazomib 3 mg315.450± 75.0886
Phase 1: Ixazomib 3.7 mg284.576± 47.8233
Day 11
GroupValue95% CI
Phase 1: Ixazomib 3 mg1105.44± 457.5939
Phase 1: Ixazomib 3.7 mg1023.52± 284.3709

Adverse events — posted to ClinicalTrials.gov

Time frame: From first study drug administration up to 30 days after the last dose (Up to approximately 2067 days). Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Phase 1: Ixazomib 3 mg
Serious: 5/7 (71%)
Deaths: 0/7
Phase 1: Ixazomib 3.7 mg
Serious: 2/7 (29%)
Deaths: 0/7
Phase 2: Ixazomib 3.0 mg
Serious: 23/50 (46%)
Deaths: 1/50

Serious adverse events (50 terms)

ReactionSystemPhase 1: Ixazomib 3 mgPhase 1: Ixazomib 3.7 mgPhase 2: Ixazomib 3.0 mg
PneumoniaInfections and infestations
Lung infectionInfections and infestations
CellulitisInfections and infestations
Atrial fibrillationCardiac disorders
Skin infectionInfections and infestations
Subcutaneous abscessInfections and infestations
InfluenzaInfections and infestations
Scrotal infectionInfections and infestations
Infective myositisInfections and infestations
SepsisInfections and infestations
Urinary tract infectionInfections and infestations
Guillain-Barre syndromeNervous system disorders
SyncopeNervous system disorders
HeadacheNervous system disorders
AmnesiaNervous system disorders
Cognitive disorderNervous system disorders
Neuropathy peripheralNervous system disorders
Atrial flutterCardiac disorders
Cardiac failureCardiac disorders
Cardio-respiratory arrestCardiac disorders
DyspepsiaGastrointestinal disorders
Abdominal painGastrointestinal disorders
Intestinal perforationGastrointestinal disorders
VomitingGastrointestinal disorders
Femur fractureInjury, poisoning and procedural complications
Other adverse events (171 terms — click to expand)

ReactionSystemPhase 1: Ixazomib 3 mgPhase 1: Ixazomib 3.7 mgPhase 2: Ixazomib 3.0 mg
FatigueGeneral disorders
DiarrhoeaGastrointestinal disorders
Oedema peripheralGeneral disorders
NauseaGastrointestinal disorders
ConstipationGastrointestinal disorders
DysgeusiaNervous system disorders
Upper respiratory tract infectionInfections and infestations
Neuropathy peripheralNervous system disorders
InsomniaPsychiatric disorders
Pain in extremityMusculoskeletal and connective tissue disorders
Rash maculo-papularSkin and subcutaneous tissue disorders
HypokalaemiaMetabolism and nutrition disorders
DizzinessNervous system disorders
ArthralgiaMusculoskeletal and connective tissue disorders
Vision blurredEye disorders
Back painMusculoskeletal and connective tissue disorders
AnxietyPsychiatric disorders
VomitingGastrointestinal disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
Muscle spasmsMusculoskeletal and connective tissue disorders
HeadacheNervous system disorders
Peripheral sensory neuropathyNervous system disorders
CoughRespiratory, thoracic and mediastinal disorders
AstheniaGeneral disorders
HypophosphataemiaMetabolism and nutrition disorders
Peripheral swellingGeneral disorders
Muscular weaknessMusculoskeletal and connective tissue disorders
Dry mouthGastrointestinal disorders
SinusitisInfections and infestations
PyrexiaGeneral disorders
TremorNervous system disorders
HypoaesthesiaNervous system disorders
AlopeciaSkin and subcutaneous tissue disorders
Oropharyngeal painRespiratory, thoracic and mediastinal disorders
Decreased appetiteMetabolism and nutrition disorders
Musculoskeletal painMusculoskeletal and connective tissue disorders
Viral upper respiratory tract infectionInfections and infestations
Abdominal distensionGastrointestinal disorders
RashSkin and subcutaneous tissue disorders
Night sweatsSkin and subcutaneous tissue disorders

Most-reported serious reactions: Pneumonia, Lung infection, Cellulitis, Atrial fibrillation, Skin infection, Subcutaneous abscess, Influenza, Scrotal infection.

Data from ClinicalTrials.gov NCT01383928 adverse events section.

Sponsor's own description

The purpose of this study is to determine the safety, tolerability, maximum tolerated dose (MTD), and recommended phase 2 dose (RP2D) in phase 1 and to determine the combined response rate of clinical response CR and very good partial response (VGPR) in phase 2 of oral (PO) ixazomib administered twice-weekly in combination with lenalidomide and low-dose dexamethasone in a 21-day cycle in participants with newly diagnosed multiple myeloma (NDDM).

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Phase 1 study of twice-weekly ixazomib, an oral proteasome inhibitor, in relapsed/refractory multiple myeloma patients.
    Richardson PG, Baz R, Wang M, Jakubowiak AJ, et al · · 2014 · cited 162× · PMID 24920586 · DOI 10.1182/blood-2014-01-548826
  2. Spotlight on ixazomib: potential in the treatment of multiple myeloma.
    Muz B, Ghazarian RN, Ou M, Luderer MJ, et al · · 2016 · cited 87× · PMID 26811670 · DOI 10.2147/dddt.s93602
  3. Population Pharmacokinetic Analysis of Ixazomib, an Oral Proteasome Inhibitor, Including Data from the Phase III TOURMALINE-MM1 Study to Inform Labelling.
    Gupta N, Diderichsen PM, Hanley MJ, Berg D, et al · · 2017 · cited 31× · PMID 28290121 · DOI 10.1007/s40262-017-0526-4
  4. Lenalidomide for the treatment of relapsed and refractory multiple myeloma.
    van de Donk NW, Görgün G, Groen RW, Jakubikova J, et al · · 2012 · cited 30× · PMID 22956884 · DOI 10.2147/cmar.s27087
  5. The role of high-dose melphalan with autologous stem-cell transplant in multiple myeloma: is it time for a paradigm shift?
    Kazandjian D, Mo CC, Landgren O, Richardson PG. · · 2020 · cited 25× · PMID 32501533 · DOI 10.1111/bjh.16764
  6. Twice-weekly ixazomib in combination with lenalidomide-dexamethasone in patients with newly diagnosed multiple myeloma.
    Richardson PG, Hofmeister CC, Rosenbaum CA, Htut M, et al · · 2018 · cited 24× · PMID 29938772 · DOI 10.1111/bjh.15394
  7. Lenalidomide use in multiple myeloma (Review).
    Zhang CW, Wang YN, Ge XL. · · 2024 · cited 16× · PMID 38125742 · DOI 10.3892/mco.2023.2705
  8. 19th Congress of the European Hematology Association, Milan, Italy, June 12–15, 2014
    · 2014

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