A Study of Atezolizumab (Anti-Programmed Death-Ligand 1 [PD-L1] Antibody) Alone or in Combination With an Immunomodulatory Drug and/or Daratumumab in Participants With Multiple Myeloma (MM)

NCT02431208 — Phase 1, Completed, 85 participants, Hoffmann-La Roche

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A Phase Ib Study of the Safety and Pharmacokinetics of Atezolizumab (Anti-PD-L1 Antibody) Alone or in Combination With an Immunomodulatory Drug and/or Daratumumab in Patients With Multiple Myeloma (Relapsed/Refractory and Post-Autologous Stem Cell Transplantation)

RegistryNCT02431208
StatusCompleted
PhasePhase 1
Study typeInterventional; non randomized, parallel, masking: none, treatment
Enrollment85 (Actual)
SponsorHoffmann-La Roche (Industry)
ConditionsMultiple Myeloma
InterventionsAtezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody, Daratumumab, Lenalidomide, Pomalidomide, Dexamethasone (Drug)
Datesstart 2015-07-22, primary completion 2021-03-19, completion 2021-03-19, first posted 2015-04-30, last updated 2021-04-02
Locations31 sites in United States

Related Papers Related Patents Related Grants Related Experts
All trials for Multiple Myeloma All trials of Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody All trials of Daratumumab

-Summary

This multicenter, open-label, Phase I study will evaluate the safety, efficacy, and pharmacokinetics of atezolizumab alone or in combination with daratumumab and/or various immunomodulatory agents in participants with MM who have relapsed or who have undergone autologous stem cell transplantation (ASCT). Cycle length will be 21 days in Cohorts A to C and 28 days in Cohorts D to F.

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+Arms and interventions

ArmTypeInterventionsDescription
Cohort A: ATZ (Run-In)ExperimentalDrug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibodyCohort A will involve a safety run-in to evaluate atezolizumab administered as a single agent in participants with relapsed or refractory MM who have received up to 3 lines of prior treatment. NOTE: This cohort has been completed.
Cohort B1: ATZ + LEN (Dose Escalation)ExperimentalDrug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody; Drug: LenalidomideCohort B1 will involve a dose escalation to evaluate atezolizumab administered in combination with ascending-dose lenalidomide in participants with relapsed or refractory MM who have received up to 3 lines of prior treatment. NOTE: This cohort has been completed.
Cohort C: ATZ + LEN (Post-ASCT):ExperimentalDrug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody; Drug: LenalidomideCohort C will evaluate atezolizumab administered in combination with lenalidomide in participants with MM who have measureable disease after ASCT. NOTE: This cohort is closed to enrollment.
Cohort D1: ATZ + DAR (Run-in)ExperimentalDrug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody; Drug: DaratumumabCohort D1 will involve a safety run-in to evaluate atezolizumab administered in combination with daratumumab in participants with relapsed or refractory MM who have received up to 3 lines of prior treatment.
Cohort D2: ATZ + DAR (Expansion)ExperimentalDrug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody; Drug: DaratumumabCohort D2 will involve an expansion to evaluate atezolizumab administered in combination with daratumumab in participants with relapsed or refractory MM who have received 2 but no more than 3 lines of prior treatment that must have included a PI and IMiD and are refractory to the last line of treatment.
Cohort D3: ATZ + DAR (Progressed)ExperimentalDrug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody; Drug: DaratumumabCohort D3 will involve an expansion to evaluate atezolizumab in combination with daratumumab in participants with relapsed or refractory MM who have received 2 or more lines of prior treatment and have progressed with an anti-cluster of differentiation (CD) 38 monoclonal antibody, either alone or in combination, and are refractory to both a proteasome inhibitor (PI) and immunomodulatory drug (IMiD).
Cohort E1: ATZ + DAR + LEN (Dose Escalation)ExperimentalDrug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody; Drug: Daratumumab; Drug: LenalidomideCohort E1 will involve a dose escalation to evaluate atezolizumab administered in combination with daratumumab and ascending-dose lenalidomide in participants with relapsed or refractory MM who have received up to 3 lines of prior treatment. NOTE: This cohort is closed to enrollment.
Cohort E2: ATZ + DAR + LEN (Expansion)ExperimentalDrug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody; Drug: Daratumumab; Drug: LenalidomideCohort E2 will involve an expansion to evaluate atezolizumab administered in combination with daratumumab and the maximum tolerated dose (MTD) of lenalidomide determined in Cohort E1 in participants with relapsed or refractory MM who have received up to 3 lines of prior treatment. NOTE: This cohort is closed to enrollment.
Cohort F1: ATZ + DAR + POM (Dose Escalation)ExperimentalDrug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody; Drug: Daratumumab; Drug: PomalidomideCohort F1 will involve a dose escalation to evaluate atezolizumab administered in combination with daratumumab and ascending-dose pomalidomide in participants with relapsed or refractory MM who have received 4 or more lines of prior treatment and are refractory to the last line of treatment. NOTE: This cohort has been completed.
Cohort F2: ATZ + DAR + POM (Expansion)Active comparatorDrug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody; Drug: Daratumumab; Drug: PomalidomideCohort F2 will involve an expansion to evaluate atezolizumab administered in combination with daratumumab and the MTD of pomalidomide determined in Cohort F1 in participants with relapsed or refractory MM who have received 4 or more lines of prior treatment and are refractory to the last line of treatment. NOTE: This cohort is randomized.
Cohort F3: DAR + POM + DexamethasoneActive comparatorDrug: Daratumumab; Drug: Pomalidomide; Drug: DexamethasoneCohort F3 is an expansion control arm for cohort F2. Participants will receive daratumumab in combination with pomalidomide at the MTD and dexamethasone. NOTE: This cohort is randomized.
  • Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody (Drug), also known as Tecentriq, MPDL3280A, "ATZ": Participants will receive intravenous (IV) atezolizumab until loss of clinical benefit, withdrawal, or study end. Cohorts A to C will receive 1200 milligrams (mg) on Day 1 of each 21-day cycle. Cohorts D to F (combination with daratumumab) will receive 840 mg on Days 2 and 16 of Cycle 1 and on Days 1 and 15 of each 28-day cycle thereafter.
  • Daratumumab (Drug), also known as Darzalex, "DAR": Participants will receive 16 milligrams per kilogram (mg/kg) IV daratumumab until loss of clinical benefit, withdrawal, or study end. Treatment will be per the U.S. Package Insert and given on Days 1, 8, 15, 22 of Cycles 1 and 2; on Days 1 and 15 of Cycles 3 to 6; and on Day 1 of each 28-day cycle thereafter.
  • Lenalidomide (Drug), also known as Revlimid, "LEN": Lenalidomide will be administered orally (PO) until loss of clinical benefit, withdrawal, or study end. Cohort B1 will receive 10, 15, or 25 mg, ascending-dose lenalidomide, on Days 1-14 of each 21-day cycle. Cohort C will receive 10 mg on Days 1-14 of each 21-day cycle, beginning in Cycle 4. Cohort E (combination with daratumumab) will receive 10, 15, or 25 mg on Days 1-21 of each 28-day cycle. Participants in Cohort E1 will receive ascending-dose lenalidomide, and those in Cohort E2 will receive lenalidomide at the MTD as determined in Cohort E1.
  • Pomalidomide (Drug), also known as Pomalyst, "POM": Pomalidomide will be administered PO until loss of clinical benefit, withdrawal, or study end. Cohort F (combination with daratumumab) will receive 2 or 4 mg on Days 1-21 of each 28-day cycle. Participants in Cohort F1 will receive ascending-dose pomalidomide, and those in Cohort F2 will receive pomalidomide at the MTD as determined in Cohort F1.
  • Dexamethasone (Drug): Participants will receive either 20mg or 40mg of dexamethasone PO every 7 days from Day 1 of each cycle.

+Outcome measures

Primary outcomes

  • Percentage of Participants by Best Overall Response According to International Myeloma Working Group (IMWG) Criteria [From Day 1 of Cycle 2 (cycle = 21 or 28 days) until progression, withdrawal, or study end (up to 36 months overall)]
  • Recommended Phase II Dose (RP2D) of Lenalidomide in the Combinations Tested [From start of treatment until 30 days after last dose (up to approximately 36 months)]
  • RP2D of Pomalidomide in the Combinations Tested [From start of treatment until 30 days after last dose (up to approximately 36 months)]
  • Number of Participants With Adverse Events (AEs) or Serious Adverse Events (SAEs) [From start of treatment until 30 days after last dose (up to approximately 36 months)]

Secondary outcomes

  • Duration of Response (DOR) According to IMWG Criteria [From first observed response until the date of first recorded progression or death from any cause (up to 36 months overall)]
  • Progression-Free Survival (PFS) According to IMWG Criteria [From start of treatment until the date of first recorded progression or death from any cause (up to 36 months overall)]
  • Percentage of Participants with Objective Response According to IMWG Criteria [From Day 1 of Cycle 2 until progression, withdrawal, or study end (up to 36 months overall). For Cohort D3 Only: 6, 9, and 12 months.]
  • Overall Survival [From start of treatment until death from any cause (up to 36 months overall)]
  • Maximum Observed Serum Concentration (Cmax) of Atezolizumab [From predose (0 hours [h]) on Day 1 of Cycle 1 until treatment discontinuation (up to 36 months overall); see Outcome Measure Description for details]: Predose (0 h) and postdose (0.5 h) (infusion = 0.5-1 h) on Day 1 of Cycles 1, 3 (cycle = 21 or 28 days) and Day 2 of Cycle 1; predose (0 h) on Day 1 of Cycles 2, 4, 8; then every 8 cycles until/at treatment discontinuation (up to 36 months); and 90 days after last dose (up to 36 months overall)
  • Minimum Observed Serum Concentration (Cmin) of Atezolizumab [Predose (0 h) on Day 1 of Cycles 1, 2, 3, 4, 8 (cycle = 21 or 28 days) and Day 2 of Cycle 1; then every 8 cycles until/at treatment discontinuation (up to 36 months); and 90 days after last dose (up to 36 months overall)]
  • Cmax of Lenalidomide [Predose (0 h) and postdose (1 h) on Day 1 of Cycles 1, 4 (cycle = 21 days); predose (0 h) and postdose (0.5, 1, 2, 4, 8 h) on Day 15 of Cycles 1, 3; predose (0 h) and postdose (2 h) on Day 15 of Cycles 2, 4, 8]
  • Cmin of Lenalidomide [Predose (0 h) on Day 1 of Cycles 1, 4 (cycle = 21 days) and Day 15 of Cycles 1, 2, 3, 4, 8]
  • Cmax of Pomalidomide [Predose (0 h) and postdose (1, 2, 4, 6, 8 h) on Day 15 of Cycles 1, 3 (cycle = 28 days); predose (0 h) and postdose (4 h) on Day 15 of Cycles 2, 4, 8]
  • Cmin of Pomalidomide [Predose (0 h) on Day 15 of Cycles 1, 2, 3, 4, 8 (cycle = 28 days)]
  • Cmax of Daratumumab [From predose (0 h) on Day 1 of Cycle 1 until treatment discontinuation (up to 36 months overall); see Outcome Measure Description for details]: Predose (0 h) and postdose (0.5 h) (infusion \~3-6 h) on Day 1 of Cycles 1, 3 (cycle = 28 days); predose (0 h) on Day 1 of Cycles 2, 4, 8; then every 8 cycles until/at treatment discontinuation (up to 36 months); and 90 days after last dose (up to 36 months overall)
  • Cmin of Daratumumab [Predose (0 h) on Day 1 of Cycles 1, 2, 3, 4, 8 (cycle = 28 days); then every 8 cycles until/at treatment discontinuation (up to 36 months); and 90 days after last dose (up to 36 months overall)]
  • Change in Number of Participants With Anti-Drug Antibody (ADA) Response to Atezolizumab from Baseline to End of Study [From treatment start until study end (up to 36 months overall); see Outcome Measure Description for details]: From treatment start until study end; assessed predose (0 h) on Day 1 of Cycles 1, 2, 3, 4, 8 (cycle = 21 or 28 days) and Day 2 of Cycle 1; then every 8 cycles until/at treatment discontinuation (up to 36 months); and 90 days after last dose (up to 36 months overall)
  • Change in Number of Participants With ADA Response to Daratumumab from Baseline to End of Study [From treatment start until study end; assessed predose (0 h) on Day 1 of Cycles 1, 3, 8 (cycle = 28 days); at treatment discontinuation (up to 36 months); and 90 days after last dose (up to 36 months overall)]

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Previous diagnosis of MM with objective evidence of measurable disease
* Willing and able to undergo bone marrow aspiration and biopsy tissue sample collection during screening and on study
* Eastern Cooperative Oncology Group (ECOG) performance status score less than or equal to (</=) 2
* Left ventricular ejection fraction (LVEF) greater than or equal to (>/=) 40 percent (%)
* Total bilirubin </=2 times the ULN
* Creatinine </=2.0 milligrams per deciliter (mg/dL), with creatinine clearance (CrCl) using the Cockcroft-Gault formula >/=40 milliliters per minute (mL/min) or 60 mL/min for those who receive lenalidomide
* Corrected calcium at or below ULN
* Transaminase levels </=2.5 times the upper limit of normal (ULN)
* Receipt of >/=1 but not more than 3 prior lines of therapy (Cohorts A, B, C, D1, E)
* Receipt of 2, but not more that 3 prior lines of therapy that must have included a proteasome inhibitor (PI) and immunomodulatory drug (IMiD) (alone or in combination, and are refractory to the last line of treatment(Cohort D2)
* Receipt of >/=2 prior lines of therapy and progressed on treatment with an anti-CD38 monoclonal antibody and are refractory to both a PI and IMiD (Cohort D3)
* Receipt of >/=4 lines of prior therapy and are refractory to the last line of treatment (Cohort F)
* Absolute neutrophil count (ANC) >/=1000 cells per microliter (cells/mcL) (Cohorts A, B, D, E, F)
* Platelet count >/=50,000 cells/mcL, or >/=30,000 cells/mcL if more than 50% bone marrow involvement (Cohorts A, B, D, E, F)
* All participants who are prescribed lenalidomide or pomalidomide must be counseled at a minimum of every 21-28 days about pregnancy precautions and risks of fetal exposure (Cohorts B, C, E, F)
* Agree to be registered in and comply with all requirements of the Revlimid Risk Evaluation and Mitigation Strategy (REMS) program (Cohorts B, C, E)
* Agree to be registered in and comply with all requirements of the Pomalyst REMS program (Cohort F)
* Sufficient recovery from first or second ASCT within 60-120 days of transplant (Cohort C)
* Off antibiotic/antifungal therapy for >/=14 days (Cohort C)
* Completion of any prior radiotherapy (Cohort C)
* ANC >/=1500 cells/mcL (Cohort C)

Exclusion Criteria:

* Other malignancy within 2 years prior to screening, with some exceptions
* Prior therapy with atezolizumab or other immunotherapies including CD137 agonists, anti-programmed death (PD)-1, anti-cytotoxic T-lymphocyte associated protein 4 (CTLA-4), and anti-PD-L1 therapeutic antibodies
* Uncontrolled cancer pain
* Treatment with any investigational drug within 30 days or 5 half-lives of the investigational drug, whichever is longer
* Known hypersensitivity to study drug and/or drug class
* History of autoimmune disease except for controlled, treated thyroidism or Type 1 diabetes
* Prior systemic anti-myeloma therapy within 14 days of Cycle 1 Day 1
* Prior treatment with chimeric antigen receptor (CAR) T cells or other forms of adoptive cellular therapy, with the exception of autologous stem cell transplantation
* Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome
* Plasma cell leukemia (greater than 2,000 cells/mcL of circulating plasma cells by standard differential)
* Immunosuppressive therapy within 6 weeks of Cycle 1 Day 1
* Daily corticosteroid requirement within 2 weeks of Cycle 1 Day 1
* Prior allogeneic stem cell transplant or solid organ transplant
* Active hepatitis B, active hepatitis C, or positive for human immunodeficiency virus (HIV)
* Uncontrolled, clinically significant pulmonary disease (for example, chronic obstructive pulmonary disease, pulmonary hypertension, idiopathic pulmonary fibrosis) that in the opinion of the investigator would put the participant at significant risk for pulmonary complications during the study
* History of pneumonitis
* Uncontrolled intercurrent illness including but not limited to uncontrolled infection, disseminated intravascular coagulation, or psychiatric illness/social situations that would limit compliance with study requirements
* Pregnant or breastfeeding females
* Inability to tolerate thromboprophylaxis (Cohorts B, C, E, F)
* Evidence of progressive MM compared to pretransplant evaluation (Cohort C)
* Prior treatment with anti-CD38 therapy including daratumumab (Cohorts D1, D2, E, F)

+Locations (31)

FacilityCityCountryStatus
University of Alabama at BirminghamBirmingham, AlabamaUnited States
University Of ArkansasLittle Rock, ArkansasUnited States
Scripps Clinic Torrey PinesLa Jolla, CaliforniaUnited States
UC Davis; Comprehensive Cancer CenterSacramento, CaliforniaUnited States
University of California, San FranciscoSan Francisco, CaliforniaUnited States
Yale UniversityNew Haven, ConnecticutUnited States
Mayo Clinic Hospital - FloridaJacksonville, FloridaUnited States
Emory Univ Winship Cancer InstAtlanta, GeorgiaUnited States
Loyola University Med CenterMaywood, IllinoisUnited States
Indiana University Health; Goshen Center for Cancer CareGoshen, IndianaUnited States
Indiana University Department of Medicine; IU Simon Cancer CenterIndianapolis, IndianaUnited States
University of LouisvilleLouisville, KentuckyUnited States
University of Maryland School of MedicineBaltimore, MarylandUnited States
Massachusetts General HospitalBoston, MassachusettsUnited States
Beth Israel Deaconess Med Ctr; Hem/OncBoston, MassachusettsUnited States
Univ of Michigan Medical CtrAnn Arbor, MichiganUnited States
Karmanos Cancer Institute.Detroit, MichiganUnited States
Henry Ford Hospital; Hematology OncologyDetroit, MichiganUnited States
Washington University School of MedicineSt Louis, MissouriUnited States
Comprehensive Cancer Centers of NevadaHenderson, NevadaUnited States
Mount SInai Medical CenterNew York, New YorkUnited States
Memorial Sloan-Kettering Cancer CenterNew York, New YorkUnited States
UNC Chapel HillChapel Hill, North CarolinaUnited States
Cleveland Clinic FoundationCleveland, OhioUnited States
University of Oklahoma Health Sciences Center; Stephenson Cancer CenterOklahoma City, OklahomaUnited States
Lifespan Cancer InstituteProvidence, Rhode IslandUnited States
Medical University of South Carolina; Hollings Cancer CenterCharleston, South CarolinaUnited States
Texas Oncology-Baylor Sammons Cancer CenterDallas, TexasUnited States
UT Southwestern MC at DallasDallas, TexasUnited States
Houston Methodist Cancer CenterHouston, TexasUnited States
Seattle Cancer Care AllianceSeattle, WashingtonUnited States

+Publications

  • Results publication: Wong S, Hamidi H, Costa LJ, Bekri S, Neparidze N, Vij R, Nielsen TG, Raval A, Sareen R, Wassner-Fritsch E, Cho HJ. Multi-omic analysis of the tumor microenvironment shows clinical correlations in Ph1 study of atezolizumab +/- SoC in MM. Front Immunol. 2023 Jul 25;14:1085893. doi: 10.3389/fimmu.2023.1085893. eCollection 2023. PMID 37559718

+Investigators

  • Clinical Trials, Study director, Hoffmann-La Roche