E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10028228 |
E.1.2 | Term | Multiple myeloma |
E.1.2 | System Organ Class | 100000004864 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To compare the efficacy of daratumumab when combined with VELCADE and dexamethasone (DVd) to that of VELCADE and dexamethasone (Vd), in terms of progression-free survival (PFS) in subjects with relapsed or refractory multiple myeloma. |
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E.2.2 | Secondary objectives of the trial |
The major secondary objectives are as follows:
- To evaluate clinical outcomes including time to disease progression (TTP), overall response rate (ORR), and overall survival (OS).
- To evaluate the proportion of subjects with a response of very good partial response (VGPR) or better.
- To evaluate duration of and time to response.
- To assess the safety and tolerability of daratumumab when administered in combination with Vd.
- To assess Minimal Residual Disease (MRD) in subjects who achieve ≥VGPR.
- To assess the pharmacokinetics of daratumumab in combination with Vd.
- To assess the immunogenicity of daratumumab.
-To assess the immunogenicity of rHuPH20 in subjects receiving
daratumumab SC.
- To evaluate treatment effects on patient reported outcomes (PROs) including the EuroQol-5 Dimensions (EQ-5D-5L) and EORTC QLQ-C30.
- To evaluate clinical efficacy of DVd in high risk molecular subgroups (del17p, t(4;14), t(14;20), UAMS-70). |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Subject must be at least 18 years of age.
2.Subject must have had documented multiple myeloma as defined by the criteria below:
● Monoclonal plasma cells in the bone marrow 10% at some point in their disease history, or presence of a biopsy-proven plasmacytoma.
●Measurable disease at Screening as defined by any of the following:
-IgG multiple myeloma: Serum monoclonal paraprotein (M-protein) level ≥1.0 g/dL or urine M-protein level ≥200 mg/24 hours; or
-IgA, IgD, IgE, IgM multiple myeloma: serum M-protein level ≥0.5 g/dL or urine M-protein level ≥200 mg/24 hours; or
- Light chain multiple myeloma without measurable disease in the serum or the urine:
Serum immunoglobulin free light chain ≥10 mg/dL and abnormal serum immunoglobulin kappa lambda free light chain ratio.
3. Subject must have received at least 1 prior line of therapy for multiple myeloma . NOTE: A "line of therapy" is defined as 1 or more cycles of a planned treatment program.
4. Subject must have documented evidence of progressive disease (PD) based on investigator's determination of response by the IMWG criteria on or after their last regimen.
5.Subject must have achieved a response (partial response [PR] or better based on investigator's determination of response by the IMWG criteria) to at least 1 prior regimen in the past (refer to Attachment 1).
6. Subject must have an ECOG Performance Status score of 0, 1, or 2
7. For subjects experiencing toxicities resulting from previous therapy (including peripheral neuropathy), the toxicities must be resolved or stabilized to ≤Grade 1.
8. Women of childbearing potential must commit to either abstain continuously from heterosexual sexual intercourse or to use 2 methods of reliable birth control simultaneously. This includes one highly effective form of contraception (tubal ligation, intrauterine device [IUD], hormonal [birth control pills, injections, hormonal patches, vaginal rings or implants]
or partner's vasectomy) and one additional effective contraceptive method (male latex or synthetic condom, diaphragm, or cervical cap). Contraception must begin 4 weeks prior to dosing. Reliable contraception is indicated even where there has been a history of infertility, unless due to hysterectomy
9. A woman of childbearing potential must have a negative urine or serum pregnancy test at screening within 14 days prior to randomization.
10. Each subject (or their legally acceptable representative) must sign an Informed Consent Form (ICF) indicating that he or she understands the purpose of and procedures required for the study and are willing to participate in the study. Subjects must be willing and able to adhere to the prohibitions and restrictions specified in this protocol, as referenced
in the ICF.
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E.4 | Principal exclusion criteria |
1. Subject has received daratumumab or other anti-CD38 therapies previously.
2.Subject is refractory to VELCADE, or another PI, like ixazomib and carfilzomib (ie, subject had progression of disease while receiving VELCADE therapy or within 60 days of ending VELCADE therapy, or another PI therapy, like ixazomib and carfilzomib).
3. Subject is intolerant to VELCADE (ie, discontinued due to any adverse event while on VELCADE treatment.
4.Subject has received anti-myeloma treatment within 2 weeks or 5 pharmacokinetic halflives of the treatment, whichever is longer, before the date of randomization. The only exception is emergency use of a short course of corticosteroids (equivalent of dexamethasone 40 mg/day for a maximum of 4 days) before treatment. A list of anti-myeloma treatments with the corresponding pharmacokinetic half-lives is provided in the Site Investigational Product Procedures Manual (SIPPM).
5. Subject has received ASCT within 12 weeks before the date of randomization, or the subject has previously received an allogenic stem cell transplant (regardless of timing).
6. Subjects planning to undergo a stem cell transplant prior to progression of disease on this study, ie, these subjects should not be enrolled in order to reduce disease burden prior to transplant.
7.Subject has a history of malignancy (other than multiple myeloma) within 3 years before the date of randomization (exceptions are squamous and basal cell carcinomas of the skin and carcinoma in situ of the cervix, or breast, or other non-invasive lesion, that in the opinion of the investigator, with concurrence with the sponsor's medical monitor, is
considered cured with minimal risk of recurrence within 3 years).
8. Subject has known meningeal involvement of multiple myeloma.
9.Subject has peripheral neuropathy or neuropathic pain Grade 2 or higher, as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCICTCAE) most recent version.
10.Subject has either of the following:
a. Known chronic obstructive pulmonary disease (COPD) with a forced expiratory volume in 1 second (FEV1) <50% of predicted normal. Note that FEV1 testing is required for subjects suspected of having COPD and subjects must be excluded if FEV1 <50% of predicted normal.
b. Known moderate or severe persistent asthma, or a history of asthma within the last 2 years , or currently has uncontrolled asthma of any classification.
(Note that subjects who currently have controlled intermittent asthma or controlled mild persistent asthma are allowed to participate in the study).
11.Subject is known to be seropositive for human immunodeficiency virus (HIV) or known to have hepatitis B surface antigen positivity, or known to have a history of hepatitis C.
12. Subject has any concurrent medical condition or disease (eg, active systemic infection) that is likely to interfere with study procedures or results, or that in the opinion of the investigator would constitute a hazard for participating in this study.
13.Subject has clinically significant cardiac disease, including:
● Myocardial infarction within 6 months before date of randomization, or unstable or uncontrolled disease/condition related to or affecting cardiac function (eg, unstable angina, congestive heart failure, New York Heart Association Class III-IV).
● Uncontrolled cardiac arrhythmia (Common Terminology Criteria for Adverse Events [CTCAE] [most recent version] Grade 2 or higher) or clinically significant ECG abnormalities.
● Screening 12-lead ECG showing a baseline QT interval as corrected by Fridericia's formula (QTcF) >470 msec.
14.Subject has any of the following laboratory test results during the Screening Phase:
●Absolute neutrophil count ≤1.0 × 109/L;
●Hemoglobin level ≤7.5 g/dL (≤5 mmol/L) (it is not permissible to transfuse a subject to reach this level);
● Platelet count <75 × 109/L for subjects in whom <50% of bone marrow nucleated cells are plasma cells; otherwise platelet count <50 × 109/L (it is not permissible to transfuse a subject to reach this level);
● Alanine aminotransferase level ≥2.5 times the upper limit of normal (ULN);
● Aspartate aminotransferase ≥2.5 x ULN
●Total bilirubin level ≥1.5 × ULN, (except for Gilbert Syndrome: direct bilirubin 1.5 × ULN);
● Creatinine clearance ≤20 mL/min/1.73 m2 (may be calculated using the Cockcroft-Gault formula, Modification of Diet in Renal Disease [MDRD] formula or Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formula, provided in Attachment 3), or measured);
● Serum calcium corrected for albumin >14.0 mg/dL (>3.5 mmol/L), or free ionized calcium 6.5 mg/dL (>1.6 mmol/L)
18. Subject is a woman who is pregnant or breastfeeding or planning to become pregnant while enrolled in this study or within 3 months after the last dose of study drug.
Please refer to protocol for complete overview of exclusion criteria |
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E.5 End points |
E.5.1 | Primary end point(s) |
Percentage of participants with progression-free survival (PFS) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Baseline, up to the end of the study |
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E.5.2 | Secondary end point(s) |
1. Time to disease progression (TTP)
2. Percentage of Participants With Overall Response
3. Duration of response
4. Time to Response
5. Percentage of participants with a very good partial response (VGPR) or better
6. Percentage of participants with Minimal Residual Disease (MRD)
7. Percentage of participants with overall survival (OS) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
- For all secondary end points except 4 is Baseline, up to the end of the study
- for secondary end point 4 is Baseline until first documented response |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 78 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Brazil |
Czech Republic |
Germany |
Hungary |
Italy |
Korea, Republic of |
Mexico |
Netherlands |
Poland |
Russian Federation |
Spain |
Sweden |
Turkey |
Ukraine |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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the following is included in the protocol : The study is considered completed after 320 deaths have occurred. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 6 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | 1 |
E.8.9.2 | In all countries concerned by the trial years | 6 |
E.8.9.2 | In all countries concerned by the trial months | 10 |
E.8.9.2 | In all countries concerned by the trial days | 27 |