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    Clinical Trial Results:
    Pomalidomide, ixazomib, and dexamethasone (PId) with or without intensification by cyclophosphamide (PICd): A phase II study in relapsed or refractory multiple myeloma

    Summary
    EudraCT number
    2014-001757-16
    Trial protocol
    DE  
    Global end of trial date
    22 Apr 2024

    Results information
    Results version number
    v1(current)
    This version publication date
    16 Apr 2025
    First version publication date
    16 Apr 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    DSMMXV
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03731832
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    GWT-TUD GmbH
    Sponsor organisation address
    Freiberger Str. 33, Dresden, Germany, 01067
    Public contact
    Medical Consulting, GWT-TUD GmbH, 0049 35125933100, medical.consulting@g-wt.de
    Scientific contact
    Medical Consulting, GWT-TUD GmbH, 0049 35125933100, medical.consulting@g-wt.de
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    23 Dec 2024
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    22 Apr 2024
    Global end of trial reached?
    Yes
    Global end of trial date
    22 Apr 2024
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the clinical activity of pomalidomide administered once daily in combination with oral ixazomib and dexamethasone (PId)
    Protection of trial subjects
    Patients were monitored closely for anticipated toxicities. Additionally, an independent Data Safety Monitoring Board (DSMB) reviewed safety data when the first 6 patients each had completed the 1st cycle of PICd. Afterwards, safety data were reviewed on an ongoing basis throughout conduct of the study.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Sep 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 61
    Worldwide total number of subjects
    61
    EEA total number of subjects
    61
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    25
    From 65 to 84 years
    36
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    From Sep 2018 until Dec 2021 in total 66 patients were enrolled in this study at 10 study sites in Germany.

    Pre-assignment
    Screening details
    Of them, 61 patients received treatment. 4 patients were screening failures and 1 patients died before treatment.

    Pre-assignment period milestones
    Number of subjects started
    61
    Number of subjects completed
    61

    Period 1
    Period 1 title
    Treatment period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Induction treatment
    Arm description
    Patients starting the induction treatment pomalidomide, ixazomib, and dexamethasone (PId). Treatment was given until further disease progression. Patients with isolated biochemical relapse with an increase of ≥ 25% in serum M-protein (absolute increase ≥ 5 g/L) and/or urine M-protein (absolute increase ≥ 200 mg/24h) or in the difference between involved and uninvolved FLC levels (provided, the absolute increase is > 100 mg/l) without further signs or symptoms of end organ damage proceeded to the intensification phase (PICd) until further disease progression.
    Arm type
    Experimental

    Investigational medicinal product name
    Pomalidomide
    Investigational medicinal product code
    CC-4047
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    Study drug was given as an oral dose of 4 mg on day 1 until day 21, followed by 1 week without study drug in a 28-day cycle.

    Investigational medicinal product name
    Ixazomib
    Investigational medicinal product code
    MLN9708
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Study drug was given as a single, oral dose of 4 mg weekly (day 1, 8 and 15) for 3 weeks, followed by 1 week without study drug in a 28-day cycle.

    Investigational medicinal product name
    Dexamethasone
    Investigational medicinal product code
    Other name
    Fortecortin®
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Study drug was administered as a single, oral dose of 40 mg/day weekly on day 1, 8, 15 and 22 in patients from 18 to 74 years old. For patients ≥ 75 years old dose has to be reduced to 20 mg/day with the same treatment schedule.

    Number of subjects in period 1
    Induction treatment
    Started
    61
    Completed
    28
    Not completed
    33
         Physician decision
    4
         Consent withdrawn by subject
    2
         Adverse event, non-fatal
    4
         Death
    4
         Progression
    12
         Unknown
    6
         Protocol deviation
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Treatment period (overall period)
    Reporting group description
    -

    Reporting group values
    Treatment period (overall period) Total
    Number of subjects
    61 61
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    25 25
        From 65-84 years
    36 36
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    42 42
        Male
    19 19

    End points

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    End points reporting groups
    Reporting group title
    Induction treatment
    Reporting group description
    Patients starting the induction treatment pomalidomide, ixazomib, and dexamethasone (PId). Treatment was given until further disease progression. Patients with isolated biochemical relapse with an increase of ≥ 25% in serum M-protein (absolute increase ≥ 5 g/L) and/or urine M-protein (absolute increase ≥ 200 mg/24h) or in the difference between involved and uninvolved FLC levels (provided, the absolute increase is > 100 mg/l) without further signs or symptoms of end organ damage proceeded to the intensification phase (PICd) until further disease progression.

    Primary: overall response rate (ORR)

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    End point title
    overall response rate (ORR) [1]
    End point description
    End point type
    Primary
    End point timeframe
    14 months
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The efficacy analyses were performed on the efficacy analysis set (EFF), which included all patients who received at least one complete cycle of pomalidomide and ixazomib. Efficacy of the PId regime was reported by appropriate descriptive statistics.
    End point values
    Induction treatment
    Number of subjects analysed
    59
    Units: percent
        number (confidence interval 95%)
    67.8 (54.4 to 79.4)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    26 months
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    15.0
    Reporting groups
    Reporting group title
    Safety Analysis Set
    Reporting group description
    The safety analyses were performed on the safety analysis set (SAF), which included all patients who received at least one dose of pomalidomide and ixazomib.

    Serious adverse events
    Safety Analysis Set
    Total subjects affected by serious adverse events
         subjects affected / exposed
    26 / 61 (42.62%)
         number of deaths (all causes)
    34
         number of deaths resulting from adverse events
    4
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Adenocarcinoma of colon
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Plasma cell myeloma
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Pain
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pyrexia
         subjects affected / exposed
    2 / 61 (3.28%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonitis
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Investigations
    Neutrophil count decreased
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Accident
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Femur fracture
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Rib fracture
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Atrial tachycardia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac failure
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Spinal cord compression
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Eye disorders
    Diplopia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ulcerative keratitis
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    2 / 61 (3.28%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Renal failure
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Anal abscess
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Atypical pneumonia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bronchiolitis
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Bronchitis
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Corona virus infection
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diverticulitis
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Empyema
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Endocarditis
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatitis B reactivation
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Influenza
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Lung infection
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Metapneumovirus infection
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    3 / 61 (4.92%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Pneumonia streptococcal
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Rash pustular
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Superinfection
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Urinary tract infection
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Hypercalcemia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyponatremia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Safety Analysis Set
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    59 / 61 (96.72%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
         subjects affected / exposed
    4 / 61 (6.56%)
         occurrences all number
    4
    Vascular disorders
    Vascular disorders
         subjects affected / exposed
    7 / 61 (11.48%)
         occurrences all number
    7
    Surgical and medical procedures
    Surgical and medical procedures
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences all number
    1
    General disorders and administration site conditions
    General disorders and administration site conditions
         subjects affected / exposed
    32 / 61 (52.46%)
         occurrences all number
    32
    Immune system disorders
    Immune system disorders
         subjects affected / exposed
    2 / 61 (3.28%)
         occurrences all number
    2
    Social circumstances
    Social circumstances
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences all number
    1
    Reproductive system and breast disorders
    Reproductive system and breast disorders
         subjects affected / exposed
    4 / 61 (6.56%)
         occurrences all number
    4
    Respiratory, thoracic and mediastinal disorders
    Respiratory, thoracic and mediastinal disorders
         subjects affected / exposed
    23 / 61 (37.70%)
         occurrences all number
    23
    Psychiatric disorders
    Psychiatric disorders
         subjects affected / exposed
    13 / 61 (21.31%)
         occurrences all number
    13
    Investigations
    Investigations
         subjects affected / exposed
    16 / 61 (26.23%)
         occurrences all number
    16
    Injury, poisoning and procedural complications
    Injury, poisoning and procedural complications
         subjects affected / exposed
    7 / 61 (11.48%)
         occurrences all number
    7
    Cardiac disorders
    Cardiac disorders
         subjects affected / exposed
    6 / 61 (9.84%)
         occurrences all number
    6
    Nervous system disorders
    Nervous system disorders
         subjects affected / exposed
    24 / 61 (39.34%)
         occurrences all number
    24
    Blood and lymphatic system disorders
    Blood and lymphatic system disorders
         subjects affected / exposed
    36 / 61 (59.02%)
         occurrences all number
    36
    Ear and labyrinth disorders
    Ear and labyrinth disorders
         subjects affected / exposed
    8 / 61 (13.11%)
         occurrences all number
    8
    Gastrointestinal disorders
    Gastrointestinal disorders
         subjects affected / exposed
    25 / 61 (40.98%)
         occurrences all number
    25
    Hepatobiliary disorders
    Hepatobiliary disorders
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Skin and subcutaneous tissue disorders
         subjects affected / exposed
    23 / 61 (37.70%)
         occurrences all number
    23
    Renal and urinary disorders
    Renal and urinary disorders
         subjects affected / exposed
    11 / 61 (18.03%)
         occurrences all number
    11
    Endocrine disorders
    Endocrine disorders
         subjects affected / exposed
    6 / 61 (9.84%)
         occurrences all number
    6
    Musculoskeletal and connective tissue disorders
    Musculoskeletal and connective tissue disorders
         subjects affected / exposed
    31 / 61 (50.82%)
         occurrences all number
    31
    Infections and infestations
    Infections and infestations
         subjects affected / exposed
    29 / 61 (47.54%)
         occurrences all number
    29
    Metabolism and nutrition disorders
    Metabolism and nutrition disorders
         subjects affected / exposed
    23 / 61 (37.70%)
         occurrences all number
    23

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    29 May 2019
    Protocol V10.0 dated 13 Mar 2019, updated overall study duration, adjustment of inclusion and exclusion criteria
    15 Jun 2020
    Protocol V12.0 dated 12 May 2020 including update of contraceptional timeframes for donating semen as well as utilizing reliable forms of contraception
    08 Oct 2021
    Protocol V13.0 dated 20 Jul 2021 including update of administrative aspects and study conduct changes
    02 Jun 2022
    Protocol V15.0 dated 19 May 2022 including reduction of total patients enrolled, adjustment of statistical part and population for efficacy analysis, update of timelines, change of CPI contact, additional criterion for early termination added

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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