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    Clinical Trial Results:
    Ixazomib in combination to thalidomide - dexamethasone for patients with relapsed and/or refractory multiple myeloma

    Summary
    EudraCT number
    2014-002749-23
    Trial protocol
    AT   CZ   DE  
    Global end of trial date
    28 Mar 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    29 Mar 2020
    First version publication date
    29 Mar 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    AGMT_MM-1/EMN-13
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02410694
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    AGMT
    Sponsor organisation address
    Gentzgasse 60/21, Vienna, Austria, 1180
    Public contact
    Daniela Wolkersdorfer, AGMT, 0043 66264044412, d.wolkersdorfer@agmt.at
    Scientific contact
    Richard Greil, AGMT, 0043 5725525801, r.greil@salk.at
    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
    03 Mar 2020
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    26 Jul 2018
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Mar 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To determine progression-free survival in patients with relapsed/refractory multiple myeloma receiving ixazomib in combination with thalidomide and dexamethasone for 8 cycles followed by an ixazomib maintenance phase of a maximum period of 12 months.
    Protection of trial subjects
    Recommendations for dose reductions or delay of a subsequent treatment cycle were given. Criteria for the start of a new treatment cycle (e.g. ANC, platelet count, nonhematologic toxicity solved to ≤ grade 1) were specified. Defined concomitant medications like antiemetics, antidiarrheals, or growth factors and procedures like transfusions were permitted. Anti-thrombotic prophylaxis was mandatory during treatment with thalidomide. As adverse drug reactions such as thrombocytopenia, diarrhea, fatigue, nausea, vomiting, and rash have been associated with ixazomib treatment, detailed management guidelines regarding these events were given. Patients were informed that female patients participating in this study must avoid becoming pregnant, and male patients must avoid impregnating a female partner.
    Background therapy
    Dexamethasone 20 mg or 40 mg at days 1, 8, 15 of a 28-day treatment cycle.
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Jun 2015
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Austria: 60
    Country: Number of subjects enrolled
    Czech Republic: 9
    Country: Number of subjects enrolled
    Germany: 25
    Worldwide total number of subjects
    94
    EEA total number of subjects
    94
    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)
    35
    From 65 to 84 years
    58
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    From 01-Jun-2015 to 07-Dec-2017 94 patients were enrolled in Austria (11 sites, 60 patients), Germany (3 sites, 25 patients) and Czech Republic (2 sites, 9 patients).

    Pre-assignment
    Screening details
    Adult patients (≥18 years) with a confirmed diagnosis of symptomatic MM and relapsed and/or refractory disease could have been enrolled in this study. Patients may have been enrolled after one prior line of therapy.

    Period 1
    Period 1 title
    Intent-to-treat population (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Overall trial
    Arm description
    Therapy with ixazomib, thalidomide and dexamethasone for 8 cycles, followed by ixazomib maintenance for a maximum of 12 months.
    Arm type
    Experimental

    Investigational medicinal product name
    Ixazomib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    8 cycles à 28 days: Ixazomib 4.0mg po on days 1, 8, 15 (± 1 day) followed by Ixazomib maintenance phase 4.0mg/3.0mg* po on days 1, 8, 15 every 28 days for a maximum duration of 12 months *) 4.0mg in patients <75 years of age, 3.0mg in patients ≥ 75 years of age at start of maintenance phase

    Investigational medicinal product name
    Thalidomide
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    8 cycles à 28 days: Thalidomide 100mg po on days 1-28 in patients <75 years of age at C1/d1 Thalidomide 50mg po on days 1-28 in patients ≥ 75 years of age at C1/d1

    Number of subjects in period 1 [1]
    Overall trial
    Started
    90
    Completed
    76
    Not completed
    14
         Consent withdrawn by subject
    1
         Physician decision
    2
         Toxicity
    2
         Progressive disease
    9
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: Due to protocol violations 4 patients did not qualifiy for intent-to-treat population.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Intent-to-treat population
    Reporting group description
    -

    Reporting group values
    Intent-to-treat population Total
    Number of subjects
    90 90
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    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)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        arithmetic mean (full range (min-max))
    67.3 (44 to 84) -
    Gender categorical
    Units: Subjects
        Female
    44 44
        Male
    46 46

    End points

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    End points reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    Therapy with ixazomib, thalidomide and dexamethasone for 8 cycles, followed by ixazomib maintenance for a maximum of 12 months.

    Primary: Progression free survival

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    End point title
    Progression free survival [1]
    End point description
    Time from day 1 of cycle 1 to the date of first documentation of disease progression based on IMWG criteria, including MR, or death due to any cause, whichever occurs first.
    End point type
    Primary
    End point timeframe
    3 years
    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: No statistical analysis is provided as this is an one armed, open label, non-comperative study.
    End point values
    Overall trial
    Number of subjects analysed
    90
    Units: months
        median (confidence interval 95%)
    8.5 (6.4 to 10.3)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    All (serious) adverse events occurring during study treatment have been collected from signing the informed consent form until 30 days after the end of study treatment.
    Adverse event reporting additional description
    Any SAR that occurred at any time after completion of ixazomib treatment or after the designated follow-up period until end of study was documented. New primary malignancies that occurred during the follow-up periods were reported for a minimum of three years after the last dose of the investigational product.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    22.0
    Reporting groups
    Reporting group title
    Safety population
    Reporting group description
    The safety population includes all enrolled patients who received at least one dose of the study treatment.

    Serious adverse events
    Safety population
    Total subjects affected by serious adverse events
         subjects affected / exposed
    34 / 94 (36.17%)
         number of deaths (all causes)
    32
         number of deaths resulting from adverse events
    2
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Chronic myeloid leukaemia
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Malignant melanoma
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Myelodysplastic syndrome
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Circulatory collapse
         subjects affected / exposed
    2 / 94 (2.13%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Hypertensive crisis
         subjects affected / exposed
    1 / 94 (1.06%)
         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 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    3 / 94 (3.19%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Investigations
    C-reactive protein increased
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Femoral neck fracture
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Fracture
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Humerus fracture
         subjects affected / exposed
    2 / 94 (2.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Pubis fracture
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Rib fracture
         subjects affected / exposed
    2 / 94 (2.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Cardiac amyloidosis
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac failure
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Ventricular fibrillation
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Nervous system disorders
    Ischaemic stroke
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Polyneuropathy
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Sciatica
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    2 / 94 (2.13%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    2 / 94 (2.13%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal failure
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Urethral stenosis
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Back pain
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Groin pain
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Abscess oral
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Bronchitis
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cystitis
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infection
         subjects affected / exposed
    2 / 94 (2.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Influenza
         subjects affected / exposed
    2 / 94 (2.13%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Lung infection
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Parainfluenzae virus infection
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    7 / 94 (7.45%)
         occurrences causally related to treatment / all
    3 / 7
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Dehydration
         subjects affected / exposed
    2 / 94 (2.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hypercalcaemia
         subjects affected / exposed
    2 / 94 (2.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hyperkalaemia
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Hyponatraemia
         subjects affected / exposed
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pubic pain
         subjects affected / exposed
    2 / 94 (2.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Safety population
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    85 / 94 (90.43%)
    Nervous system disorders
    Polyneuropathy
         subjects affected / exposed
    17 / 94 (18.09%)
         occurrences all number
    24
    Peripheral sensory neuropathy
         subjects affected / exposed
    9 / 94 (9.57%)
         occurrences all number
    18
    Headache
         subjects affected / exposed
    8 / 94 (8.51%)
         occurrences all number
    11
    Neuropathy peripheral
         subjects affected / exposed
    7 / 94 (7.45%)
         occurrences all number
    8
    Paraesthesia
         subjects affected / exposed
    6 / 94 (6.38%)
         occurrences all number
    8
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    20 / 94 (21.28%)
         occurrences all number
    32
    Thrombocytopenia
         subjects affected / exposed
    13 / 94 (13.83%)
         occurrences all number
    25
    Leukopenia
         subjects affected / exposed
    6 / 94 (6.38%)
         occurrences all number
    9
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    33 / 94 (35.11%)
         occurrences all number
    51
    Oedema peripheral
         subjects affected / exposed
    22 / 94 (23.40%)
         occurrences all number
    24
    Oedema
         subjects affected / exposed
    5 / 94 (5.32%)
         occurrences all number
    7
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    16 / 94 (17.02%)
         occurrences all number
    18
    Eye disorders
    Visual impairment
         subjects affected / exposed
    5 / 94 (5.32%)
         occurrences all number
    5
    Vomiting
         subjects affected / exposed
    7 / 94 (7.45%)
         occurrences all number
    10
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    28 / 94 (29.79%)
         occurrences all number
    35
    Nausea
         subjects affected / exposed
    16 / 94 (17.02%)
         occurrences all number
    19
    Diarrhoea
         subjects affected / exposed
    10 / 94 (10.64%)
         occurrences all number
    17
    Dry mouth
         subjects affected / exposed
    6 / 94 (6.38%)
         occurrences all number
    6
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    11 / 94 (11.70%)
         occurrences all number
    12
    Cough
         subjects affected / exposed
    7 / 94 (7.45%)
         occurrences all number
    8
    Dyspnoea exertional
         subjects affected / exposed
    6 / 94 (6.38%)
         occurrences all number
    6
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    6 / 94 (6.38%)
         occurrences all number
    7
    Psychiatric disorders
    Sleep disorder
         subjects affected / exposed
    7 / 94 (7.45%)
         occurrences all number
    7
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    11 / 94 (11.70%)
         occurrences all number
    12
    Arthralgia
         subjects affected / exposed
    10 / 94 (10.64%)
         occurrences all number
    11
    Muscle spasms
         subjects affected / exposed
    7 / 94 (7.45%)
         occurrences all number
    8
    Pain in extremity
         subjects affected / exposed
    6 / 94 (6.38%)
         occurrences all number
    9
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    14 / 94 (14.89%)
         occurrences all number
    19
    Bronchitis
         subjects affected / exposed
    11 / 94 (11.70%)
         occurrences all number
    14
    Respiratory tract infection
         subjects affected / exposed
    10 / 94 (10.64%)
         occurrences all number
    19
    Upper respiratory tract infection
         subjects affected / exposed
    8 / 94 (8.51%)
         occurrences all number
    12
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    5 / 94 (5.32%)
         occurrences all number
    5

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    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

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/31558804
    http://www.ncbi.nlm.nih.gov/pubmed/31556753
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