Neoplasms

Heart and Blood Diseases

Blood and Lymph Conditions

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Rare Diseases

Multiple Myeloma

Neoplasms, Plasma Cell

Neoplasms by Histologic Type

Hemostatic Disorders

Blood Coagulation Disorders

Vascular Diseases

Paraproteinemias

Blood Protein Disorders

Hematologic Diseases

Hemorrhagic Disorders

Lymphoproliferative Disorders

Immunoproliferative Disorders

Anti-Infective Agents

Antineoplastic Agents

All Drugs and Chemicals

Thalidomide

Lenalidomide

Bortezomib

Bortezomib is replaced with carfilzomib in a combined regimen identical to the patient's previous regimen. Regimen cannot include thalidomide or lenalidomide.

Bortezomib is replaced with carfilzomib in a regimen that includes IMiDs (lenalidomide or thalidomide). Thus, the regimen is carfilzomib in an IMiD-containing regimen.

Carfilzomib will be administered intravenously starting at a dose of 20 mg/m\^2 over 30 minutes for the first cycle and will then be increased to 27, 36 and 45 mg/m2 during cycles 2-4, respectively. Doses will be administered IV once daily on days 1, 2, 8, 9, 15, and 16 of each cycle. Cycles will be 28 days in length.

Combination non-IMiD drug is dosed on the identical schedule and dosage as patient was in previous bortezomib containing regimen.

Maintenance regimen maybe administered if patient does not progress while on study.

Group A: Carfilzomib & Non-IMiD Regimen

Carfilzomib will be administered intravenously starting at a dose of 20 mg/m\^2 over 30 minutes for the first cycle and will then be increased to 27, 36 and 45 mg/m2 during cycles 2-4, respectively. Doses will be administered IV once daily on days 1, 2, 8, 9, 15, and 16 of each cycle. Cycles will be 28 days in length.

Combination IMiD drug is dosed on the identical schedule and dosage as patient was in previous bortezomib containing regimen.

Maintenance regimen maybe administered if patient does not progress while on study.

Group B: Carfilzomib & IMiD containing regimen.

James R Berenson, MD

This is a phase I/II multicenter, open label, nonrandomized study for patients with Multiple Myeloma (MM) who will receive treatment with carfilzomib in place of bortezomib using the same bortezomib-containing combination regimen to which a MM patient has progressed while receiving. This study will enroll 45 patients total. These patients will be resistant to bortezomib as demonstrated by progressive disease while on bortezomib or have relapsed within 12 weeks of the last dose of bortezomib in a combination regimen. Patients will be sub-divided into 2 groups in this study, treatments containing (Group A) or not containing immunomodulatory drugs (IMiDs) (Group B). Thirty patient will be enrolled into Group A and 15 patients into Group B for a total of 45 patients. Patients must have received 4 doses of a minimum of 1.0 mg/m\^2 of bortezomib in no more than 4 weeks per cycle. Patients must have received at least one cycle meeting this definition and have shown progressive disease to be considered eligible. Patients who have been refractory to or relapsed within 12 weeks of the last dose of bortezomib in their most recent bortezomib-containing regimen that does not include either thalidomide or lenalidomide are eligible regardless of when patients received that regimen, as long as they meet the above criteria.

Carfilzomib will subsequently replace bortezomib using the patient's most recent bortezomib-containing regimen to which the patient progressed while receiving. Patients will be eligible if they progressed from bortezomib with an alkylating agent (melphalan or cyclophosphamide), an anthracycline (doxorubicin or pegylated liposomal doxorubicin) and/or a glucocorticosteroid (prednisone, dexamethasone or medrol)and IMiD (thalidomide or lenalidomide). The study will consist of a screening period, followed by up to eight open label treatment cycles, a final assessment to occur 28 days after the end of the last treatment cycle, a follow-up period and maintenance cycles of single agent carfilzomib.

Patient who complete the combination treatment period without progressive disease will be eligible for maintenance therapy with single-agent carfilzomib. During maintenance therapy carfilzomib will be administered at the same dose given during the last cycle of combination treatment.

Study of Carfilzomib for Multiple Myeloma Patients Who Are Relapsed/Refractory to Bortezomib-containing Treatments

A Phase I/II Study of Carfilzomib as a Replacement for Multiple Myeloma Patients Failing Bortezomib-containing Regimens

Phase I:

• To establish the maximum tolerated dose (MTD) and determine the dose limiting toxicities (DLT) following treatment.

Phase II:

• To determine the efficacy as assessed by the overall response rate \[CR + VGPR + PR + MR\] and the Time to Progression (TTP) of disease.

Phase I:

Obtain preliminary evidence of efficacy following treatment based on:

* SPEP, UPEP and quantification of serum immunoglobulins
* Bone marrow aspirates \& biopsies
* B2M
* A roentgenographic skeletal survey of bones

Phase II:

Establish the safety \& tolerability following treatment based on:

* Adverse events
* Clinical lab tests
* Vital signs
* Medical history \& body weight measurements
* ECOG performance status
* Concomitant medication usage

Both phases:

Progression Free Survival among patients who continue onto maintenance treatment

Amgen

Oncotherapeutics

Spots Global Cancer Trial Database for group b: carfilzomib & imid containing regimen.