Phase 3
Completed N=307
Multinational Clinical Study Comparing Isatuximab, Pomalidomide, and Dexamethasone to Pomalidomide and Dexamethasone in Refractory or Relapsed and Refractory Multiple Myeloma Patients
Source: ClinicalTrials.gov NCT02990338 ↗Enrolled (actual)
307
Serious AEs
67.4%
Results posted
Dec 2019
Primary outcomePrimary: Progression Free Survival (PFS) — 6.47; 11.53 months — p=0.0005
◆ Published Evidence
Established
31citations · ~6 / year
Isatuximab plus pomalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma according to prior lines of treatment and refractory status: ICARIA-MM subgroup analysis.
Summary
Primary Objective:
To demonstrate the benefit of isatuximab in combination with pomalidomide and low-dose dexamethasone in the prolongation of Progression Free Survival (PFS) as compared to pomalidomide and low-dose dexamethasone in participants with refractory or relapsed and refractory multiple myeloma (MM).
Secondary Objectives:
* To evaluate the Overall Response Rate (ORR) as per International Myeloma Working Group (IMWG) criteria in each arm.
* To compare the Overall Survival (OS) between the two arms.
* To evaluate the Time To Progression (TTP) in each arm.
* To evaluate the PFS in high risk cytogenetic population in each arm.
* To evaluate the Duration of Response (DOR) in each arm.
* To evaluate the safety in both treatment arms.
* To determine the Pharmacokinetic profile of isatuximab in combination with pomalidomide.
* To evaluate the immunogenicity of isatuximab.
* To assess disease-specific and generic health-related quality of life (HRQL), disease and treatment-related symptoms, health state utility, and health status.
Linked Publications (5)
-
Isatuximab plus pomalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma according to prior lines of treatment and refractory status: ICARIA-MM subgroup analysis.
-
Isatuximab-pomalidomide-dexamethasone <i>versus</i> pomalidomide-dexamethasone in patients with relapsed and refractory multiple myeloma: final overall survival analysis.
-
Evaluation of isatuximab in patients with soft-tissue plasmacytomas: An analysis from ICARIA-MM and IKEMA.
-
Isatuximab-Pomalidomide-Dexamethasone Versus Pomalidomide-Dexamethasone in East Asian Patients With Relapsed/Refractory Multiple Myeloma: ICARIA-MM Subgroup Analysis.
-
Isatuximab: Nursing Considerations for Use in the Treatment of Multiple Myeloma.
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Progression Free Survival (PFS) |
6.47; 11.53 | 0.0005 sig |
| SECONDARY Overall Response Rate (ORR): Percentage of Participants With Disease Response as Per Independent Response Committee (IRC) |
35.3; 60.4 | <0.0001 sig |
| SECONDARY Percentage of Participants With Best Overall Response (BOR) as Per Independent Response Committee |
0.7; 0; 1.3; 4.5; 6.5; 27.3 | — |
| SECONDARY Percentage of Participants With Very Good Partial Response (VGPR) or Better as Per Independent Response Committee |
8.5; 31.8 | — |
| SECONDARY Clinical Benefit Rate (CBR): Percentage of Participants With Clinical Benefit as Per Independent Response Committee |
46.4; 66.9 | — |
| SECONDARY Overall Survival (OS): Final Analysis |
17.71; 24.57 | 0.0319 sig |
| SECONDARY Time to Progression (TTP) as Per Independent Response Committee |
7.75; 12.71 | — |
| SECONDARY Progression Free Survival in High Risk Cytogenetic Population |
3.745; 7.491 | — |
| SECONDARY Duration of Response (DOR) as Per Independent Response Committee |
11.07; 13.27 | — |
| SECONDARY Time to First Response (TT1R) as Per Independent Response Committee |
3.02; 1.94 | — |
| SECONDARY Time to Best Response (TTBR) as Per Independent Response Committee |
5.06; 4.30 | — |
| SECONDARY Number of Participants With Minimal Residual Disease (MRD) |
0; 10; 0; 8; 0; 2 | — |
| SECONDARY Number of Participants With Treatment Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) |
146; 151; 91; 112; 22; 19 | — |
| SECONDARY Pharmacokinetics (PK) Parameter: Plasma Concentration of Isatuximab at End of Infusion (CEOI) |
163.05; 269.20; 299.85; 279.31 | — |
| SECONDARY Pharmacokinetic Parameter: Accumulation Ratio of Isatuximab at Concentration at the End of Infusion (CEOI) |
1.860; 1.777 | — |
| SECONDARY Pharmacokinetic Parameter: Plasma Concentration of Isatuximab at 1 Hour After End of Infusion (CEOI+1 Hour) |
171.55; 294.96 | — |
| SECONDARY PK Parameter: Plasma Concentration of Isatuximab at Ctrough |
0.00; 31.49; 57.89; 84.82; 89.09; 89.35 | — |
| SECONDARY PK Parameter: Accumulation Ratio of Isatuximab at Trough Concentration (Ctrough) |
2.689; 2.620 | — |
| SECONDARY Number of Participants With Anti-drug Antibodies (ADA) |
0; 0; 0 | — |
| SECONDARY Change From Baseline in European Organization for Research and Treatment of Cancer Quality of Life Cancer Specific Questionnaire With 30 Items (EORTC QLQ-C30): Global Health Status (GHS)/Quality of Life (QOL) Score |
61.19; 60.10; -1.45; -1.22; -0.12; -0.16 | — |
| SECONDARY Change From Baseline in European Organization for Research and Treatment of Cancer Quality of Life Multiple Myeloma Specific Module With 20 Items (EORTC QLQ-MY20): Disease Symptoms Domain Score |
24.91; 24.12; -3.79; -2.07; -4.08; -3.30 | — |
| SECONDARY Change From Baseline in European Organization for Research and Treatment of Cancer Quality of Life Multiple Myeloma Specific Module With 20 Items (EORTC QLQ-MY20): Side Effects of Treatment Domain Score |
17.49; 15.60; 1.69; 2.61; -0.13; 2.11 | — |
| SECONDARY Change From Baseline in European Quality of Life Working Group Health Status Measure 5 Dimensions (5D), 5 Levels (5L) (EQ-5D-5L) Score: Health State Utility Index Value |
0.70; 0.71; -0.01; -0.01; 0.02; -0.00 | — |
| SECONDARY Change From Baseline in European Quality of Life Working Group Health Status Measure 5 Dimensions, 5 Levels (EQ-5D-5L) Score: Visual Analogic Scale (VAS) |
65.38; 66.62; 0.26; 0.92; 2.49; 1.19 | — |
Eligibility Criteria
Inclusion criteria
- Age superior or equal to 18 years or country's legal age of majority if the legal age was superior to 18 years old.
- Participants had a documented diagnosis of multiple myeloma with evidence of measurable disease i.e. serum M protein superior or equal to 0.5 grams per decilitre (g/dL) measured using serum protein immunoelectrophoresis and or urine M protein superior or equal to 200 mg per 24 hours measured using urine protein immunoelectrophoresis.
- Participants had received at least 2 prior lines of anti-myeloma therapy, which must include at least 2 consecutive cycles of lenalidomide and a proteasome inhibitor (bortezomib, carfilzomib or ixazomib) given alone or in combination.
- Participants had failed treatment with lenalidomide and a proteasome inhibitor (bortezomib, carfilzomib, or ixazomib) alone or in combination (Intolerant, progression within 6 months after reaching Partial Response or better).
- Participants had progressed on or within 60 days after end of previous therapy before to study entry, i.e., refractory to the last line of treatment.
Exclusion criteria
- Primary refractory multiple myeloma defined as participants who had never achieved at least a minimal response (MR) with any treatment during the disease course.
- Free Light Chain measurable disease only.
- Prior therapy with pomalidomide.
- Any anti-myeloma drug treatment within 14 days before randomization, including dexamethasone.
- Eastern Cooperative Oncology Group performance status superior to 2.
- Platelets inferior to 75 000 cells per microliter (mcL) if inferior to 50% of bone marrow (BM) nucleated cells are plasma cells, and inferior to 30 000 cells per mcL if superior or equal to 50% of BM nucleated cells are plasma cells. Platelet transfusion was not allowed within three days before the screening visit.
- Absolute neutrophil count inferior to 1000 per mcL (1*10^9/L).
- Creatinine clearance inferior to 30 mL per minute (Modification of Diet in Renal Disease [MDRD] Formula).
- Total bilirubin superior to 2*ULN (Upper Limit of Normal).
- Corrected serum calcium superior to 14 milligrams per deciliter (mg/dL) (superior to 3.5 millimoles per liter (mmol/L).
- Aspartate aminotransferase (AST) and/or Alanine Aminotransferase (ALT) superior to 3*ULN.
- Hypersensitivity to immunomodulatory drugs (IMiDs) (thalidomide or lenalidomide) defined as any hypersensitivity reaction leading to stop IMiDs within the 2 first cycles or toxicity, which does meet intolerance definition.
- Hypersensitivity to dexamethasone, sucrose histidine (as base and hydrochloride salt), and polysorbate 80 or any of the components of study therapy that are not amenable to premedication with steroids, or H2 blockers that would prohibit further treatment with these agents.
- Significant cardiac dysfunction; myocardial infarction within 12 months; unstable, poorly controlled angina pectoris.
- Pregnant or breastfeeding woman or female who intends to become pregnant during the participation in the study.
- Male participants who disagreed to practice true abstinence or disagreed to use a condom during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions and at least 3 or 5 months following study treatment discontinuation, even if he had undergone a successful vasectomy.
- All participants who disagreed to refrain from donating blood while on study treatment and for 4 weeks after discontinuation from this study treatment.
The above information was not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.
Data sourced from ClinicalTrials.gov (NCT02990338) and the linked publication. Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication. Informational only — not medical advice.