Study of Bendamustine, Velcade and Dexamethasone in the Treatment of Elderly Patients With Multiple Myeloma
Study of Bendamustine, Velcade and Dexamethasone in the Treatment of Elderly Patients With Multiple Myeloma
The present trial is designed as a phase II study that aims at estimating the efficacy of the
 combination of bendamustine, bortezomib and dexamethasone in relapsed/refractory multiple
 myeloma (MM). The response rate, i.e. the rate of the patients achieving a Complete Response
 or Partial Response at cycle 4, divided by the total intent to treat patient number is chosen
 as primary efficacy endpoint.

 The estimation of the efficacy rate is to be based on an explorative pilot study, since
 immediate embarking on a large-scale comparative efficacy trial would not be acceptable from
 the point of view of resources. Moreover, this would induce ethical objections, as it does
 not seem to be justifiable to expose a large number of patients to an experimental approach
 without sufficient exploratory indications of an improved risk-benefit ratio.
After relapse or after early progression on first-line treatment, the prognosis of multiple
 myeloma (MM) patients is unfavourable, and the search for new treatment regimens, including
 drugs with novel mechanisms of action is essential.

 Bendamustine and bortezomib have shown high activity boch in first-line regimens and
 pre-treated patients. The novel mechanism of action of the proteasome inhibitor and the
 non-cross resistance of bendamustine to other alkylating agents established in the first-line
 treatment of multiple myeloma seem to recommend a combination of the two drugs for salvage
 therapy (second-line regimen). Finally, the promising response data in a series of relapsing
 MM patients treated with bendamustine, bortezomib and prednisone support this assumption, as
 well as the feasibility and tolerability of the combination.

 In summary, there is some evidence for a favorable risk/benefit ratio for the combination of
 bendamustine, bortezomib and a corticoid drug, warranting the exploration in a larger,
 prospectively designed multicenter phase II study.
Inclusion Criteria:

 -  Symptomatic multiple myeloma (MM) patient at the time of diagnosis (but not
 necessarily at the time of relapse), according to International Myeloma Working Group
 criteria.

 -  Patient having received conventional chemotherapy in 1st line treatment because of age
 65 years or over, or younger than 65 years and ineligible to high-dose therapy plus
 stem cell transplantation.

 -  Measurable disease (≥10g/L monoclonal gammapathy and/or ≥ 200 mg/24h proteinuria or
 involved serum free light chain ≥ 100mg/L with abnormal FLC ratio < 0.26 or > 1.65)

 -  Patient in 1st relapse or refractory to 1st line therapy. Relapse is defined by
 M-component increase of ≥25% from baseline, in serum and/or urine (the absolute
 increase in serum must be ≥ 5 g/l - the absolute increase of BJ proteins in urine must
 be ≥200 mg/24 h). (It is recommended to treat only symptomatic or rapidly evolutive
 relapses)

 -  Life expectancy of at least 3 months

 -  ECOG performance status <= 2 at study entry

 -  Laboratory test results within these ranges:

 -  Absolute neutrophil count >= 1.5 x 109/L

 -  Platelet count >= 100 x 109/L

 -  Serum creatinine <= 250 umol/l

 -  AST (SGOT) and ALT (SGPT) <= 3 x ULN

 -  Disease free of prior malignancies for >= 5 years, with exception of curatively
 treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the
 cervix or breast

 -  Able to adhere to the study visit schedule and other protocol requirements

 -  Using effective contraceptive methods during and for 6 months after study treatment
 (for fertile men, women of childbearing potential).

 -  Provision of informed consent.

 -  A period of at least 15 days must be respected between the last treatment of myeloma
 and the beginning of the study.

 Exclusion Criteria:

 -  Any serious medical condition, laboratory abnormality, or psychiatric illness that
 would prevent the subject from signing the informed consent form.

 -  Any comorbidity which places the subject at unacceptable risk if he/she were to
 participate in the study.

 -  Patients treated with high-dose therapy plus stem cell transplantation in 1st line
 therapy

 -  Any prior use of bortezomib (Velcade) or bendamustine (Ribomustin)

 -  Concurrent use of other anti-cancer agents or treatments other than those stated in
 this treatment plan

 -  Use of any other experimental drug or therapy within 28 days prior to the start of
 study treatment.

 -  Known hypersensitivity to the study drugs

 -  Positive HIV serology, positive hepatitis C serology, active infection hepatitis A,
 active infection hepatitis B.

 -  Severe cardiovascular disorders within 12 months prior to the start of study treatment
 (e.g. myocardial infarct, ischemic episodes, arrhythmias)

 -  Previous major surgery less than 30 days before start of treatment

 -  Active infection,

 -  Pregnant or lactating women.