Ixazomib + Pomalidomide + Dexamethasone In MM
Ixazomib + Pomalidomide + Dexamethasone In MM
This is a Phase I/II study using the combination of twice weekly ixazomib plus pomalidomide
 and dexamethasone in relapsed and or refractory multiple myeloma (RRMM) patients.
This is a Phase I/II clinical trial. A Phase I clinical trial tests the safety of an
 investigational drug and tries to define the appropriate dose of the investigational drug to
 use for further studies. "Investigational" means that the drug is being studied.

 The FDA has approved both pomalidomide and ixazomib individually for the treatment of
 multiple myeloma. Dexamethasone, also FDA approved, is a type of steroid and is usually
 combined with other chemotherapy for the treatment of blood cancers, such as myeloma and
 leukemias.

 -  Ixazomib targets a part of cells called proteasomes. It works by slowing down or
 blocking proteasomes from doing their job of digesting proteins. In myeloma cells, there
 is a greater need for proteasomes to digest proteins; the buildup of excess proteins
 causes cell death.

 -  Pomalidomide has also been shown to cause tumor cell deaths. Dexamethasone can stop
 white blood cells from traveling to areas myeloma cells are causing damage. When
 combined with myeloma drugs, it sometimes makes those drugs work better.

 In this research study, the investigators are:

 -  Testing the safety of ixazomib when given with pomalidomide and dexamethasone

 -  Pomalidomide and ixazomib are given individually for the treatment of multiple myeloma.
 Dexamethasone is also given for multiple myeloma

 -  Ixazomib when combined with pomalidomide and dexamethasone may help control the disease

 -  Ixazomib is FDA approved to treat multiple myeloma

 -  The investigators are looking for the highest dose of ixazomib that can be given safely
 in combination with pomalidomide and dexamethasone
Inclusion Criteria:

 -  Patients with relapsed and relapsed refractory myeloma may be eligible for this trial
 of they meet all the following entry criteria.

 -  Previously diagnosed with MM based on standard IMWG criteria and currently requires
 treatment.

 -  Patient has given voluntary written informed consent before performance of any
 study-related procedures not part of normal medical care, with the understanding that
 consent may be withdrawn by the patient at any time without prejudice to their future
 medical care

 -  Patient had received at least two previous therapies OR received 1 prior line of
 therapy if previously treated with an IMiD plus a proteasome inhibitor and has
 demonstrated disease progression on or within 60 days of completion of the last
 therapy

 -  Patient has measurable disease defined as at least one of the following according to
 Standard Diagnostic Criteria (Rajkumar 2014):

 -  Serum IgG, IgA, or IgM M-protein ≥ 0.5 g/dL, or

 -  Serum IgD M-protein ≥ 0.05 g/dL, or

 -  Urine M protein ≥200 mg/24 hours or

 -  Serum free light chain (FLC) assay: Involved FLC assay ≥10 mg/dL (≥100 mg/L) and
 an abnormal serum FLC ratio (<0.26 or >1.65)

 -  Screening Laboratory evaluations within the following parameters

 -  Absolute neutrophil count (ANC) ≥ 1,000 cells/dL (1.0 x 109/L) (Growth
 factors cannot be used more recently than 14 days prior to initiation of
 therapy)

 -  Platelet count ≥ 75,000 cells/dL (75 x 109/L) (without transfusions required
 during the 14 days prior to initiation of therapy)

 -  Hemoglobin ≥ 8.0 g/dl (RBC transfusions are permitted)

 -  Total Bilirubin ≤ 1.5 X upper limit of normal (ULN) (except subjects with
 Gilbert Syndrome, who can have total bilirubin < 3.0 mg/dL)

 -  AST (SGOT) and ALT (SGPT) ≤ 3.0 x ULN

 -  Calculated creatinine clearance ≥ 45 mL/min

 -  ECOG performance status ≤2 (Karnofsky ≥60%, see Appendix A)

 -  All study participants must be registered into the mandatory POMALYST REMS®
 program, and be willing and able to comply with the requirements of the POMALYST
 REMS® program.

 -  Females of reproductive potential must adhere to the scheduled pregnancy testing
 as required in the POMALYST REMS® program.

 -  Ability to understand and the willingness to sign a written informed consent
 document.

 Exclusion Criteria:

 -  Prior exposure to ixazomib OR is refractory to pomalidomide

 -  Patients that have previously been treated with ixazomib, or participated in a study
 with ixazomib,whether treated with the agent or not, are also excluded

 -  Participation in other clinical trials, including those with other investigational
 agents not included in this trial, within 30 days of the start of this trial and
 throughout the duration of this trial.

 -  Diagnosed or treated for another malignancy within 3 years prior to enrollment, with
 the exception of complete resection of basal cell carcinoma or squamous cell carcinoma
 of the skin, an in situ malignancy, or low risk prostate cancer after curative
 therapy.

 -  Known GI disease or is in need of, or has had a previous GI procedure that could
 interfere with the oral absorption or tolerance of ixazomib or pomalidomide including
 difficulty swallowing.

 -  Known central nervous system involvement.

 -  Systemic treatment, within 14 days before the first dose of treatment, with strong
 CYP3A or inducers (rifampin, rifapentine, rifabutin, carbamazepine, phenytoin,
 phenobarbital), or use of St. John's wort OR systemic treatment within 14 days of the
 first dose of treatment with a strong inhibitor of CYP1A2 (ciprofloxacin, fluvoxamine,
 cimetidine, enoxacin, ethynyl estradiol, mexiletine)

 -  Any medical or psychiatric illness/social situation that in the Investigator's
 opinion, would impose excessive risk to the patient, would adversely affect his/her
 participating in this study or would limit compliance with study requirements.

 -  Any active, or uncontrolled cardiovascular conditions, including but not limited to
 uncontrolled hypertension, uncontrolled cardiac arrhythmias, symptomatic congestive
 heart failure, unstable angina, grade 3 thromboembolic event or myocardial infarction
 within the past 6 months.

 -  The following therapies within the stated time frames prior to initiation of therapy:

 -  Previous cytotoxic therapies, including cytotoxic investigational agents, for
 multiple myeloma within 21 days (42 days for nitrosoureas).

 -  The use of live vaccines within 30 days.

 -  ImiDs or proteasome inhibitors within 14 days.

 -  Other investigational therapies and/or monoclonal antibodies within 4 weeks.

 -  Prior peripheral stem cell transplant within 12 weeks.

 -  Prior allogeneic stem cell transplantation with active graft-versus-host-disease.

 -  Currently active graft versus host disease of any stage or grade after allogeneic stem
 cell transplantation

 -  Prior major surgical procedure or radiation therapy within 14 days of initiation of
 therapy.

 -  Those who require a limited course of radiation for management of bone pain more
 than 14 days out from initiation of therapy are not excluded

 -  If the involved field is small, 7 days will be considered a sufficient interval
 between radiotherapy and administration of the ixazomib.

 -  Daily requirement for corticosteroids (equivalent to > 10 mg/day prednisone, though
 >10mg/day is acceptable if physiological levels require, so long as the dose is stable
 for at least 7 days prior to initiation of therapy. Inhalation corticosteroids are
 exempt from this criterion.

 -- Lower amounts of corticosteroids that are not part of a daily requirement within 14
 days prior to initiating therapy

 -  Concurrent symptomatic amyloidosis or plasma cell leukemia

 -  POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly,
 endocrinopathy, monoclonal protein and skin changes)

 -  Infection requiring systemic antibiotic therapy or other serious infection within 14
 days before study enrollment.

 -- Those who are on prophylactic antibiotics only, or on antibiotics and have
 confirmation of resolution of active infection are eligible.

 -  Known seropositive for active viral infection with human immunodeficiency virus (HIV)
 hepatitis B (HBV) or hepatitis C viral (HCV). Those who are seropositive because of
 hepatitis B vaccine are eligible. Patients who are positive for HBV core antibody or
 HBV surface antigen must have a negative polymerase chain reaction (PCR) result prior
 to enrollment. Those who are PCR positive will be excluded

 -  Female patients who are lactating or have a positive serum pregnancy test during the
 screening period

 -  Participants who are receiving any other investigational agents for any indication

 -  History of erythema multiforme or severe hypersensitivity to prior IMiD's® or those
 who have a known allergy to any of the study medications, their analogues, or
 excipients in the various formulations of any agent.

 -  Inability to tolerate thromboprophylaxis

 -  Failure to have fully recovered (≤ Grade 1 according to CTCAE v 5) from the reversible
 effects of prior chemotherapy

 -  Peripheral neuropathy must have resolved to Grade 1 toxicity or peripheral neuropathy
 grade 2 with no pain to be eligible

 -  Alopecia of any grade is eligible