Isatuximab for Amyloidosis
Recruiting at 5 trial locations
CC
Overseen ByCraig C Hofmeister, MD, MPH
Age: 18+
Sex: Any
Trial Phase: Phase 1
Sponsor: Emory University
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Approved in 2 JurisdictionsThis treatment is already approved in other countries
Trial Summary
Will I have to stop taking my current medications?
The trial protocol does not specify if you need to stop taking your current medications. However, it mentions that patients may continue low-dose corticosteroids for symptom management and comorbid conditions.
What data supports the effectiveness of the drug Isatuximab for treating amyloidosis?
How is the drug Isatuximab different from other treatments for amyloidosis?
What is the purpose of this trial?
This phase I trial studies the side effects of isatuximab and to see how well it works in treating patients with high risk immunoglobulin light chain amyloidosis (AL amyloidosis). Isatuximab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread.
Research Team
CC
Craig C Hofmeister, MD, MPH
Principal Investigator
Emory University
Eligibility Criteria
This trial is for adults with high risk AL amyloidosis, a condition where abnormal proteins build up in organs. Participants must have specific biomarkers indicating severe disease, adequate organ function, and no prior significant treatments for AL amyloidosis. They should not be HIV positive or have hepatitis B/C unless certain conditions are met. Women of childbearing potential must test negative for pregnancy and agree to use contraception.Inclusion Criteria
My diagnosis of amyloidosis was confirmed through specific tests on my tissue samples.
Must have evidence of high risk AL amyloidosis defined as one of the following any time within the 6 months prior to consent: Biomarker-based indicators of severe disease: NT-proBNP > 8500 ng/L OR hs-cTnT >= 50 ng/L, BUMC 2019 stage 3b requiring both TnI > 0.1 ng/mL and BNP > 700 pg/mL, Mayo 2012 stage 4 that includes each of the following a) cTnT >= 0.025 ng/mL or hs-cTnT >= 40 ng/mL; b) NT-proBNP >= 1800 pg/mL; and c) dFLC >= 180 mg/L, Significant AL amyloid related hypotension (systolic blood pressure [SBP] < 100 mm Hg or symptomatic orthostatic hypotension defined as a decrease in systolic blood pressure upon standing of > 20 mm Hg despite medical management [fludrocortisone, midodrine, etc] in the absence of volume depletion), Absolute neutrophil count (ANC) >= 1000/uL, Platelet count >= 50,000 and platelet transfusion independent for 1 week prior to screening, Estimated creatinine clearance >= 20 mL/min/1.73 m^2 as defined by Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI), Total bilirubin < 1.5 x institutional upper limit of normal (IULN) except for patients with Gilbert syndrome in which case total bilirubin =< 2 x IULN, Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 3 x IULN, Left ventricular ejection fraction >= 30%, Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL within 10 - 14 days prior to and again within 24 hours of starting study medication. The effects of protocol therapy on the developing human fetus are unknown. For this reason, FCBP and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 5 months after completion of protocol therapy. Men must refrain from donating sperm during the same period that they must agree to use contraception. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. A female of childbearing potential (FCBP) is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months, Ability to understand and the willingness to sign a written informed consent document, Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
Exclusion Criteria
> 1 prior line of therapy, Refractory to any proteasome inhibitor, Prior CD38 antibody exposure, Subjects with a history of sustained ventricular tachycardia EXCEPT in patients with a pacemaker/implantable cardioverter defibrillator (ICD), Baseline QT interval as corrected by institutional rate correction algorithm (e.g. corrected QT interval by Bazett formula [QTc]B or corrected QT interval by Fridericia formula [QTcF]) > 500 msec EXCEPT in patients with a pacemaker, Grade 2 or greater peripheral sensory neuropathy, Received any investigational drug within 14 days or 5 half-lives of the investigational drug, whichever is longer, Hypersensitivity or history of intolerance to steroids, mannitol, pregelatinized starch, sodium stearyl fumarate, histidine (as base and hydrochloride salt), arginine hydrochloride, poloxamer 188, sucrose or any of the other components of study therapy that are not amenable to premedication with steroids and H2 blockers or would prohibit further treatment with these agents, Human immunodeficiency virus (HIV) positive EXCEPT if the patient meets all the following: CD4 > 350 cells/mm3, undetectable viral load, maintained on modern therapeutic regimen utilizing non CYP interacting agents (e.g. excluding ritonavir), and no untreated acquired immune deficiency syndrome defining opportunistic infections, Seropositive for hepatitis B surface antigen [HBsAg]) EXCEPT subjects with resolved infection (i.e., subjects who are positive for antibodies to hepatitis B core antigen [antiHBc] and/or antibodies to hepatitis B surface antigen [antiHBs]) must be screened using real-time polymerase chain reaction (PCR) measurement of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) levels. Those who are PCR positive will be excluded. Subjects with serologic findings suggestive of HBV vaccination (antiHBs positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA by PCR, Seropositive for hepatitis C EXCEPT in the setting of a sustained virologic response [SVR], defined as without viremia for at least 12 weeks after completion of antiviral therapy, Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome, wild type or mutated (ATTR) amyloidosis, and Waldenstrom macroglobulinemia, Known allergies, hypersensitivity, or intolerance to monoclonal antibodies, hyaluronidase, human proteins, or their excipients (refer to investigational brochure [IB]), or known sensitivity to mammalian-derived products, Patients who have had any plasma cell directed treatment, radiotherapy, plasmapheresis, or major surgery (as defined by the investigator) within 1 week prior to cycle 1 day 1 of the study. Patients may be receiving concomitant therapy with low dose corticosteroids (e.g., prednisone up to but no more than 10 mg by mouth daily or its equivalent) for symptom management and comorbid conditions, Concurrent medical condition or disease (e.g., active infection requiring treatment with a parenteral antibiotic, active tuberculosis, etc) that would expose excessive risk to the patient or may interfere with compliance or interpretation of the study results, Known or suspected of not being able to comply with the study protocol (e.g. alcoholism, drug dependency, or psychological disorder) or the subject has any condition for which, in the opinion of the investigator, participation would not be in the best interest of the subject (e.g., compromise their well-being) or that could prevent, limit, or confound the protocol-specified assessments, Pregnant women are excluded from this study because protocol therapy has the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to protocol treatment of the mother, breastfeeding should be discontinued. Women planning to become pregnant 1 year after discontinuation of cyclophosphamide or 3 months following discontinuation of isatuximab
Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive isatuximab and dexamethasone with potential escalation to include Velcade and cyclophosphamide based on tolerance
6 months
Weekly visits initially, then bi-weekly
Maintenance
Participants receive maintenance treatment with dexamethasone and isatuximab twice per month
12 months
Bi-weekly visits
Follow-up
Participants are monitored for safety and effectiveness after treatment
3 months
Treatment Details
Interventions
- Isatuximab
Trial Overview The trial tests the safety and effectiveness of isatuximab as an initial treatment option for high risk AL amyloidosis patients. Isatuximab is a monoclonal antibody designed to disrupt tumor cell growth. It's given alongside standard drugs like dexamethasone, bortezomib, and cyclophosphamide to see if it improves outcomes.
Participant Groups
1Treatment groups
Experimental Treatment
Group I: Treatment (isatuximab, chemotherapy)Experimental Treatment4 Interventions
All patients will receive Isatuximab plus dexamethasone 4 mg PO/IV days weekly. Based on tolerance, patients will add to their treatment subcutaneous Velcade (earliest time to add Velcade is cycle 1 day 15) and intravenous cyclophosphamide (earliest time to add cyclophosphamide is cycle 4 day 1)
Patients then receive dexamethasone and isatuximab as maintenance treatment twice per month for 12 months in the absence of disease progression or unacceptable toxicity.
Isatuximab is already approved in European Union, United States for the following indications:
Approved in European Union as Sarclisa for:
- Multiple myeloma
Approved in United States as Sarclisa for:
- Multiple myeloma in combination with pomalidomide and dexamethasone for adults who have received at least two prior therapies including lenalidomide and a proteasome inhibitor
- Multiple myeloma in combination with carfilzomib and dexamethasone for adults with relapsed or refractory multiple myeloma who have received one to three prior lines of therapy
- Newly diagnosed multiple myeloma in combination with bortezomib, lenalidomide, and dexamethasone for adults who are not eligible for autologous stem cell transplant
Find a Clinic Near You
Who Is Running the Clinical Trial?
Emory University
Lead Sponsor
Trials
1,735
Recruited
2,605,000+
Sanofi
Industry Sponsor
Trials
2,246
Recruited
4,085,000+
Paul Hudson
Sanofi
Chief Executive Officer since 2019
Degree in Economics from Manchester Metropolitan University
Christopher Corsico
Sanofi
Chief Medical Officer
MD from Cornell University, MPH in Chronic Disease Epidemiology from Yale University
National Cancer Institute (NCI)
Collaborator
Trials
14,080
Recruited
41,180,000+
Findings from Research
In a study of 49 patients with relapsed/refractory AL amyloidosis treated with daratumumab, the overall hematologic response rate was 81%, with 64% achieving a very good partial response or better, indicating strong efficacy in this challenging patient population.
Daratumumab was found to be safe and well tolerated, with no patients discontinuing treatment due to toxicity, and it demonstrated significant cardiac and renal responses (74% and 73%, respectively), supporting its use in real-world settings.
NCBI (Pubmed)
pubmed.ncbi.nlm.nih.gov
Daratumumab for relapsed AL amyloidosis-When cumulative real-world data precedes clinical trials: A multisite study and systematic literature review.Shragai, T., Gatt, M., Lavie, N., et al.[2021]
In a real-life study involving 33 patients with AL amyloidosis, daratumumab demonstrated good efficacy, achieving a 60% rate of favorable hematological responses and a 50% rate of organ responses.
The treatment was well-tolerated, indicating an acceptable toxicity profile, making daratumumab a promising option for patients with relapsed or refractory AL amyloidosis.
NCBI (Pubmed)
pubmed.ncbi.nlm.nih.gov
Daratumumab in AL Amyloidosis: A Real-Life Experience of the "RTM" (Regional Tuscan Myeloma Network).Sammartano, V., Antonioli, E., Buda, G., et al.[2022]
Daratumumab, an anti-CD38 immunotherapy, has shown significant efficacy in treating newly diagnosed systemic light-chain (AL) amyloidosis by improving hematologic and organ response rates, suggesting it may become a new standard of care.
In relapsed or refractory cases, daratumumab alone or in combination therapies has also demonstrated promising results, highlighting the potential of targeting CD38 on plasma cells for effective treatment options.
NCBI (Pubmed)
pubmed.ncbi.nlm.nih.gov
Daratumumab in the Treatment of Light-Chain (AL) Amyloidosis.Palladini, G., Milani, P., Malavasi, F., et al.[2021]
References
Daratumumab for relapsed AL amyloidosis-When cumulative real-world data precedes clinical trials: A multisite study and systematic literature review. [2021]
Daratumumab in AL Amyloidosis: A Real-Life Experience of the "RTM" (Regional Tuscan Myeloma Network). [2022]
Daratumumab in AL amyloidosis. [2022]
Teclistamab in relapsed or refractory AL amyloidosis, a multinational retrospective case series. [2023]
Budget impact analysis of daratumumab for light-chain amyloidosis in Cyprus. [2023]
Daratumumab in the Treatment of Light-Chain (AL) Amyloidosis. [2021]
[Interest of daratumumab in refractory AL amyloidosis in a 96-year-old patient]. [2022]
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