A Study to Evaluate the Effectiveness and Safety of CAEL-101 in Patients With Mayo Stage IIIa AL Amyloidosis
Amyloidosis / Posted 8 months ago
AL (or light chain) amyloidosis begins in the bone marrow where abnormal proteins misfold and create free light chains that cannot be broken down. These free light chains bind together to form amyloid fibrils that build up in the extracellular space of organs, affecting the kidneys, heart, liver, spleen, nervous system and digestive tract.
The primary purpose of this study is to determine whether CAEL-101, a monoclonal antibody that removes AL amyloid deposits from tissues and organs, improves overall survival and it is safe and well tolerated in patients with stage IIIa AL amyloidosis.
This is a double-blind, randomized, multicenter international Phase 3 study of CAEL-101 combined with the standard of care (SoC) for plasma cell dyscrasia (PCD) versus placebo combined with standard of care PCD treatment in patients with Mayo stage IIIa AL amyloidosis that have not received prior treatment. The minimum planned treatment time for each patient will be at least 50 weeks or until the patient’s death. It is planned that all patients will continue their double-blind treatment until the last patient completes at least 50 weeks of treatment.
Approximately 267 patients will be enrolled using a 2:1 randomization ratio of CAEL-101: placebo and will involve approximately 100 investigator sites.
The primary objective of this study is to assess the effects of CAEL-101 versus placebo on all-cause mortality.
Inclusion Criteria :
- Ages Eligible for Study: 18 Years and older
- Sexes Eligible for Study: All
- Accepts Healthy Volunteers: No
- Each patient must meet the following criteria to be enrolled in this study.
- Be able to and provide written informed consent and be willing and able to comply with all study procedures
- Adult, 18 years and older
- AL amyloidosis Mayo stage IIIa based on the 2013 European Modification of the 2004 Standard Mayo Clinic Staging in patients with advanced cardiac involvement at the time of Screening
- Measurable hematologic disease at Screening as defined by at least one of the following:
- Involved/Uninvolved Free Light Chain Difference (dFLC) > 4 mg/dL or
- Involved Free Light Chain (iFLC) &> 4 mg/dL with abnormal ratio or
- Serum Protein Electrophoresis (SPEP) m-spike > 0.5 g/dL
- Histopathological diagnosis of amyloidosis AND confirmation of AL derived amyloid deposits by at least one of the following:
- Immunohistochemistry or
- Mass spectrometry or
- Characteristic electron microscopy appearance
- Cardiac involvement as defined by:
- a. Documented clinical signs and symptoms supportive of a diagnosis of heart failure in the setting of a confirmed diagnosis of AL amyloidosis in the absence of an alternative explanation for heart failure AND b. At least one of the following: i. Endomyocardial biopsy demonstrating AL cardiac amyloidosis or
- ii. Echocardiogram demonstrating a mean left ventricular wall thickness (calculated as [IVSd+LPWd]/2) of >12 mm at diastole in the absence of other causes (e.g., severe hypertension, aortic stenosis), which would adequately explain the degree of wall thickening or
- iii. Cardiac MRI with gadolinium contrast agent diagnostic or cardiac amyloidosis
- Planned first-line treatment for plasma cell dyscrasia is a CyBorD-based regimen administered as Standard of Care (SoC)
- Adequate bone marrow reserve and hepatic function as demonstrated by:
- Absolute neutrophil count ≥ 1.0 x 109/L
- Platelet count ≥ 75 x 109/L
- Hemoglobin ≥ 9 g/dL
- Total direct bilirubin ≤ 2 times the upper limit of normal (x ULN) unless due to Gilbert's syndrome.
- Aspartate aminotransferase (AST) ≤ 3 x ULN
- Alanine aminotransferase (ALT) ≤ 3 x ULN
- Alkaline phosphatase (ALP) ≤ 5 x ULN (except for patients with hepatomegaly and isozymes specific to liver, rather than bone)
- Women of childbearing potential (WOCBP) must have a negative pregnancy test during Screening and must agree to use highly effective physician approved contraception from Screening to at least 5 months following the last study drug administration or 12 months following the last dose of her PCD therapy, whichever is longer
- Men must be surgically sterile or must agree to use effective physician approved contraception and refrain from donating sperm from Screening to at least 5 months following the last study drug administration or 12 months following the last dose of his PCD therapy, whichever is longer
Exclusion Criteria :
- Patients who meet any of the following criteria will not be permitted entry to the study.
- Have any other form of amyloidosis other than AL amyloidosis
- Received prior therapy for AL amyloidosis or multiple myeloma. A maximum exposure of 2 weeks of a CyBorD-based PCD treatment after screening laboratory samples are obtained and prior to randomization is allowed.
- Has POEMS syndrome or multiple myeloma defined as clonal bone marrow plasma cells > 10% or biopsy-proven bony or extramedullary plasmacytoma AND any one or more of the following CRAB features:
- a. Evidence of end organ damage that can be attributed to the underlying plasma cell proliferative disorder, specifically:
- i. Hypercalcemia: serum calcium > 0.25 mmol/L > 1mg/dL) higher than the ULN or >; 2.75 mmol/L > 11mg/dL)
- ii. Renal insufficiency: creatinine clearance <40 mL per minute or serum creatinine > 177mol/L > 2mg/dL)
- iii. Anemia: hemoglobin value of > 20g/L below the lowest limit of normal, or a hemoglobin value <100g/L
- iv. Bone lesions: one or more osteolytic lesion on skeletal radiography, CT, or PET/CT. If bone marrow has<10% clonal plasma cells, more than one bone lesion is required to distinguish from solitary plasmacytoma with minimal marrow involvement
- b. Any one of the following biomarkers of malignancy:
- i. 60% or greater clonal plasma cells on bone marrow examination
- ii. More than one focal lesion on MRI that is at least 5mm or greater in size
- Have supine systolic blood pressure < 90 mmHg or symptomatic orthostatic hypotension, defined as a decrease in systolic blood pressure upon standing of < 30 mmHg despite medical management (e.g., midodrine, fludrocortisones) in the absence of volume depletion
- Taking prednisone or its equivalent > 10 mg/day
- Taking doxycycline
- Receiving dialysis
- Planned stem cell transplant during the first 6 months of protocol therapy. Stem cell collection during the protocol therapy is permitted.
- Have had myocardial infarction, uncontrolled angina, severe uncontrolled ventricular arrhythmias within 6 months prior to screening or percutaneous cardiac intervention with recent stent or coronary artery bypass grafting within 4 months prior to screening. Exacerbation of chronic condition or new acute condition will require discussion and approval by the Medical Monitor.
- Left Ventricular Ejection Fraction (LVEF) is < 40% by echocardiogram at Screening
- Have severe valvular stenosis (e.g., aortic or mitral stenosis with a valve area < 1.0 cm2) or severe congenital heart disease
- Have history of sustained ventricular tachycardia or aborted ventricular fibrillation or a history of atrioventricular nodal or sinoatrial nodal dysfunction for which a pacemaker/implantable cardioverter-defibrillator (ICD) is indicated but not placed. (Participants who do have a pacemaker or ICD are allowed in the study.)
- QT corrected by Fridericia (QTcF) is > 550 msec. Participants who have a pacemaker may be included regardless of calculated QTc interval.
- There is evidence of acute ischemia or active conduction system abnormalities with the exception of any of the following:
- First degree Atrioventricular (AV)-block
- Second degree AV-block Type 1 (Mobitz Type 1/Wenckebach type)
- Right or left bundle branch block
- Atrial fibrillation with a controlled ventricular rate. (An uncontrolled ventricular rate [i.e., > 110 beats per minute] determined by an average of three beats in lead II or representative beats in lead II is not allowed)
- Have had major surgery within 4 weeks of randomization or is planning major surgery during the study. Patients with surgical procedures conducted under local anesthesia may participate
- There is active malignancy (including lymphoma) with the exception of any of the following:
- Adequately treated basal cell carcinoma, squamous cell carcinoma, or in situ cervical cancer
- Adequately treated stage I cancer from which the patient is currently in remission and has been in remission for >; 2 years
- Low-risk prostate cancer with Gleason score < 7 and prostate-specific antigen < 10 mg/mL
- Other localized and/or low risk malignancies may be permitted with Medical Monitor approval.
- Have received an investigational drug/device in another clinical investigational study within 60 days before Screening
- Hypersensitivity to the study drug
- Have received a live vaccine within 4 weeks prior to first dose of CyBorD
- Women who are breast feeding
- Have any other medical, social or psychological factors that could affect the patient's safety or ability to consent personally or comply with study procedures.
- Study end date : March 15, 2025
- Wales-Based Study Contact : Please speak to your clinician
- Principal Investigator : Cristina C Quarta, MD, PhD Alexion, AstraZeneca Rare Disease