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Lonial S, Vij R, Harousseau JL, Facon T, Moreau P, Mazumder A, Kaufman JL, Leleu X, Tsao LC, Westland C, Singhal AK, Jagannath S. Elotuzumab in Combination With Lenalidomide and Low-Dose Dexamethasone in Relapsed or Refractory Multiple Myeloma. J Clin Oncol 2012; 30:1953-9. [DOI: 10.1200/jco.2011.37.2649] [Citation(s) in RCA: 246] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This phase I study evaluated elotuzumab, lenalidomide, and dexamethasone in patients with relapsed or refractory multiple myeloma (MM). Patients and Methods Three cohorts were enrolled and treated with elotuzumab (5.0, 10, or 20 mg/kg intravenously) on days 1, 8, 15, and 22 of a 28-day cycle in the first two cycles, and days 1 and 15 of each subsequent cycle; lenalidomide 25 mg orally [PO] on days 1 to 21; and dexamethasone 40 mg PO weekly. Dose-limiting toxicities (DLTs) were assessed during cycle 1 of each cohort, and clinical responses were evaluated during each cycle. The first five patients received up to six cycles of therapy; subsequent patients were treated until disease progression. Results Twenty-nine patients with advanced MM and a median of three prior MM therapies were enrolled; 28 patients were treated, three each in the 5.0-mg/kg and 10-mg/kg cohorts and 22 in the 20-mg/kg cohort. No DLTs were observed up to the maximum proposed dose of 20 mg/kg. The most frequent grade 3 to 4 toxicities were neutropenia (36%) and thrombocytopenia (21%). Two patients experienced a serious infusion reaction (one grade 4 anaphylactic reaction and one grade 3 stridor) during the first treatment cycle. Objective responses were obtained in 82% (23 of 28) of treated patients. After a median of 16.4 months follow-up, the median time to progression was not reached for patients in the 20-mg/kg cohort who were treated until disease progression. Conclusion The combination of elotuzumab, lenalidomide, and low-dose dexamethasone was generally well tolerated and showed encouraging response rates in patients with relapsed or refractory MM.
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Affiliation(s)
- Sagar Lonial
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - Ravi Vij
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - Jean-Luc Harousseau
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - Thierry Facon
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - Philippe Moreau
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - Amitabha Mazumder
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - Jonathan L. Kaufman
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - Xavier Leleu
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - L. Claire Tsao
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - Christopher Westland
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - Anil K. Singhal
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
| | - Sundar Jagannath
- Sagar Lonial and Jonathan L. Kaufman, Winship Cancer Institute, Emory University, Atlanta, GA; Sagar Lonial, Ravi Vij, Jonathan L. Kaufman, and Sundar Jagannath, Multiple Myeloma Research Consortium, Norwalk, CT; Ravi Vij, Washington University School of Medicine, St. Louis, MO; Jean-Luc Harousseau, Institut de Cancérlogie de l'Ouest René Gauducheau, Saint Herblain; Philippe Moreau, University Hospital, Nantes; Thierry Facon, Xavier Leleu, Service des Maladies du Sang Hopital Claude Huriez, Lille,
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