What's the purpose of this trial?
Background:
Multiple myeloma (MM) is an incurable cancer of certain blood cells. MM often returns after treatment, and most people survive only 5 to 8 years after diagnosis. To improve survival, researchers need to find ways to identify returning disease earlier.
Objective:
To find out if the radiotracer 18F-fluciclovine (a substance injected into the blood during imaging scans) is better at detecting MM than the one (18F-FDG) currently used for this purpose.
Eligibility:
Adults aged 18 years or older with MM. The MM may be newly diagnosed (NDMM); or it may have returned or failed to respond after at least 1 prior line of treatment (RRMM).
Design:
Participants will be screened. They will have blood tests. They will have a positron emission tomography (PET) or computed tomography (CT) scan using 18F-FDG. The radiotracer will be injected into a vein. Then participants will lie on a table while the PET/CT scan takes images of their body.
All participants will have 3 study visits. During each visit they will have:
Two PET/CT scans. One with 18F-FDG, one with 18F-fluciclovine.
An optional magnetic resonance imaging scan.
A bone marrow biopsy. An area on the hip will be numbed; a needle will be inserted to draw out a sample of the soft tissue from inside the bone.
These tests may be spread over 30 days for each visit.
NDMM participants will have their second study visit 2 to 4 weeks after they complete their usual treatment for the disease. RRMM participants will have their second visit 6 months after their first.
All participants will have a third study visit after 5 years or when their disease progresses.
This is an upcoming trial that has not yet started accepting patients.
What will happen during the trial?
You may be able to join this trial if you:
The following criteria is a partial list of reasons why patients may be
eligible to participate in this clinical trial. Further evaluation with a medical professional is
required.
* INCLUSION CRITERIA:
* Participants must have a documented diagnosis of MM defined by the IMWG Criteria. Participants at diagnosis must have had a serum M-protein \>= 3 g/dL and/or bone marrow plasma cells \>= 10% and at least one of the following:
* Anemia: Hemoglobin \<=10 g/dL, or
* Renal Failure: serum creatinine \>= 2.0 mg/dL, or
* Hypercalcemia: Ca \>= 10.5 mg/dL, or
* Lytic bone lesions on X-ray, CT, or PET/CT, or
* \>= 2 focal lesions on spinal MRI, or
* \>= 60% bone marrow plasma cells, or
* Involved/un-involved serum free light chain ration \>= 100
* Participants must have measurable disease defined by any one of the following:
* Monoclonal bone marrow plasma cells \> 5%
* Serum monoclonal protein \>= 0.2 g/dl
* Urine monoclonal protein \> 200 mg/24 hr
* Serum immunoglobulin free light chain \> 10 mg/dL AND abnormal kappa/lambda ratio
* A measurable lesion on PET/CT or MRI
* Participants fit criteria for one of the following categories:
* Newly diagnosed multiple myeloma (NDMM)
* Relapsed and/or refractory multiple myeloma (RRMM) with at least 1 prior line of therapy
* Age \>=18 years.
* ECOG performance status \<= 2
* Negative serum or urine pregnancy test at screening for WOCBP.
* Women of child-bearing potential and men must agree to use effective contraception (hormonal or barrier method of birth control; abstinence) 24 hours prior to and for the 24 hours after each 18F-fluciclovine administration.
* Ability of subject to understand and the willingness to sign a written informed consent document.
EXCLUSION CRITERIA:
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to 18F-FDG
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to 18F-fluciclovine or other similar agents.
* Subjects with severe claustrophobia unresponsive to oral anxiolytics or unwilling to take them.
* Uncontrolled intercurrent illness including, psychiatric illness/social situations that would limit compliance with study requirements.
* Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with 18F-fluciclovine, breastfeeding should be discontinued if the mother is treated with 18F-fluciclovine until 3 days after 18F-fluciclovine.
Additional Trial Information
Phase 2
Enrollment: 55 patients (estimated)
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