A Phase II Study of Dasatinib in the Treatment of Relapsed or Plateau Phase Multiple Myeloma

Inclusion Criteria

Multiple myeloma diagnosed by standard criteria with either relapsed or plateau-phase disease.

Relapsed: At least 1 prior therapy for multiple myeloma with documented evidence of progression on the most recent treatment.
Plateau-phase: subjects with myeloma who had a response to their most recent multiple myeloma therapy (including autologous transplantation or other investigational agents) and have residual detectable monoclonal protein in their serum or urine that has been stable for greater than or equal to 3 months (+/- 25% change in M-protein).
Measurable levels of monoclonal protein in serum (greater than or equal to 0.5 g/dL) or urine (greater than or equal to 1.0 g/24 hr).
Age 18 years or older.
ECOG performance status of less than or equal to 2.

Acceptable organ and marrow function as defined below:

Hemoglobin of greater than or equal to 8 gm/dL
Absolute neutrophil count of greater than or equal to 500/mm3
Platelets of greater than or equal to 50,000/mm3
PT and PTT of less than or equal to 1.5 times the institutional Upper Limit of Normal (ULN)
Total bilirubin of less than or equal to 2.0 times the institutional ULN institutional ULN
Hepatic enzymes (AST, ALT ) equal to 2.5 times the institutional ULN
Serum Na, K+, Mg2+, Phosphate and Ca2+ greater than or equal to Lower Limit of Normal (LLN)
Serum Creatinine of less than or equal to 1.5 times the institutional ULN
Ability to understand and the willingness to sign a written informed consent document.
Ability to take oral medication (dasatinib must be swallowed whole)
Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test (sensitivity of less than or equal to 25IU HCG/L) within 72 hours prior to the start of study drug administration
Persons of reproductive potential must agree to use an adequate method of contraception throughout treatment and for at least 4 weeks after study drug is stopped.
Signed written informed consent including HIPAA according to institutional guidelines.

Exclusion Criteria

Receiving any of the following therapies or medications:

Any investigational agents within 30 days.
Drugs that are generally accepted to have a risk of causing Torsade de Pointes including:
quinidine, procainamide, disopyramide
amiodarone, sotalol, ibutilide, dofetilide
erythromycin, clarithromycin
chlorpromazine, haloperidol, mesoridazine, thioridazine, pimozide
cisapride, bepridil, droperidol, methadone, arsenic, chloroquine, domperidone,
halofantrine, levomethadyl, pentamidine, sparfloxacin, lidoflazine
Subjects who have discontinued any of these medications must have a wash-out period of at least 7 days prior to the first dose of dasatinib.
Medications known to be potent CYP3A4 inhibitors (See Appendix D).
The concomitant use of H2 blockers or proton pump inhibitors with dasatinib is not recommended. The use of antacids should be considered in place of H2 blockers or proton pump inhibitors in patients receiving dasatinib therapy (See section 5.5.2.3 for important cautions regarding use of antacids.)
Patient agrees to discontinue St. Johns Wort while receiving dasatinib therapy.
Patient agrees that IV bisphosphonates will be withheld for the first 8 weeks of dasatinib therapy due to risk of hypocalcemia.
Prior therapy with dasatinib
Biopsy proven amyloidosis.
History of other malignancy (except for basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or breast) which required radiotherapy or systemic treatment within the past 5 years.

Concurrent medical condition which may increase the risk of toxicity, including:

Pleural or pericardial effusion of any grade
Clinically-significant coagulation or platelet function disorder (e.g. known von Willebrand's disease)

Cardiac Symptoms or Cardiovascular Disease, including:

Myocardial infarction within 6 months
Uncontrolled angina within 6 months
Congestive heart failure within 6 months
Diagnosed or suspected congenital long QT syndrome
Any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsade de Pointes). Any subject with a history of any arrhythmia should be discussed with the Investigator prior to entry into the study.
Prolonged QTc interval on pre-entry electrocardiogram (greater than 450 msec) on Bazett's correction. However, if Bazett's correction is high (i.e., greater than 450 msec) and Fridericia is less than or equal to 450 msec, the subject is eligible.
Subjects with hypokalemia or hypomagnesemia if it cannot be corrected
Dementia or altered mental status that would prohibit the understanding or rendering of informed consent

History of significant bleeding disorder unrelated to cancer, including:

Diagnosed congenital bleeding disorder (e.g., von Willebrand's disease)
Diagnosed acquired bleeding disorder within one year (e.g., acquired anti-factor VIII antibodies)
Ongoing or recent (less than or equal to 3 months) significant gastrointestinal bleeding

Women:

are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for at least 4 weeks after cessation of study drug, or
have a positive pregnancy test at baseline, or
are breastfeeding.
Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (e.g., infectious) illness

Sexually active women of childbearing potential (WOCBP) must use an effective method of birth control during the course of the study, in a manner such that risk of failure is minimized.

Prior to study enrollment, women of childbearing potential must be advised of the importance of avoiding pregnancy during trial participation and the potential risk factors for an unintentional pregnancy.

All WOCBP MUST have a negative pregnancy test prior to first receiving dasatinib. If the pregnancy test is positive, the patient must not receive dasatinib and must not be enrolled in the study.