Oral ONC201 in Relapsed/Refractory Multiple Myeloma

Inclusion Criteria:

Patients must be refractory to, or not a candidate for, established therapy known to provide clinical benefit for their malignancy.
Measurable disease M protein component in serum (at least 0.5 g/dL) and/or urine (if present) (>=0.2 g excreted in a 24 hour collection sample).
All previous therapies for cancer, including radiotherapy, major surgery and investigational therapies discontinued for ≥ 14 days (≥ 28 days for mitomycin C or nitrosoureas) before study entry, and all acute effects of any prior therapy resolved to baseline severity or Grade ≤ 1 Common Terminology Criteria for Adverse Events (CTCAE v4.03), except alopecia or parameters defined in this eligibility list.
Age ≥ 18 years.
ECOG performance status ≤ 1.

Adequate organ and marrow function as defined below:

Absolute neutrophil count ≥1,000/mm3 without growth factor use ≤ 7 days prior to treatment (cycle 1 day 1, C1D1)
Platelets ≥75,000/mm3 without platelet transfusion ≤ 3 days prior to C1D1
Hemoglobin >8.0 mg/dL without red blood cell transfusion ≤ 3 days prior to C1D1
Total serum bilirubin <1.5 X upper limit of normal (ULN)
AST (SGOT)/ALT (SGPT) ≤2 X ULN; ≤ 5 X ULN if there is liver involvement secondary to tumor
Serum creatinine ≤ 1.5 X ULN (OR creatinine clearance ≥ 60 mL/min/1.73 m2)
Serum or urine pregnancy test (for females of childbearing potential) negative ≤7 days of starting treatment
Ability to understand and the willingness to sign a written informed consent document and comply with the study scheduled visits, treatment plans, laboratory tests and other procedures.
Female patients must be surgically sterile or be postmenopausal, or must agree to use effective contraception during the period of the trial and for at least 90 days after completion of treatment. Male patients must be surgically sterile or must agree to use effective contraception during the period of the trial and for at least 90 days after completion of treatment. The decision of effective contraception will be based on the judgment of the principal investigator or a designated associate.

Exclusion Criteria:

Active inflammatory gastrointestinal disease, chronic diarrhea (unless related to underlying malignancy or prior related treatment) or history of abdominal fistula, gastrointestinal perforation, peptic ulcer disease, or intra-abdominal abscess within 6 months prior to study enrollment. Gastroesophageal reflux disease under treatment with proton pump inhibitors is allowed.
Pregnancy or breast feeding.
Current active treatment in another clinical study.
Active bacterial, fungal or viral infection including hepatitis B (HBV), hepatitis C (HCV)
Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)-related illness that is not well controlled.
Active or prior plasma cell leukemia (defined as either 20% of peripheral WBC comprised of plasma/CD138+ cells or an absolute count of 2 x 10^9/L).
Solitary bone or solitary extramedullary plasmacytoma as the only evidence of plasma cell dyscrasia.
Subjects with serum calcium (corrected for albumin) ≥ 12 mg/dL
Any of the following in the previous 6 months: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure, cerebrovascular accident, transient ischemic attack or symptomatic pulmonary embolism.
Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, or in the judgment of the investigator would make the patient inappropriate for entry into the study.