Cancer | Denosumab Compared to Zoledronic Acid in the Treatment of Bone Disease in Patients With Multiple Myeloma

Cancer research study

What is the primary objective of this study?

The purpose of this study is to determine if denosumab is non-inferior to zoledronic acid in the treatment of bone disease from multiple myeloma.

Who is eligible to participate?

Inclusion Criteria: - Documented evidence of multiple myeloma (per local assessment): - Monoclonal plasma cells in the bone marrow greater than or equal to 10% and/or presence of a biopsy-proven plasmacytoma, and - Monoclonal protein present in the serum and/or urine - Radiographic (X-ray, or computer tomography [CT]) evidence of at least 1 lytic bone lesion (or at least 1 focal lesion per magnetic resonance imaging [MRI]) - Plan to receive or is receiving primary frontline anti-myeloma therapies - Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2 - Age ≥ 18 years - Adequate organ function, as defined by the following criteria (per central or local laboratory values): - Serum aspartate aminotransferase (AST) ≤ 2.0 x upper limit of normal (ULN) - Serum alanine aminotransferase ≤ (ALT) 2.0 x ULN - Serum total bilirubin ≤ 2.0 x ULN - Creatinine clearance ≥ 30 mL/min - Serum calcium or albumin-adjusted serum calcium 2.0 mmol/L (8.0 mg/dL) and 2.9 mmol/L (11.5 mg/dL) - Written informed consent before any study-specific procedure is performed Exclusion Criteria: - Nonsecretory multiple myeloma based upon standard M-component criteria (ie, measurable serum/urine M-component) unless the baseline serum free light chain level is elevated - POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes) - Plasma cell leukemia - More than 30 days of previous treatment (before screening) with anti-myeloma therapy (does not include radiotherapy or a single short course of steroid [ie, less than or equal to the equivalent of dexamethasone 60 mg/day for 4 days]). - Planned radiation therapy or surgery to the bone (does not include procedures performed before randomization) - Prior administration of denosumab - Use of oral bisphosphonates with a cumulative exposure of more than 1 year - More than 1 previous dose of IV bisphosphonate administration - Prior history or current evidence of osteonecrosis/osteomyelitis of the jaw - Active dental or jaw condition which requires oral surgery, including tooth extraction - Non-healed dental/oral surgery, including tooth extraction - Planned invasive dental procedures - Evidence of any of the following conditions per subject self-report or medical chart review: - Any prior invasive malignancy within 5 years before randomization - Any non-invasive malignancy not treated with curative intent or with knownactive disease within 5 years before randomization - Major surgery or significant traumatic injury occurring within 4 weeks before randomization - Active infection with Hepatitis B virus or Hepatitis C virus - Known infection with human immunodeficiency virus (HIV) - Active infection requiring IV anti-infective therapy - Subject is pregnant or breast feeding, or planning to become pregnant within 5 months after end of treatment - Female subject of child bearing potential is not willing to use highly effective contraception during treatment and for 5 months after the end of treatment (see section 6.3) - Known sensitivity to any of the products to be administered during the study (eg, mammalian derived products, calcium or vitamin D) - Subject is receiving or is less than 30 days since ending other experimental device or drug (no marketing authorization for any indication) - Subject will not be available for follow-up assessment - Any major medical or psychiatric disorder that in the opinion of the investigator, might prevent the subject from completing the study or interfere with the interpretation of the study results

Which medical condition, disease, disorder, syndrome, illness, or injury is researched?


Hematologic Malignancies

Multiple Myeloma


Bone Metastases

Multiple Myeloma Bone Lesions

Study Interventions

Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.

Drug:DenosumabAdministered by subcutaneous injection once every 4 weeks.

Drug:Zoledronic acidAdministered by intravenous infusion over 15 minutes once every 4 weeks

Drug:Placebo to DenosumabAdministered by subcutaneous injection once every 4 weeks.

Drug:Placebo to zoledronic acidAdministered by intravenous infusion over 15 minutes once every 4 weeks

Study Arms

Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.

Zoledronic acidParticipants received zoledronic acid 4 mg intravenously plus placebo to denosumab subcutaneous injection once every 4 weeks until the required number of events was reached.

DenosumabParticipants received denosumab 120 mg subcutaneous injection and placebo to zoledronic acid intravenously once every 4 weeks until the required number of events was reached.

Study Status


Start Date: May 17, 2012

Completed Date: March 29, 2019

Phase: Phase 3

Type: Interventional


Primary Outcome: Time to First On-study Skeletal Related Event

Secondary Outcome: Time to First On-study Skeletal Related Event - Superiority Analysis

Study sponsors, principal investigator, and references

Principal Investigator: MD

Lead Sponsor: Amgen

Collaborator: Daiichi Sankyo, Inc.

More information:

Raje N, Roodman GD, Willenbacher W, Shimizu K, García-Sanz R, Terpos E, Kennedy L, Sabatelli L, Intorcia M, Hechmati G. A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in the United States of America. J Med Econ. 2018 May;21(5):525-536. doi: 10.1080/13696998.2018.1445634. Epub 2018 Mar 5.

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