Inobrodib, Pomalidomide and Dexamethasone Versus Standard Available Therapy in Relapsed or Refractory Multiple Myeloma

This is a Phase 3, multicenter, open-label, randomized study to evaluate inobrodib in combination with pomalidomide and dexamethasone (InoPd) versus standard available therapy (SAT), defined as Investigator's choice of daratumumab or elotuzumab in combination with pomalidomide and dexamethasone (DPd and EPd, respectively) or carfilzomib in combination with dexamethasone (Kd), in participants with relapsed or refractory multiple myeloma (RRMM).

Participants must be 18 years or older and have received 1 to 4 prior lines of therapy only.

Approximately 450 participants will be randomized 1:1 to be treated with either InoPd (Arm A) or Investigator's choice of SAT (Arm B), which includes DPd, EPd and Kd.

Study treatment should be continued until disease progression, initiation of new anticancer therapy, unacceptable toxicity or the participant meets any criteria for withdrawal from the study.

The dual primary objectives are to compare the efficacy of InoPd with Investigator's choice of SAT in terms of progression-free survival (PFS) and objective response rate (ORR) by Blinded Independent Central Review (BICR) in participants receiving InoPd versus participants receiving SAT.

The study will use a Steering Committee, consisting of selected participating Principal Investigators, Contract Research Organization (CRO) and Sponsor representatives, and an Independent Data Monitoring Committee (IDMC), for the purposes of conduct and oversight of the study.

Inclusion criteria

• Adults aged 18 years or older (or the minimum age of consent under local rules, if that is 18 or over)
• A diagnosis of multiple myeloma that has either come back (relapsed) or did not respond (refractory) after the most recent treatment
• Myeloma that can be measured using standard study tests (blood and/or urine tests)
• Between 1 and 4 previous courses (lines) of myeloma treatment, which must have included both a treatment that targets CD38 (such as daratumumab or isatuximab) and lenalidomide
• Well enough to carry out daily activities with little or no help (Eastern Cooperative Oncology Group [ECOG] performance status of 0 to 2)
• Suitable blood test results and adequate kidney and liver function
• Willingness to use highly effective contraceptive measures (if sexually active) with all sexual partners

Exclusion criteria

• Recent anticancer treatment before starting study treatment: any experimental medicine, chemotherapy, immunotherapy or other anticancer treatment within 14 days or 5 half-lives (whichever is shorter), or certain antibody-based treatments within longer set periods
• Previous treatment with a medicine that works in the same way as inobrodib (a p300/CBP bromodomain inhibitor)
• Myeloma that has already stopped responding to pomalidomide (pomalidomide-refractory), unless only short-term pomalidomide was used and the study doctor confirms the person still meets the study rules
• Unable to receive at least one of the standard treatment options offered in the study, or unable/unwilling to follow the requirements for at least one of those options
• Taking medicines, herbal supplements or foods (for example, strong CYP3A4 inducers or inhibitors) that would interfere with the study treatment
• Major surgery within 4 weeks before the first dose of study treatment
• A live vaccine within 4 weeks before study treatment
• A recent stem cell transplant, or ongoing transplant-related problems such as graft-versus-host disease
• Myeloma affecting the brain, spinal fluid or spinal cord, or ongoing pressure on the spinal cord
• Another active cancer (progressing or needing a change in treatment) in the last 24 months, other than multiple myeloma, apart from certain low-risk or fully treated cancers
• Serious or uncontrolled medical problems, such as uncontrolled heart, lung, liver, bleeding or diabetes conditions, uncontrolled high blood pressure, or a heart-rhythm problem (including QT prolongation)
• An active or uncontrolled infection, including certain cases of HIV, hepatitis B or hepatitis C
• Digestive problems that could stop the study medicines being swallowed or properly absorbed
• Pregnant or breastfeeding, or planning to become pregnant, father a child or donate sperm during treatment or the required post-treatment period
• Any illness or medical history that could affect safety, the ability to follow study requirements, or the interpretation of study results