Phase I Trial of Everolimus, Pomalidomide and Dexamethasone in Patients With Relapsed/Refractory Multiple Myeloma

Given that pomalidomide is an FDA approved drug for patients with relapsed or progressive
myeloma, and everolimus has been shown to have single agent activity in relapsed myeloma, it
seems reasonable to combine these two active drugs in patients with relapsed/refractory
disease. Given that low dose dexamethasone dramatically improved the response rate of
pomalidomide, this drug will be added to the combination.

Inclusion Criteria:

Age > 18 years

Relapsed or progressive multiple myeloma (MM) (Progressive Disease), defined as a 25%
increase from the lowest response value in ANY of the following:

Serum M-protein (absolute increase ≥0.5 g/dL)

Urine M-protein (absolute increase of ≥200 mg/24 hours)

Bone marrow plasma cell percentage (≥ 10% absolute increase) in absence of measurable
M-protein

Difference in kappa & lambda free light chain levels (ratio must be abnormal; absolute
change must be >10 mg/dL)

Patients are also considered to have progressive disease when:

New bone or soft tissue lesions (e.g. plasmacytomas) are identified; or

There is an unequivocal increase in the size of previously existing lesions; or

The development of an otherwise unexplained serum calcium >11.5 mg/dL

Have received 1, but no more than 4 prior treatment regimens or lines of therapy for MM
(Induction therapy followed by stem cell transplant & consolidation/maintenance therapy
will be considered as one line of therapy)

ECOG Performance status 0 - 2

Life expectancy of at least 12 weeks

Evaluable MM with, at least one of the following, assessed within 21 days prior to
randomization:

Serum M-protein ≥ 0.5 g/dL, or Urine M-protein ≥ 200 mg/24 hour, or

In absence of detectable serum or urine M-protein, serum FLC (SFLC) > 100 mg/L (involved
light chain) and/or an abnormal kappa/lamda ratio (>4:1 or <2:1), or

Monoclonal plasma cells in a bone marrow biopsy/aspirate of >5%

Adequate organ and marrow function as defined below:

- Leukocytes ≥ 2,500/mcL

- Absolute neutrophil count ≥ 1,500/mcL

- Platelets ≥ 100,000/mcL

- Total bilirubin < 2 X ULN

- AST(SGOT)/ALT(SPGT) ≤ 2.5 X ULN

- Creatinine < 1.5 X ULN

Contraception Women of child-bearing potential and men must agree to use adequate
contraception prior to study entry, for duration of study, and for 90 days after
completion of therapy.

A female of child-bearing potential is considered to be any woman (regardless of sexual
orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets
the following criteria:

- No hysterectomy or bilateral oophorectomy; or

- Not naturally postmenopausal for at least 12 consecutive months (i.e., has had menses
at any time in the preceding 12 consecutive months).

Male patients must use an effective barrier method of contraception during study and for 3
months following the last dose if sexually active with a female of child-bearing
potential.

No prior therapy with pomalidomide or everolimus.

Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

Have had chemotherapy or radiotherapy within 4 weeks prior to entering the study or those
who have not recovered from adverse events due to agents administered more than 4 weeks
earlier.

Receiving any other investigational agents. Minimum 4 week "washout" period is required.

History of allergic reactions attributed to compounds of similar chemical or biologic
composition to pomalidomide, everolimus, or other agents used in the study.

Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements.

Pregnant or nursing (due to the rick for congenital abnormalities and the potential of
this regimen to harm nursing infants).

Glucocorticoid therapy (prednisone > 30 mg/day or equivalent) within 14 days prior to
randomization.

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin
changes).

Plasma cell leukemia or circulating plasma cells ≥ 2 × 10^9/L.

Waldenstrom's Macroglobulinemia.

Patients with known amyloidosis.

Focal radiation therapy within 7 days prior to randomization. Radiation therapy to an
extended field involving a significant volume of bone marrow within 21 days prior to
randomization (i.e., prior radiation must have been to less than 30% of the bone marrow).

Immunotherapy within 21 days prior to randomization.

Myelodysplastic syndrome

Major surgery (excluding kyphoplasty) within 28 days

Known cirrhosis.

Significant neuropathy (Grades 3 to 4, or Grade 2 with pain) within 14 days

Ongoing graft-vs-host disease.

Using CYP3A4 inhibitors such as Ketoconazole, Ritonavir, Itraconazole, Erythromycin,
Clarithromycin, Nelfinavir, Fluconazole, Amiodarone, Cyclosporine, Diltiazem,
nefazadone,fluvoxamine, verapamil, chloramphenicol, Indinavir or saquinavir within 7 days
of treatment.