LCI-HEM-MYE-CRD-004 (MMRC-073 CARJAK): Study of CRD for Carfilzomib-Refractory Multiple Myeloma

This is an open-label, Phase I/II study of carfilzomib, ruxolitinib, and low-dose
dexamethasone for carfilzomib-refractory multiple myeloma. Phase I is designed to evaluate
overall maximum tolerated dose (MTD) of ruxolitinib in combination with carfilzomib and
dexamethasone in the following cohorts: Cohort 1) 5mg ruxolitinib, Cohort 2) 10mg
ruxolitinib, Cohort 3) 15mg ruxolitinib. Phase II is designed to evaluate 4-month
progression-free survival (PFS) in the following cohorts: Cohort A) non-responders to Phase I
regimen, Cohort B) responders to Phase I regimen. Up to 18 evaluable subjects will be
enrolled in Phase I over approximately 12 months. An additional 30 evaluable subjects will be
enrolled in Phase II over 24 months.

Subjects must meet all of the following criteria:

1. Documented history of relapsed and or refractory multiple myeloma with > 2 lines of
therapy and evidence of relapse or progression within the last 60 days with
carfilzomib or carfilzomib containing regimen with a dose of at least 27 mg/m2.
Carfilzomib containing regimen at the standard dose of 20/27 mg/m2 is acceptable.

2. Measurable disease, as defined by at least one of the following:

1. Serum monoclonal protein level ≥0.5 g/dL for IgG, IgA, or IgM disease

2. Urinary M-protein excretion of ≥200 mg over a 24-hour period

3. Involved free light chain level ≥10 mg/dL, along with an abnormal free
light chain ratio

3. Adequate bone marrow reserves, as defined by the following:

1. Absolute neutrophil count (ANC) ≥ 1000 cells/mm3 within 1 week of the
initiation of treatment

2. Platelet count of ≥75 ,000 cells/mm3 for subjects who have bone marrow
plasmacytosis of <50%, or ≥50,000 cells/mm3 for subjects who have bone
marrow plasmacytosis of >50%

4. Adequate hepatic function, as defined by the following:

1. Total bilirubin ≤2 times the upper limit of the institutional normal values

2. Total AST and ALT ≤3 times the upper limit of the institutional normal
values

5. Adequate renal function, as defined by the following: creatinine clearance (CrCl)
≥30 mL/min., as measured by a 24-hour urine collection, or estimated by the
Cockcroft and Gault formula.

6. Adequate cardiac function defined as LVEF > 40% by MUGA or echocardiogram.

7. Be 18-75 years of age

8. Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.

9. FOCBP and male subjects who are sexually active with FOCBP must agree to use two
highly effective (as determined per the Investigator) methods of contraception during
the study and for 6 months (female subjects) or for 3 months (male subjects) following
the last dose of study treatment including a male condom.

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

Subjects must not meet any of the following criteria:

1. Non-secretory multiple myeloma

2. Known amyloidosis

3. Known POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly,
endocrinopathy, monoclonal protein, and skin changes)

4. Clinically significant illness including, but not limited to the following: active
systemic infection, uncontrolled hypertension (as defined by BP > 160/90), New York
Heart Association Class III and IV heart failure, unstable angina pectoris, myocardial
infarction within the past 6 months of consent, uncontrolled cardiac arrhythmia, or
any other condition (including laboratory abnormalities) that, in the opinion of the
Investigator, places the subject at unacceptable risk for adverse outcome if he/she
were to participate in the study

5. Prior cerebrovascular accident with persistent neurologic deficit.

6. Psychiatric illness/social situations that would limit compliance with study treatment
and requirements

7. Pregnant or breast feeding. Females of childbearing potential (FOCBP) must have a
negative serum pregnancy test within the 7 days prior to study drug administration and
a negative urine pregnancy test within the 3 days prior to the first study drug
administration.

8. Known human immunodeficiency virus (HIV) infection

9. Active hepatitis B and/or hepatitis C infection

10. "Currently active" second malignancy, other than non-melanoma skin cancer and
carcinoma in situ of the cervix, should not be enrolled. Subjects are not considered
to have a "currently active" malignancy if they have completed therapy for a prior
malignancy, are disease free from prior malignancies for >5 years, and are considered
by their physician to be at less than 30% risk of relapse. In addition, subjects with
basal cell carcinoma of the skin, superficial carcinoma of the bladder, carcinoma of
the prostate with a current PSA value of <0.5 ng/mL, or cervical intraepithelial
neoplasia will be eligible. Finally, subjects who are on hormonal therapy for a
history of either prostate cancer or breast cancer may enroll, provided that there has
been no evidence of disease progression during the previous three years.

11. Known history of allergy to Captisol® (a cyclodextrin derivative used to solubilize
carfilzomib).

12. Contraindication to any of the required concomitant drugs or supportive treatments or
intolerance to hydration due to preexisting pulmonary or cardiac impairment including
pleural effusion requiring thoracentesis or ascites requiring paracentesis.

13. Known intolerance to carfilzomib.

14. Co-administration with strong CYP3A4 inhibitors (such as, but not limited to,
boceprevir, clarithromycin, indinavir, itraconazole, ketoconazole,
lopinavir/ritonavir, ritonavir, mibefradil, nefazodone, nelfinavir, posaconazole,
saquinavir, telaprevir, telithromycin, voriconazole) as well as fluconazole (a dual
inhibitor of CYP3A4 and CYP2C9).