Clinical Trials /

Study of the Safety, Tolerability and Efficacy of KPT-8602 in Participants With Relapsed/Refractory Cancer Indications

NCT02649790

Description:

This is a first-in-human, multi-center, open-label clinical study with separate dose escalation (Phase 1) and expansion (Phase 2) stages to assess preliminary safety, tolerability, and efficacy of the second generation oral XPO1 inhibitor KPT-8602 in participants with relapsed/refractory multiple myeloma (MM), metastatic colorectal cancer (mCRC), metastatic castration resistant prostate cancer (mCRPC), and higher risk myelodysplastic syndrome (HR-MDS). Dose escalation and dose expansion may be included for all parts of the study as determined by ongoing study results.

Related Conditions:
  • Acute Myeloid Leukemia
  • Myelodysplastic Syndromes
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Study of the Safety, Tolerability and Efficacy of KPT-8602 in Participants With Relapsed/Refractory Cancer Indications
  • Official Title: A Phase 1/2 Open-Label Study of the Safety, Tolerability and Efficacy of the Selective Inhibitor of Nuclear Export (SINE) Compound KPT-8602 in Patients With Relapsed/Refractory Cancer Indications

Clinical Trial IDs

  • ORG STUDY ID: KCP-8602-801
  • NCT ID: NCT02649790

Conditions

  • Relapsed/Refractory Multiple Myeloma (RRMM)
  • Metastatic Colorectal Cancer (mCRC)
  • Metastatic Castration Resistant Prostate Cancer (mCRPC)
  • Higher Risk Myelodysplastic Syndrome (HR-MDS)

Interventions

DrugSynonymsArms
KPT-8602Part A1: RRMM- KPT-8602 single agent; QoDx5/week
ASTX727Part G: Newly Diagnosed Intermediate/High-Risk MDS -KPT-8602 with ASTX727
DexamethasonePart B: RRMM- KPT-8602 with low-dose dexamethasone; QDx5/week

Purpose

This is a first-in-human, multi-center, open-label clinical study with separate dose escalation (Phase 1) and expansion (Phase 2) stages to assess preliminary safety, tolerability, and efficacy of the second generation oral XPO1 inhibitor KPT-8602 in participants with relapsed/refractory multiple myeloma (MM), metastatic colorectal cancer (mCRC), metastatic castration resistant prostate cancer (mCRPC), and higher risk myelodysplastic syndrome (HR-MDS). Dose escalation and dose expansion may be included for all parts of the study as determined by ongoing study results.

Trial Arms

NameTypeDescriptionInterventions
Part A1: RRMM- KPT-8602 single agent; QoDx5/weekExperimentalParticipants received KPT-8602 once daily for 5 days per week (QDx5/week) at escalated doses (completed).
  • KPT-8602
Part A2: RRMM- KPT-8602 single agent; QoDx3/weekExperimentalParticipants received KPT-8602 once daily for 3 days per week (QoDx3/week). The starting dose for Part A2 will be informed by Part A1 (completed).
  • KPT-8602
Part B: RRMM- KPT-8602 with low-dose dexamethasone; QDx5/weekExperimentalParticipants received KPT-8602 for 5 consecutive days (QDx5/week) in combination with low dose dexamethasone (20 milligram [mg] on Days 1, 3, 8, 10, 15, 17, 22, and 24 of each 28-day cycle) (completed).
  • KPT-8602
  • Dexamethasone
Part C: RRCRC- KPT-8602 single agentExperimentalParticipants were treated with KPT-8602 at a dose and schedule that has been cleared in Part A (completed).
  • KPT-8602
Part D: RRmCRPC- KPT-8602 single agentExperimentalParticipants were treated with KPT-8602 at a dose and schedule that has been cleared in Part A (completed).
  • KPT-8602
Part E: RRmCRPC- KPT-8602 with abiraterone and corticosteroidsExperimentalParticipants were treated with KPT-8602 at a dose and schedule that had been cleared in Part A in combination with abiraterone and corticosteroids. Participants continued to receive the dose and schedule of abiraterone and corticosteroids that they were receiving at the time of enrollment (completed).
  • KPT-8602
Part F: High-risk Myelodysplastic Syndrome (MDS)- KPT-8602 single agentExperimentalParticipants were treated with KPT-8602 at a dose and schedule that had been cleared in Part A. In select cases (for example, participants achieving stable disease [SD], hematological improvement [HI], partial response [PR] and tolerating treatment, etc.), the dose may be escalated 1 level based on safety and efficacy considerations (completed).
  • KPT-8602
Part F Phase 2: High-risk MDS- KPT-8602 single agentExperimentalParticipants will be enrolled at recommended Phase 2 doses (RP2D) of 10 mg daily on Days 1 to 5 of each week, in a dose expansion, based upon the results from the Phase 1 portion of Part F.
  • KPT-8602
Part G: Newly Diagnosed Intermediate/High-Risk MDS -KPT-8602 with ASTX727ExperimentalParticipants will receive KPT-8602 once daily at escalated doses. The starting dose for KPT-8602 is 5 mg orally once daily from Day 8 to Day 28 (Weeks 2 to 4) on a 28-day cycle in combination with ASTX727.
  • KPT-8602
  • ASTX727
Part H: AML Maintenance Therapy- KPT-8602 single agentExperimentalParticipants with high-risk Acute Myeloid Leukemia (AML) prior to transplant will be enrolled to receive maintenance therapy with KPT-8602 post-allogeneic stem cell transplantation. The dose for KPT-8602 will be 10 mg (RP2D from Part F) oral, to be administered once daily from Day 1 to Day 21 (Weeks 1 to 3) on a 28-day cycle.
  • KPT-8602

Eligibility Criteria

        INCLUSION CRITERIA

          1. Written informed consent obtained prior to any screening procedures and in accordance
             with federal, local, and institutional guidelines.

          2. Age ≥ 18 years.

             INDICATION-SPECIFIC INCLUSION CRITERIA

             Relapsed/Refractory Multiple Myeloma (Parts A1, A2, and B):

          3. Symptomatic, histologically confirmed multiple myeloma (MM) and evidence of disease
             progression, based on International Myeloma Working Group (IMWG) guidelines.

          4. Participants receiving hematopoietic growth factor support including erythropoietin,
             darbepoetin, granulocyte-colony stimulating factor, granulocyte macrophage-colony
             stimulating factor, and platelet stimulators can continue to do so, but must be
             transfusion independent for at least 1 week prior to Cycle 1 Day 1 (C1D1) in the
             study.

             Relapsed/Refractory Colorectal Cancer (Part C):

          5. Histological or cytological documentation of adenocarcinoma of the colon or rectum.

          6. Documented evidence of progressive disease according to Response Evaluation Criteria
             in Solid Tumors (RECIST) Version 1.1.

             Relapsed/Refractory Metastatic Castration-resistant Prostate Cancer (Parts D and E):

          7. Histologically confirmed adenocarcinoma of the prostate with archival tumor tissue
             available for molecular analyses. If the participants does not have a prior
             histological diagnosis, then a fresh biopsy at screening may be used for this purpose.

          8. Participants should not be transfusion dependent.

          9. Part E only: Participants currently receiving treatment with abiraterone and
             appropriate to continue in the opinion of the Investigator. Participants must also
             have been on and continue on a stable dose of corticosteroids (prednisone or
             dexamethasone) for 30 days prior to C1D1.

             Higher Risk Myelodysplastic Syndrome (Part F):

         10. Documented diagnosis of MDS with 5-19% myeloblasts.

         11. Participants should be intermediate-2 or high-risk MDS by International Prognostic
             Scoring System (IPSS).

         12. Participants believed to be IPSS high risk, without clearly meeting IPSS categories
             above should be discussed with the medical monitor prior to enrolling.

         13. Hypomethylating agents (HMA) refractory participants including:

               1. ≥ 2 cycles of azacitidine and/or decitabine or experimental agents (such as
                  SGI-110 or ASTX727 or similar) with clear progressive disease (PD) (no count
                  recovery with ≥50% increase in bone marrow blasts) OR

               2. ≥ 4 cycles of azacitidine and/or decitabine (or other hypomethylating therapy)
                  with lack of improvement (no CR/CRi/PR/HI).

         14. Participants receiving a stable dose of erythropoiesis-stimulating agent (ESA) for at
             least 1 month at the time of study entry may continue to receive ESA.

         15. Participants in Part F Phase 2 with RR high-risk myelodysplastic Syndrome should have
             documented diagnosis of MDS with 5 to 19 percentage myeloblasts in the bone marrow.

         16. Participants in Part G with Newly Diagnosed Intermediate/ High-risk Myelodysplastic
             Syndrome should have diagnosis of MDS with 5 to 19 percentage myeloblasts in the bone
             marrow.

        EXCLUSION CRITERIA

        Participants in All Parts of the Study:

          1. Major surgery within 4 weeks before C1D1.

          2. Impaired cardiac function or clinically significant cardiac diseases.

          3. Uncontrolled active severe systemic infection requiring parenteral antibiotics,
             antivirals, or antifungals within one week prior to C1D1.

          4. Participants with known symptomatic brain metastasis.

          5. Prior malignancies:

               1. Participants in All Parts of the Study: Participants with adequately resected
                  basal or squamous cell carcinoma of the skin, or adequately resected carcinoma in
                  situ (i.e. cervix) may enroll irrespective of the time of diagnosis.

               2. Participants with Higher Risk MDS only: Concomitant malignancies or previous
                  malignancies with less than a 1-year disease free interval at the time of
                  enrollment.

          6. Participants with gastrointestinal tract disease (or uncontrolled vomiting or
             diarrhea) that could interfere with the absorption of eltanexor (or ASTX727 in Part
             G).

             INDICATION-SPECIFIC EXCLUSION CRITERIA

             Relapsed/Refractory Multiple Myeloma (RRMM) (Parts A1, A2 and B):

          7. Time since the last prior therapy for treatment of RRMM:

               1. Radiation, chemotherapy, immunotherapy or any other anticancer therapy, including
                  investigational anticancer therapy <=2 weeks prior to C1D1.

               2. Palliative steroids for disease related symptoms are allowed up to 3 days prior
                  to C1D1.

               3. Participants must have recovered or stabilized (<=Grade 1 or to their baseline)
                  from toxicities related to their previous treatment except for alopecia.

          8. Participants with active graft versus host disease after allogeneic stem cell
             transplantation. At least 3 months must have elapsed since completion of allogeneic
             stem cell transplantation.

          9. Grade >2 peripheral neuropathy or Grade 2 peripheral neuropathy with pain within 2
             weeks prior to C1D1.

             Relapsed/Refractory Colorectal Cancer (Part C):

         10. Radiotherapy, chemotherapy, or any other anticancer therapy, including investigational
             anticancer therapy within 2 weeks prior to Screening. Participants must have recovered
             from clinically significant toxicities. The site of irradiation should have evidence
             of progressive disease (new lesions or increase in lesion size) if this is the only
             site of disease.

         11. Participants who have been treated with their most recent chemotherapy or
             investigational drugs <=21 days or 5 half-lives (whichever is longer) prior to the
             first dose of study treatment, and/or have any acute toxicities due to prior
             chemotherapy and/ or radiotherapy that have not resolved to a National Cancer
             Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.03
             Grade 0 or Grade 1 with the exception of chemotherapy induced alopecia and Grade 2
             peripheral neuropathy.

             Relapsed/Refractory Metastatic Castration-Resistant Prostate Cancer (Parts D and E):

         12. Participants who have been treated with their most recent chemotherapy or
             investigational drugs <=21 days or 5 half-lives (whichever is longer) prior to the
             first dose of study treatment, and/or have any acute toxicities due to prior
             chemotherapy and/ or radiotherapy that have not resolved to a NCI CTCAE v4.03 Grade 0
             or Grade 1 with the exception of chemotherapy induced alopecia and Grade 2 peripheral
             neuropathy.

         13. Initiating bisphosphonate therapy or adjusting bisphosphonate dose/regimen within 30
             days prior to C1D1. Participants on a stable bisphosphonate or denosumab regimen are
             eligible and may continue.

             Higher risk Myelodysplastic Syndrome (Part F Phase 2 and Part G):

         14. IPSS very low or low-1 risk MDS.

         15. Evidence of transformation to AML by World Health Organization (WHO) (≥20% blasts in
             bone marrow or peripheral blood).

         16. Participants receiving granulocyte-colony stimulating factor (G-CSF) or granulocyte
             macrophage-colony stimulating factor (GM-CSF) within the 3 weeks prior to C1D1.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Part A1, A2, B, C, D, E, F: Maximum Tolerated Dose (MTD) and Recommended Phase 2 Dose (RP2D)
Time Frame:Approximately 4 weeks
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Part A1, A2, B, C, D, E, F, H: Area Under the Plasma Concentration Time Curve From Time Zero to the Time of the Last Quantifiable Concentration (AUC0-t) of Eltanexor
Time Frame:Pre-dose 2 hours post-dose Cycle1Day1 and 15; Pre-dose 0.5, 1, 2, 3, 4, 6 and 8 hours post-dose on Cycle1Day21 and 26; 24 hours post-dose Cycle1Day2, 22,and 27; 48 hours post-dose Cycle1Day23 and 28 and up to approximately 8 years
Safety Issue:
Description:
Measure:Part A1, A2, B, C, D, E, F, H: Maximum Observed Plasma Concentration (Cmax) of Eltanexor
Time Frame:Pre-dose 2 hours post-dose Cycle1Day1 and 15; Pre-dose 0.5, 1, 2, 3, 4, 6 and 8 hours post-dose on Cycle1Day21 and 26; 24 hours post-dose Cycle1Day2, 22,and 27; 48 hours post-dose Cycle1Day23 and 28 and up to approximately 8 years
Safety Issue:
Description:
Measure:Part A1, A2, B, C, D, E, F, H: Time to Reach Maximum Observed Plasma Concentration (Tmax) of Eltanexor
Time Frame:Pre-dose 2 hours post-dose Cycle1Day1 and 15; Pre-dose 0.5, 1, 2, 3, 4, 6 and 8 hours post-dose on Cycle1Day21 and 26; 24 hours post-dose Cycle1Day2, 22,and 27; 48 hours post-dose Cycle1Day23 and 28 and up to approximately 8 years
Safety Issue:
Description:
Measure:Part A1, A2, B, C, D, E, F, H: Apparent Terminal Half Life (t1/2) of Eltanexor
Time Frame:Pre-dose 2 hours post-dose Cycle1Day1 and 15; Pre-dose 0.5, 1, 2, 3, 4, 6 and 8 hours post-dose on Cycle1Day21 and 26; 24 hours post-dose Cycle1Day2, 22,and 27; 48 hours post-dose Cycle1Day23 and 28 and up to approximately 8 years
Safety Issue:
Description:
Measure:Part A1, A2, B, C, D, E, F, H: Apparent Total Body Clearance Eltanexor
Time Frame:Pre-dose 2 hours post-dose Cycle1Day1 and 15; Pre-dose 0.5, 1, 2, 3, 4, 6 and 8 hours post-dose on Cycle1Day21 and 26; 24 hours post-dose Cycle1Day2, 22,and 27; 48 hours post-dose Cycle1Day23 and 28 and up to approximately 8 years
Safety Issue:
Description:
Measure:Part A1, A2, B, C, D, E, F, H: Apparent Volume of Distribution During Terminal Phase (VZ/f) of Eltanexor
Time Frame:Pre-dose 2 hours post-dose Cycle1Day1 and 15; Pre-dose 0.5, 1, 2, 3, 4, 6 and 8 hours post-dose on Cycle1Day21 and 26; 24 hours post-dose Cycle1Day2, 22,and 27; 48 hours post-dose Cycle1Day23 and 28 and up to approximately 8 years
Safety Issue:
Description:
Measure:Part F Phase 2: Overall Survival (OS)
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part F Phase 2: 6-Month Overall Survival (OS)
Time Frame:Approximately Up to 6 Months
Safety Issue:
Description:
Measure:Part F Phase 2: Progression-free survival (PFS)
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part F Phase 2: Disease control rate (DCR)
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part F Phase 2: Duration of Response (DOR)
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part F Phase 2: Rate of Conversion from Red Blood Cell (RBC) Transfusion Dependence to Independence
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part F Phase 2: Rate of Conversion from Platelet Transfusion Dependence to Independence
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part G: Overall Response Rate (ORR)
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part G: Duration of Response (DOR)
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part H: Rate of Minimal Residual Disease (MRD) Conversion from Positive to Negative
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part H: Time to Minimal Residual Disease (MRD) Negativity
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part H: Percentage of Participants with Acute and Chronic Graft-versus-Host Disease (GVHD)
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part H: Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)
Time Frame:Approximately 8 years
Safety Issue:
Description:
Measure:Part H: Overall Survival (OS)
Time Frame:Approximately 8 years
Safety Issue:
Description:

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Karyopharm Therapeutics Inc

Trial Keywords

  • Multiple Myeloma
  • Karyopharm
  • KPT-8602
  • MM
  • Phase 1
  • Relapsed/ Refractory Multiple Myeloma
  • Myelodysplastic Syndrome
  • MDS
  • Metastatic Castration Resistant Prostate Cancer
  • mCRPC
  • CRC
  • Metastatic Colorectal Cancer

Last Updated

August 5, 2021