Description:
This is a prospective, 2-arm (with an additional exploratory arm), open-label, multicenter
study looking at the response rate of patients receiving selinexor (KPT-330), in combination
with carfilzomib, daratumumab or pomalidomide.
Multiple Myeloma patients with documented disease progression or refractory disease while on
current treatment with any carfilzomib-containing regimen (arm 1), any
pomalidomide-containing regimen (arm 2) or any daratumumab-containing regimen (exploratory
arm) will be included in the study. Patients will be assigned to the respective groups
according to their current treatment. If a subject has received more than one of the above
therapies, then assignment will be made at their physician's discretion (e.g treatment
decision can be made based upon patient and physician preferred tolerance.).
Patients will receive treatment until progressive disease (PD), death, toxicity that cannot
be managed by standard of care, or withdrawal, whichever occurs first.
Title
- Brief Title: A Study of Selinexor, in Combination With Carfilzomib, Daratumumab or Pomalidomide in Patients With Multiple Myeloma
- Official Title: A Phase 2B Study of Selinexor (KPT-330), in Combination With Carfilzomib, Daratumumab or Pomalidomide in Patients With Multiple Myeloma Relapsing on Current Therapy
Clinical Trial IDs
- ORG STUDY ID:
Pro2020-0369
- SECONDARY ID:
IST-318
- NCT ID:
NCT04661137
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Selinexor 60 MG | KPT-330 | Pomalidomide-containing Regimen |
Selinexor 80 MG | KPT-330 | Carfilzomib-containing Regimen |
Selinexor 100 MG | KPT-330 | Exploratory/Daratumumab-containing Regimen |
Carfilzomib | Kyprolis | Carfilzomib-containing Regimen |
Pomalidomide | Pomalyst | Pomalidomide-containing Regimen |
Daratumumab | Darzalex | Exploratory/Daratumumab-containing Regimen |
Dexamethasone | Dextenza, Ozurdex, Neofordex, others | Carfilzomib-containing Regimen |
Purpose
This is a prospective, 2-arm (with an additional exploratory arm), open-label, multicenter
study looking at the response rate of patients receiving selinexor (KPT-330), in combination
with carfilzomib, daratumumab or pomalidomide.
Multiple Myeloma patients with documented disease progression or refractory disease while on
current treatment with any carfilzomib-containing regimen (arm 1), any
pomalidomide-containing regimen (arm 2) or any daratumumab-containing regimen (exploratory
arm) will be included in the study. Patients will be assigned to the respective groups
according to their current treatment. If a subject has received more than one of the above
therapies, then assignment will be made at their physician's discretion (e.g treatment
decision can be made based upon patient and physician preferred tolerance.).
Patients will receive treatment until progressive disease (PD), death, toxicity that cannot
be managed by standard of care, or withdrawal, whichever occurs first.
Detailed Description
This is a Phase 2b, two-arm, open-label, multicenter study of Sd (selinexor 100, 80 or 60 mg)
in combination with carfilzomib, or pomalidomide in patients with MM previously treated with
carfilzomib or pomalidomide respectively, and refractory to prior treatment. An additional
exploratory arm will focus on patients treated with SD in combination with daratumumab.
This study will enroll approximately 96 patients overall (43 in each of the arms and 10
additional patients in the exploratory arm. Patients will be assigned to the respective arms
based on their previous treatment.
Patients who are relapsed or refractory to their current carfilzomib-based regimen will be
enrolled on Arm 1 and will receive the following treatment regimen on a 28-day cycle:
Carfilzomib 56 mg/m2 on days 1, 8 and 15. They will also receive dexamethasone 40 mg (or 20
mg if patient is ≥ 75 years old) once weekly and Selinexor 80 mg on days 1, 8 and 15.
Patients who are relapsed or refractory to their current pomalidomide-based regimen will be
enrolled on Arm 2 and will receive the following treatment regimen on a 28-day cycle:
Pomalidomide 4 mg po daily for 21 days combined with Dexamethasone 40 mg (or 20 mg if patient
is ≥ 75 years old) once weekly and Selinexor 60 mg days 1, 8 and 15.
For arms 1 and 2, 13 patients will be accrued in each arm in the first stage. If there are 3
or fewer responses in these 13 patients, the study will be stopped. Otherwise, 30 additional
patients will be accrued for a total of 43 (in each arm).
Finally, in the exploratory arm, we will enroll up to 10 patients who are relapsed or
refractory to their current daratumumab-based regimen. Patients enrolled on the exploratory
arm will receive the following treatment regimen on a 28-day cycle:
Daratumumab on current schedule (16 mg/kg IV days 1,8,15,22 for cycles 1-2; days 1 and 15 for
cycles 3-6; day 1 for cycle 7 and on) combined with Dexamethasone 40 mg once weekly (or 20 mg
if patient is ≥ 75 years old) and Selinexor 100 mg once weekly.
The Investigator may remove a patient from study treatment using criteria described in
Section 10.2. Patients may decide to discontinue study treatment for any reason. Patients who
elect to discontinue study treatment should be encouraged to continue in the study so that
follow-up information on disease progression, other antineoplastic therapy, symptoms and
survival status may be obtained. However, patients may elect to withdraw consent and decline
further participation in the trial at any time.
The Investigator must determine the primary reason for a patient's discontinuation of study
treatment and record this information on the electronic case report form (eCRF). Patients who
are prematurely withdrawn from study treatment are not eligible to re-initiate study
treatment on this protocol at a later date.
Trial Arms
Name | Type | Description | Interventions |
---|
Carfilzomib-containing Regimen | Experimental | Carfilzomib 56 mg/m2 on days 1, 8 and 15. Dexamethasone 20 mg if ≥ 75 years old and 40 mg if < 75 years old on days 1, 8, 15 and 22.
Selinexor 80 mg on days 1, 8 and 15. | - Selinexor 80 MG
- Carfilzomib
- Dexamethasone
|
Pomalidomide-containing Regimen | Experimental | Pomalidomide 4 mg po daily for 21 days. Dexamethasone 20 mg if ≥ 75 years old and 40 mg if < 75 years old on days 1, 8, 15 and 22.
Selinexor 60 mg on days 1, 8 and 15. | - Selinexor 60 MG
- Pomalidomide
- Dexamethasone
|
Exploratory/Daratumumab-containing Regimen | Experimental | Daratumumab on current schedule (16 mg/kg IV days 1, 8, 15 and 22 for cycles 1-2; days 1 and 15 for cycles 3-6; day 1 for cycle 7 and on).
Dexamethasone 20 mg if ≥ 75 years old and 40 mg if < 75 years old on days 1, 8, 15 and 22.
Selinexor 100 mg on days 1, 8, 15 and 22. | - Selinexor 100 MG
- Daratumumab
- Dexamethasone
|
Eligibility Criteria
Inclusion Criteria:
1. Age ≥18 years at time of informed consent.
2. Histologically confirmed MM and evidence of disease progression while on one of the
below MM regimens:
- Arm 1: Refractory to or disease progression while on a carfilzomib-containing
regimen
- Arm 2: Refractory to or disease progression while on a pomalidomide-containing
regimen
- Exploratory Arm: Refractory to or disease progression while on a
daratumumab-containing regimen
3. Measurable disease as defined: Serum M-protein ≥ 0.5 g/dL; urine M-protein excretion
at least 200 mg/24h; serum FLC ≥ 100 mg/L, provided that FLC is abnormal; if serum
protein electrophoresis is felt to be unreliable for routine M-protein measurement
(i.e. IgA MM) then quantitative Ig levels by nephelometry or turbidometry are
acceptable; for non-secretory disease, bone marrow plasma cells ≥ 20% or a
biopsy-proven target lesion by PET/CT or MRI is acceptable
4. Documented evidence of disease progression (by IMWG criteria) or refractory disease on
the current treatment as defined as:
- Achieving SD or less for ≥ 1 cycle during treatment with regimens stated in #2
(i.e. relapsed) OR
- <25% response (i.e. never achieved MR) or PD during or within 60 days from the
end-of most recent MM regimen as listed in #2 (i.e. refractory).
5. Any non-hematological toxicities (except for peripheral neuropathy) that patients
experienced from treatments in previous regimens have resolved to Grade 2 or less by
Cycle 1 Day 1.
6. ECOG 2 or less
7. Adequate hepatic function within 28 days prior to C1D1:
1. Total bilirubin < 1.5 × upper limit of normal (ULN) (except patients with
Gilbert's syndrome who must have a total bilirubin of < 3 × ULN), and
2. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) normal to <2
× ULN.
8. Adequate renal function within 28 days prior to C1D1 as determined by estimated
creatinine clearance of ≥ 30 mL/min, calculated using the Cockcroft and Gault formula
(140 - Age) • Mass (kg)/ (72 • creatinine mg/dL); multiply by 0.85 if female
(Cockcroft 1976).
9. Adequate hematopoietic function within 7 days prior to C1D1: total white blood cell
(WBC) count ≥1500/mm3, absolute neutrophil count ≥1000/mm3, hemoglobin ≥8.5 g/dL and
platelet count ≥75,000/mm3 (patients for whom <50% of bone marrow nucleated cells are
plasma cells) or ≥50,000/mm3 (patients for whom ≥50% of bone marrow nucleated cells
are plasma cells).
1. Patients receiving hematopoietic growth factor support, including erythropoietin,
darbepoetin, granulocyte-colony stimulating factor (G-CSF), granulocyte
macrophage-colony stimulating factor (GM-CSF), and platelet stimulators (eg,
eltrombopag, romiplostim, or interleukin-11) must have a 2-week interval between
growth factor support and the Screening assessments, but they may receive growth
factor support during the study.
2. Patients must have:
- At least a 2-week interval from the last red blood cell (RBC) transfusion
prior to the Screening hemoglobin assessment, and
- At least a 1-week interval from the last platelet transfusion prior to the
Screening platelet assessment.
However, patients may receive RBC and/or platelet transfusions as clinically indicated
per institutional guidelines during the study.
10. Female patients of childbearing potential must have a negative serum pregnancy test at
Screening. Female patients of childbearing potential and fertile male patients who are
sexually active with a female of childbearing potential must use highly effective
methods of contraception throughout the study and for 3 months following the last dose
of study treatment.
Exclusion Criteria:
- Patients meeting any of the following exclusion criteria are not eligible to enroll in
this study:
1. Smoldering MM
2. Radiation therapy, chemotherapy or immunotherapy other than above stated regimens
in #2 ≤2 weeks prior to C1D1. Patients on long-term glucocorticosteroids during
screening do not require a washout period. Prior RT is permitted for treatment of
fractures or to prevent fractures as well as for pain management.
3. Active graft versus host disease after allogeneic stem cell transplant.
4. Life expectancy <3 months.
5. Known active hepatitis A, B, or C infection; or known to be positive for
hepatitis C virus ribonucleic acid (RNA) or hepatitis B virus surface antigen.
6. Has any concurrent medical condition or disease (eg, uncontrolled active
hypertension, uncontrolled active diabetes, active systemic infection, etc.) that
is likely to interfere with study procedures.
7. Uncontrolled active infection requiring parenteral antibiotics, antivirals, or
antifungals within 1 week prior to Cycle 1 Day 1 (C1D1). Patients on prophylactic
antibiotics or with a controlled infection within 1 week prior to C1D1 are
acceptable.
8. Known intolerance, hypersensitivity, or contraindication to glucocorticoids.
9. Pregnant or breastfeeding females.
10. Body surface area (BSA) <1.4 m2 at baseline, calculated by the Dubois (Dubois
1916) or Mosteller (Mosteller 1987) method.
11. Any active gastrointestinal dysfunction interfering with the patient's ability to
swallow tablets, or any active gastrointestinal dysfunction that could interfere
with absorption of study treatment.
12. Inability or unwillingness to take supportive medications such as anti-nausea and
anti-anorexia agents as recommended by the National Comprehensive Cancer Network®
(NCCN) Clinical Practice Guidelines in Oncology (CPGO) (NCCN CPGO) for antiemesis
and anorexia/cachexia (palliative care).
13. Any active, serious psychiatric, medical, or other conditions/situations that, in
the opinion of the Investigator, could interfere with treatment, compliance, or
the ability to give informed consent.
14. Contraindication to any of the required concomitant drugs or supportive
treatments.
15. Patients unwilling or unable to comply with the protocol
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall Response Rate (ORR) of patients receiving selinexor with carfilzomib and dexamethasone (Arm 1) |
Time Frame: | 30 Months |
Safety Issue: | |
Description: | ORR will include patients who experience partial response (PR), very good partial response (VGPR), complete response (CR), or stringent complete response (sCR), based on International Myeloma Working Group (IMWG) response criteria (Kumar 2016) |
Secondary Outcome Measures
Measure: | Progression Free Survival (PFS) |
Time Frame: | 30 Months |
Safety Issue: | |
Description: | Duration from start of study treatment to PD or death [regardless of cause], whichever comes first |
Measure: | Overall Survival (OS) |
Time Frame: | 30 Months |
Safety Issue: | |
Description: | Duration from start of study treatment to death |
Measure: | MRD Negativity |
Time Frame: | 30 Months |
Safety Issue: | |
Description: | Rate of achievement of minimal residual disease (MRD) by multiparametric flow cytometry |
Measure: | Incidence of Adverse Events [Safety and Tolerability] using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), v 4.03. |
Time Frame: | 30 Months |
Safety Issue: | |
Description: | Incidence of Adverse Events [Safety and Tolerability] using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), v 4.03. |
Measure: | Time To Next Treatment (TTNT) |
Time Frame: | 30 Months |
Safety Issue: | |
Description: | Duration from start of study treatment to next treament |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Hackensack Meridian Health |
Trial Keywords
Last Updated
June 9, 2021