Selinexor in Treating Younger Patients With Recurrent or Refractory Solid Tumors or High-Grade Gliomas

• ClinicalTrials.gov Identifier: NCT02323880
• Recruitment Status: Active, not recruiting
• First Posted: December 24, 2014
• Results First Posted: January 2, 2024
• Last Update Posted: January 2, 2024
• Sponsor: Children's Oncology Group
• Collaborator: National Cancer Institute (NCI)
• Information provided by (Responsible Party): Children's Oncology Group

Tracking Information

• First Submitted Date: December 16, 2014
• First Posted Date: December 24, 2014
• Results First Submitted Date: October 31, 2023
• Results First Posted Date: January 2, 2024
• Last Update Posted Date: January 2, 2024
• Actual Study Start Date: October 30, 2015
• Actual Primary Completion Date: September 30, 2022 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures (submitted: December 12, 2023)

• Number of Dose Limiting Toxicities of Selinexor [ Time Frame: Up to 28 days ]
  The number of toxicity evaluable patients experiencing a dose limiting toxicity at least possibly attributable to selinexor by study part, schema, and dose level.
• Number of Adverse Events of Selinexor [ Time Frame: Up to 6 years 11 months ]
  The number of patients experiencing adverse events at least possibly attributable to selinexor by study part, schema, and dose level.
• Area Under the Drug Concentration Curve of Selinexor [ Time Frame: Up to 2 days ]
  The median (min, max) of the area under the drug concentration curve evaluated at 0.5, 1, 2, 3, 4, 6, 8, and 24 hours post dose on day 1 for Selinexor by study part, schema, and dose level.

Original Primary Outcome Measures (submitted: December 23, 2014)

• Recommended phase 2 dose (RP2D) or the maximum tolerated dose (MTD) [ Time Frame: 28 Days ]
• Adverse events as assessed by (CTCAE) version 4.0 [ Time Frame: 28 Days ]
  DLT will be defined as possibly, probably or definitely attributable to Selinexor. The DLT observation period for the purposes of dose-escalation will be the first cycle of therapy.
• Pharmacokinetic Assessment of Selinexor Concentrations in Plasma Samples [ Time Frame: Days 1 and 2 of Cycle 1 ]
  A descriptive analysis of pharmacokinetic (PK) parameters of Selinexor will be performed to define systemic exposure, drug clearance, and other pharmacokinetic parameters.The PK parameters will be summarized with simple summary statistics, including means, medians, ranges, and standard deviations (if numbers and distribution permit). Blood samples will be collected at the following time points: Pre-dose, and at 30 min, 1, 2, 3, 4, 6, 8, and 24 hours after the dose on Day 1. For Part C, An additional PK sample will be collected after 3-4 doses prior to Tumor Resection. Surgical resection should occur after dose on Day 8 but before dose on Day 15 of Cycle 1.

Current Secondary Outcome Measures (submitted: December 12, 2023)

• Antitumor Effect of Selinexor [ Time Frame: Up to 6 years 11 months ]
  Number of patients with best response using RECIST 1.1 criteria of partial response (at least a 30% decrease in the sum of the diameters of target lesions) or complete response (disappearance of all target and non-target lesions and any pathological lymph nodes must have reduction in short axis to <10 mm).
• Pharmacodynamics of Selinexor [ Time Frame: Up to 28 days ]
  Median (min,max) ratio of XPO1 mRNA expression after treatment to pre-treatment by study part, schema, and dose
• Pharmacodynamics of Selinexor in High-grade Glioma (HGG) Patients [ Time Frame: Up to 28 days ]
  Median (min,max) ratio of XPO1 mRNA expression after treatment to pre-treatment by study part, schema, and dose
• Radiographic Response of Selinexor in High-grade Glioma (HGG) Patients [ Time Frame: Up to 6 years 11 months ]
  Number of HGG patients with radiographic response by study part, schema, and dose level.
• Progression-free Survival of Selinexor in Surgical High-grade Glioma (HGG) Patients [ Time Frame: Up to 6 months ]
  Number of surgical HGG patients with 6-month progression-free survival using the Response Evaluation Criteria in solid tumors criteria (RECIST v1.1) defining best response of progressive disease including at least 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study and no prior stable disease, partial response, or complete response.

Original Secondary Outcome Measures (submitted: December 23, 2014)

• Evaluation of disease response to preliminarily define the antitumor activity of Selinexor [ Time Frame: Every 28 Days ]
  Patients will have tumor disease evaluations performed at the end of cycles 1, 3, and 5 and then every 3 cycles. Disease response will be assessed according to RECIST criteria and will be reported descriptively. Clinical benefit for Part B will be defined in one of two ways, either PR or CR on two consecutive 2D measurements on standard imaging or as > 12 weeks from first dose without progressive disease, while clinical benefit in Part C will be defined as no visible disease progression six months from the start of treatment. Clinical benefit rate will be summarized separately for each of Parts B and C with 95% confidence intervals. Analyses will be descriptive and exploratory and hypotheses generating in nature.
• Pharmacodynamic Properties of Selinexor in Plasma and Whole Blood [ Time Frame: Day 1 ]
  Plasma samples will be collected for Plasma Protein studies and whole blood RNA will be collected for gene expression analysis on cycle 1, day 1, pre- and 4 hours after dose is given in consenting patients.
• Pharmacodynamic Effects of Selinexor in Tumor Tissue for HGG Patients [ Time Frame: 8-10 days of treatment ]
  Tissue will be collected from original diagnosis or most recent resection and the resection that occurs as part of Part C. Immunohistochemistry studies and Quantitative PCR will be performed on fixed tumor tissue from pre-treatment and post-treatment specimens. Targets for analysis include XPO1, XPO1 cargos , cell cycle regulating proteins, and cell viability and cell death markers

• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: Selinexor in Treating Younger Patients With Recurrent or Refractory Solid Tumors or High-Grade Gliomas
• Official Title: A Phase 1 Study of Selinexor (KPT-330), A Selective XPO1 Inhibitor, in Recurrent and Refractory Pediatric Solid Tumors, Including CNS Tumors
• Brief Summary: This phase I trial studies the side effects and best dose of selinexor in treating younger patients with solid tumors or central nervous system (CNS) tumors that have come back (recurrent) or do not respond to treatment (refractory). Drugs used in chemotherapy, such as selinexor, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading.

Detailed Description

PRIMARY OBJECTIVES:

I. To determine the recommended phase 2 dose (RP2D) or the maximum tolerated dose (MTD) of the tablet formulation of selinexor in children with recurrent/refractory solid and CNS tumors.

II. To describe the toxicities of selinexor in children with recurrent/refractory solid and CNS tumors.

III. To characterize the pharmacokinetics of the tablet formulation of selinexor in children with recurrent/refractory solid and CNS tumors.

SECONDARY OBJECTIVES:

I. To determine the antitumor effect of selinexor in a preliminary manner in children with recurrent/refractory solid and CNS tumors.

II. To determine the pharmacodynamic properties of selinexor in children and adolescents with refractory solid tumors in plasma proteins and whole blood ribonucleic acid (RNA).

III. To explore the penetration, pharmacodynamic effects, and biologic effects of selinexor in tumor tissue of patients with recurrent/refractory high-grade gliomas (HGG) requiring resection.

IV. To further assess the toxicity and antitumor effects of selinexor in children with recurrent/refractory HGG in expanded cohorts following dose-escalation by measuring rate of objective radiographic response (medical patients) and rate of progression-free survival (PFS) six months from the start of treatment (surgical patients).

OUTLINE: This is a dose escalation study.

Patients receive selinexor PO on either a twice weekly (days 1, 3, 8, 10, 15, 17) or once weekly (days 1, 8, 15, and 22) schedule. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 30 days.

• Study Type: Interventional
• Study Phase: Phase 1
• Study Design: Allocation: N/A; Intervention Model: Single Group Assignment; Masking: None (Open Label); Primary Purpose: Treatment

Condition

• Malignant Glioma
• Recurrent Brain Neoplasm
• Recurrent Childhood Central Nervous System Neoplasm
• Recurrent Childhood Glioblastoma
• Recurrent Lymphoma
• Recurrent Malignant Solid Neoplasm
• Refractory Lymphoma
• Refractory Malignant Solid Neoplasm
• Refractory Primary Central Nervous System Neoplasm
• WHO Grade 3 Glioma

Intervention

• Other: Pharmacological Study
  Correlative studies
• Drug: Selinexor
  Given PO
  Other Names:

  • ATG-010
  • CRM1 Nuclear Export Inhibitor KPT-330
  • KPT-330
  • Nexpovio
  • Selective Inhibitor of Nuclear Export KPT-330
  • SINE KPT-330
  • Xpovio

Study Arms

Experimental: Treatment (selinexor)

Patients receive selinexor PO on either a twice weekly (days 1, 3, 8, 10, 15, 17) or once weekly (days 1, 8, 15, and 22) schedule. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity.

Interventions:

• Other: Pharmacological Study
• Drug: Selinexor

• Publications *: Not Provided

Recruitment Information

• Recruitment Status: Active, not recruiting
• Actual Enrollment (submitted: December 12, 2023): 59
• Original Estimated Enrollment (submitted: December 23, 2014): 75
• Estimated Study Completion Date: September 22, 2024
• Actual Primary Completion Date: September 30, 2022 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

• Patients must have a body surface area (BSA) >= 0.84 m^2

• Diagnosis:

  • Part A: Patients with recurrent or refractory solid tumors, including lymphoma and CNS tumors, are eligible; patients must have had histologic verification of malignancy at original diagnosis or relapse except in patients with intrinsic brain stem tumors, optic pathway gliomas, or patients with pineal tumors and elevations of cerebrospinal fluid (CSF) or serum tumor markers including alpha-fetoprotein or beta-human chorionic gonadotropin (HCG)
  • Part B: Patients with recurrent or refractory high grade glioma (World Health Organization [WHO] grade III/IV) including disseminated tumors (excluding diffuse intrinsic pontine glioma [DIPG]), not requiring surgical resection; patients must have had histologic verification of malignancy at original diagnosis or relapse
  • Part C: Patients with recurrent or refractory high grade glioma (WHO grade III/IV) and requiring surgical resection (excluding DIPG and disseminated tumors), who in the opinion of treating physicians, are medically stable to receive 2 doses of selinexor (8-10 days of treatment) before undergoing surgery without compromising the success of the procedure; note that if, in the opinion of treating physicians, current symptoms necessitate surgery before 2 doses will be able to be received, surgery should not be delayed to administer selinexor, and the patient would be ineligible for protocol therapy

• Disease status:

  • Part A: Patients must have either measurable or evaluable disease
  • Parts B and C: Patients must have measurable disease on imaging
• Patient's current disease state must be one for which there is no known curative therapy or therapy proven to prolong survival with an acceptable quality of life
• Karnofsky >= 50% for patients > 16 years of age and Lansky >= 50 for patients =< 16 years of age; Note: Neurologic deficits in patients with CNS tumors must have been relatively stable for at least 7 days prior to study enrollment; patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score

• Patients must have fully recovered from the acute toxic effects of all prior anti-cancer therapy and must meet the following minimum duration from prior anti-cancer directed therapy prior to enrollment; if after the required timeframe, the numerical eligibility criteria are met, e.g. blood count criteria, the patient is considered to have recovered adequately

  • Myelosuppressive chemotherapy: At least 21 days after the last dose of myelosuppressive chemotherapy (42 days if prior nitrosourea)
  • Hematopoietic growth factors: At least 14 days after the last dose of a long-acting growth factor (e.g. Neulasta) or 7 days for short-acting growth factor; for agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur; the duration of this interval must be discussed with the study chair
  • Biologic (anti-neoplastic agent): At least 7 days after the last dose of a biologic agent; for agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur; the duration of this interval must be discussed with the study chair
  • Immunotherapy: At least 42 days after the completion of any type of immunotherapy, e.g. tumor vaccines
  • Antibodies: >= 21 days must have elapsed from infusion of last dose of antibody, and toxicity related to prior antibody therapy must be recovered to grade =< 1
  • Corticosteroids: If used to modify immune adverse events related to prior therapy, >= 14 days must have elapsed since last dose of corticosteroid
  • External beam radiation therapy (XRT): At least 14 days after local palliative XRT (small port); at least 150 days must have elapsed if prior total body irradiation (TBI), craniospinal XRT or if >= 50% radiation of pelvis; at least 42 days must have elapsed if other substantial bone marrow (BM) radiation
  • Stem cell infusion without TBI: No evidence of active graft vs. host disease and at least 56 days must have elapsed after transplant or stem cell infusion
  • Patients must not have received prior exposure to selinexor
• For patients with solid tumors without known bone marrow involvement:
• * Peripheral absolute neutrophil count (ANC) >= 1000/mm^3
• * Platelet count >= 100,000/mm^3 (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment)
• * Hemoglobin >= 8.0 g/dL at baseline (may receive red blood cell [RBC] transfusions)
• Patients with known bone marrow metastatic disease will be eligible for study if they meet the blood counts (may receive transfusions provided they are not known to be refractory to red cell or platelet transfusions); these patients will not be evaluable for hematologic toxicity; at least 5 of every cohort of 6 patients must be evaluable for hematologic toxicity for the dose-escalation part of the study; if dose-limiting hematologic toxicity is observed, all subsequent patients enrolled on Part A must be evaluable for hematologic toxicity
• Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 ml/min/1.73 m^2 or

• A serum creatinine based on age/gender as follows:

  • =< 0.6 mg/dL (patients age 1 to < 2 years)
  • =< 0.8 mg/dL (patients age 2 to < 6 years)
  • =< 1 mg/dL (patients age 6 to < 10 years)
  • =< 1.2 mg/dL (patients age 10 to < 13 years)
  • =< 1.4 mg/dL (female patients age >= 13 years)
  • =< 1.5 mg/dL (male patients age 13 to < 16 years)
  • =< 1.7 mg/dL (male patients age >= 16 years)
• Total bilirubin =< 1.5 x upper limit of normal (ULN) for age
• Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 3 x ULN = 135 U/L; for the purpose of this study, the ULN for SGPT is 45 U/L
• Serum albumin >= 2 g/dL
• Serum amylase =< 1.5 x ULN
• Serum lipase =< 1.5 x ULN
• Patients with seizure disorder may be enrolled if on anticonvulsants and well controlled
• Patients must be able to swallow tablets whole
• Part C: Archived paraffin-embedded tissue (20 unstained slides or a tumor block) from a prior resection must be available as a control for correlative studies; if tissue blocks or slides are unavailable, the study chair must be notified prior to enrollment
• All patients and/or their parents or legally authorized representatives must sign a written informed consent; assent, when appropriate, will be obtained according to institutional guidelines

Exclusion Criteria:

• Pregnant or breast-feeding women will not be entered on this study, since there is yet no available information regarding human fetal or teratogenic toxicities; based on its mechanism of action and findings in animals, selinexor may cause fetal harm when administered to a pregnant woman; pregnancy tests must be obtained in girls who are post-menarchal; males with female partners of reproductive potential or females of reproductive potential may not participate unless they have agreed to use two effective methods of birth control- including a medically accepted barrier method of contraceptive method (e.g., male or female condom) for the entire period in which they are receiving protocol therapy and for at least 1 week following their last dose of study drug; abstinence is an acceptable method of birth control

• Concomitant medications

  • Corticosteroids: Patients receiving corticosteroids who have not been on a stable or decreasing dose of corticosteroid for at least 7 days prior to enrollment are not eligible; if used to modify immune adverse events related to prior therapy, >= 14 days must have elapsed since last dose of corticosteroid
  • Investigational drugs: Patients who are currently receiving another investigational drug are not eligible
  • Anti-cancer agents: Patients who are currently receiving other anti-cancer agents are not eligible
• Patients who have an uncontrolled infection are not eligible
• Patients who have received a prior solid organ transplantation are not eligible
• Patients who, in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study are not eligible
• Patients with body mass index (BMI) < 3rd percentile for age, as defined by WHO criteria for patients 1-2 years of age and Centers for Disease Control and Prevention (CDC) criteria for patients > 2 years of age, are not eligible
• Patients with grade 3 ataxia or grade >1 extrapyramidal movement disorder are not eligible
• Patients with known macular degeneration, uncontrolled glaucoma, or cataracts are not eligible

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 12 Months to 21 Years (Child, Adult)
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: United States
• Removed Location Countries: Canada

Administrative Information

• NCT Number: NCT02323880
• Other Study ID Numbers: ADVL1414; NCI-2014-02410 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) ); ADVL1414; ADVL1414 ( Other Identifier: Pediatric Early Phase Clinical Trial Network ); ADVL1414 ( Other Identifier: CTEP ); UM1CA097452 ( U.S. NIH Grant/Contract )
• Has Data Monitoring Committee: Yes

U.S. FDA-regulated Product

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

• IPD Sharing Statement: Not Provided
• Current Responsible Party: Children's Oncology Group
• Original Responsible Party: Same as current
• Current Study Sponsor: Children's Oncology Group
• Original Study Sponsor: Same as current
• Collaborators: National Cancer Institute (NCI)

Investigators

• Principal Investigator: Julia Glade-Bender; COG Phase I Consortium

• PRS Account: Children's Oncology Group
• Verification Date: December 2023