Primary objective:• To determine the efficacy of selinexor in adults with recurrent GBM asdetermined by the 6-months progression-free survival (6mPFS) rateSecondary objectives:• To determine the efficacy of selinexor in adults with recurrent GBM…
ID
Source
Brief title
KCP-330-004
Condition
- Nervous system neoplasms malignant and unspecified NEC
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
6-months progression-free survival (6mPFS) rate (progression of disease
defined according to the RANO criteria). Note that a window of ±14 days
will be allowed around the 6-month visit and will be applied to the
calculation of the point estimate of 6mPFS.
Secondary outcome
• Response rate according to the RANO criteria
• Median overall survival (OS)
• Median progression-free survival (PFS)
• Safety
Background summary
High-grade gliomas (HGG) are defined as World Health Organization (WHO) Grade 3
and 4
tumors of glial origin. Grade 4 tumors are called glioblastoma (GBM). With
approximately 70%,
GBM is the most common type of malignant primary brain tumors. More than 14,000
cases are
newly diagnosed in adults in the United States each year.1
The prognosis of GBM is very poor. An extensive infiltration of the surrounding
brain tissue limits
the accessibility in surgical resection. Aggravating the blood-brain barrier is
an obstacle for many
chemotherapeutic agents. Only small and lipophilic molecules, e.g.
nitrosoureas, are able to reach
their target. Furthermore, GBM is frequently refractory to cytotoxic agents.
Median overall
survival (OS) from first diagnosis is about 13-18 months.
Study objective
Primary objective:
• To determine the efficacy of selinexor in adults with recurrent GBM as
determined by the 6-months progression-free survival (6mPFS) rate
Secondary objectives:
• To determine the efficacy of selinexor in adults with recurrent GBM as
determined by response rate according to the Response Assessment in
Neuro-Oncology (RANO) criteria
• To determine the efficacy of selinexor in adults with recurrent GBM as
estimated by median overall survival (OS)
• To determine the efficacy of selinexor in adults with recurrent GBM as
determined by median progression-free survival (PFS)
• To evaluate safety and tolerability of selinexor
Exploratory objectives
• To evaluate preliminary evidence of efficacy of selinexor in a group of
approximately 20 patients undergoing cytoreductive surgery (Arm A).
• To compare the blood/tumor ratio of selinexor for patients who were treated
with 50 mg/m2 selinexor pre-operatively with the ratio for patients who were
treated with 60 mg selinexor pre-operatively.
• To compare the efficacy, tolerability, and safety of selinexor (50 mg/m2)
administered twice weekly (Arm B), selinexor (60 mg) administered twice
weekly (Arm C), and selinexor (80 mg) administered once weekly (Arm D).
• To evaluate preliminary evidence of efficacy of selinexor in a group of
approximately 20 patients with recurrent malignant gliomas other than GBM
(Arm E).
• To evaluate preliminary evidence of efficacy of selinexor in a group of
approximately 10 patients with recurrent GBM or AG that is refractory to
antiangiogenic treatment (Arm F).
• To explore disease response as related to isocitrate dehydrogenase (IDH)
mutational status and 1p/19q deletion status (Arm E).
Study design
Open label, multicenter, Phase 2 study
• Patients will be enrolled into either an exploratory Surgical Arm (Arm A)
with sequential enrollment for patients who require surgery, or Medical Arm
(Arm B, Arm C, Arm D, Arm E or Arm F) for patients who are not eligible
for surgery. Patients in the Surgical Arm (Arm A) will receive up to 3 doses
of selinexor prior to undergoing surgery, and will resume selinexor after
recovery. Patients in the Medical Arm (Arms B, C, D, E, and F) will be
treated with selinexor alone. Patients will be treated until progression of
disease or the development of unacceptable toxicities. Patients will also be
followed for survival status.
Intervention
Screening (within 14 days prior to starting the study drug):
• Physical examination - will include measuring height, weight, blood pressure,
pulse, body temperature.
• Pulse oximetry
• Blood test
• Blood for biomarker analysis will be collected.
• Performance Score
• Urinalysis
• Pregnancy test
• Electrocardiogram (ECG)
• Neurological exam
• Eye exam
• Chest x-ray
• MRI scan
For every visit:
• Routine blood test
• Urinalysis
• Pulse oximetry
• ECG
• Neurological exam
• Performance score
• Vital signs
• Physical exam, including weight.
Every 8 weeks an MRI will be done.
End of treatment
• Physical exam
• Routine blood test
• Pregnancy test
• Urinalysis
• Pulse oximetry
• Electrocardiogram (ECG)
• Neurological exam
Follow-up
Every 4 weeks assessment of disease status including CT/MRI every 8 weeks
Long term follow-up
All patients will be contacted every three months after the end of the
treatment in order to continue collecting information regarding the status of
disease and if any other cancer treatments have started.
Study burden and risks
As part of the safety observation repeated blood draws are done to check for
renal, hepatic and hematopoietic function. In addition repeated blood draws are
performed for assessment of pharmacokinetic and pharmacodynamic characteristics
of the study drug. These are necessary to learn more about the effects of the
study drug in the patient*s body. The eye function is under regular
surveillance during the study.
All other procedures performed within this study are standard of care and would
also be performed if the patients would not participate in this study. However,
the visits, especially within the first cycles (i.e. weekly in cylce 1-2 and
biweekly in cycles 3-5) are more frequent. This allows continous monitoring of
the patients condition.
Additionally the patients have to maintain a patient diary to document
compliance of selinexor intake.
Side-effects in patients receiving single-agent selinexor have been generally
low-grade, consistent with events observed in patients with other hematological
malignancies, and responsive to standard supportive care.
In summary, the study will test a new potential class of anticancer drug in
patients who are refractory to standard therapy and for whom no approved
therapy is available. The study will examine the risks with continuous
monitoring of safety parameters. The possible risks of the trial are judged to
be acceptable and balanced with regards to the potential benefits.
Wells Ave, 2nd floor 85
Newton MA 02459
US
Wells Ave, 2nd floor 85
Newton MA 02459
US
Listed location countries
Age
Inclusion criteria
1. Confirmed diagnoses, as follows:;a. Arms A, B, C, and D: Pathologically confirmed GBM (including all histologic variants) at first diagnosis with radiographic evidence of recurrent disease after treatment with radiotherapy and temozolomide;;b. Arm E: Pathologically confirmed malignant gliomas other than GBM (WHO Grade 2 or Grade 3), with radiographic evidence of recurrent disease after treatment with radiotherapy and at least one line of systemic treatment;;c. Arm F: Pathologically confirmed GBM (including all histologic variants) or AG that is refractory to antiangiogenic treatment (defined as recurrence or progression of disease per RANO criteria during prior therapy with bevacizumab or other direct VEGF/VEGFR inhibitors) with radiographic evidence of recurrent disease after treatment with radiotherapy and temozolomide; ;2. Age >= 18 years; ;3. Karnofsky Performance Status (KPS) >= 60;;4. Patients enrolling in the medical arm (Arms B,C, D, E, and F) must be on a stable or decreasing dose of corticosteroids (or none) for at least 5 days prior to the baseline MRI;;5. Patients must have received prior treatment with radiation therapy and either temozolomide (Arms A, B, C, D, and F) or at least one line of systemic treatment (Arm E).;o Patients enrolling in the medical arm (Arms B, C, D, E, and F) must have an interval of at least 12 weeks from completion of radiation therapy and study unless there is histologic proof of active tumor from intervening resection.;6. Measurable disease (according to RANO guidelines, within 14 days of starting treatment). Measurable disease after surgery on Arm A is not required.;7. Written informed consent obtained prior to any screening procedures. Patients must be willing and able to comply with the protocol and aware of the investigational nature of this study.;8. Patients must have adequate bone marrow function and organ function within 2 weeks of study treatment as defined by the following laboratory criteria;;o Hematopoietic function: total white blood cell (WBC) count >= 3000/mm³, absolute neutrophil count (ANC) >= 1500/mm³, platelet count >= 125,000/mm³; hemoglobin >= 9g/dL.;o Hepatic function: bilirubin <= 2 times the upper limit of normal (ULN), ALT <= 2.5 times ULN, AST <= 2.5 times ULN; unless bilirubin elevation is related to Gilbert*s Syndrome for which bilirubin must be < 4 times ULN.;o Renal function: estimated creatinine clearance of >= 30 mL/min, calculated using the formula of Cockroft and Gault or other standard methods at the treating institution.;9. All female patients of childbearing potential must agree to use reliable methods of birth control during study treatment and for 3 months after the last dose of study drug and have a negative serum pregnancy test at screening. Reliable methods of contraception include intrauterine devices, hormonal contraceptives [contraceptive pills, implants, transdermal patches, hormonal vaginal devices or injections with prolonged release], abstinence or sterilization of the partner.;10. Fertile males must be willing to employ reliable methods of contraception during study treatment and for 3 months after the last dose of study drug.;11. Archived paraffin-embedded tissue: approximately 10 unstained slides (if less, contact Sponsor) or a tumor block must be available for confirmation of tumor diagnosis and correlative studies.;12. Patients in the Surgical Arm (Arm A) must be predicted pre-operatively to have sufficiently sized tumor to be resected and provide tissue samples for exploratory assessments.
Exclusion criteria
1. Patients must not have significant medical illness that in the Investigator*s opinion cannot be adequately controlled with appropriate therapy or would compromise the patient*s ability to tolerate this therapy.;2. < 24 days from prior temozolomide, < 6 weeks from nitrosourea, < 4 weeks from other chemotherapy or investigational agents prior to start of treatment within study. ;3. For Arm F only: < 6 weeks from prior bevacizumab or other direct VEGF/VEGFR inhibitor prior to start of treatment within the study For any question of the definition of a direct VEGF/VEGFR inhibitor, consult Sponsor.;4. Unstable cardiovascular function.;5. Known active hepatitis A, B, or C infection; or known to be positive for HCV RNA or HBsAg (HBV surface antigen); hepatitis testing is not required.;6. Known HIV infection; HIV testing is not required.;7. Markedly decreased visual acuity if attributed to other causes than GBM for Arms A, C, and D, malignant gliomas other than GBM (WHO Grade 2 or Grade 3) for Arm E, or GBM or AG that is refractory to antiangiogenic treatment for Arm F.;8. Active infection requiring parenteral systemic antibiotics.;9. Patients with coagulation problems and medically significant bleeding in the month prior to start of treatment (e.g., peptic ulcer, epistaxis, spontaneous bleeding). Prior history of DVT or PE is not exclusionary.;10. Patients who are pregnant or breast-feeding.;11. Other cancer (except non-melanoma skin cancer or carcinoma in-situ of the cervix), unless in complete remission and off all therapy for that disease for a minimum of 3 years.;12. Patients must not have significantly diseased or obstructed gastrointestinal tract, malabsorption, uncontrolled vomiting or diarrhea, or inability to swallow oral medications.;13. Dehydration of National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) grade >= 1.;14. Patients must not have serious psychiatric or medical conditions that could interfere with treatment.;15. History of organ allograft.;16. Concurrent therapy with approved or investigational anticancer therapeutics.;17. Arms A, B, C, and D, only: Prior treatment with bevacizumab or other direct VEGF/ VEGFR inhibitors. For any question of the definition of a direct VEGF/VEGFR inhibitor, consult Sponsor.;18. Arms C and D only: body surface area < 1.2 m2, to avoid a dose exceeding the maximum allowable dose of 70 mg/m2.;.
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2013-003668-30-NL |
ClinicalTrials.gov | NCT01986348 |
CCMO | NL55009.078.15 |