Clinical trial NCT04414475: A Study of Selinexor (Seli) + Low-dose Dexamethasone (LDD) in Penta-refractory Multiple Myeloma (MM), Seli and Bortezomib + LDD in Triple-class Refractory MM.
Official title: A Phase 2b, Open-label, Multi-arm Clinical Trial of Selinexor Plus Low-dose Dexamethasone (Sd) in Patients with Penta-refractory Multiple Myeloma or Selinexor and Bortezomib Plus Low-dose Dexamethasone (SVd) in Patients with Triple-class Refractory Multiple Myeloma
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
Conditions: Multiple Myeloma, Refractory
Keywords: Multiple Myeloma
Selinexor
Penta-refractory Multiple Myeloma
Triple-class Refractory Multiple Myeloma
KPT-330
Lead sponsor: Karyopharm Therapeutics Inc
Sponsor class: INDUSTRY
First posted: 2020-06-04
Enrollment: 127
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to assess the efficacy, antitumor activity, safety and tolerability of selinexor plus low-dose dexamethasone in participants with penta-refractory multiple myeloma or selinexor and bortezomib plus low-dose dexamethasone in participants with triple-class refractory multiple myeloma.


Eligibility criteria: Inclusion Criteria:

* Age greater than or equal to (\>=)18 years at the time of signing informed consent.
* Written informed consent in accordance with federal, local, and institutional guidelines.
* Measurable MM based on IMWG guidelines as defined by at least one of the following:

  1. Serum M-protein \>= 0.5 gram per deciliter (g/dL) by serum protein electrophoresis (SPEP) or, for Immunoglobulin (Ig) A myeloma, by quantitative IgA.
  2. Urinary M-protein excretion \>= 200 mg/24 hours.
  3. Free light chain (FLC) \>= 100 milligram per liter (mg/L), provided that the FLC ratio is abnormal.
* Only for arms Sd-40 BIW, Sd-100 QW and Sd-80 BIW prior to protocol version (PV) 5.0: Participants must have relapsed or refractory multiple myeloma (RRMM) and have previously received at least 4 anti-MM prior therapies and have MM that is refractory to previous treatment with at least 2 proteasome inhibitors (PIs), at least 2 immunomodulatory agent (IMiDs), and 1 anti-cluster of differentiation (CD38) monoclonal antibody. Refractory is defined as lesser than or equal to (\<=) 25 percent (%) response to therapy, or progression during therapy or progression within 60 days after completion of therapy.
* Only for Arms Sd-40 BIW and Sd-100 QW as of PV 5.0: Participants must have RR MM and have been previously treated with \>=3 anti-MM therapies (with exposure to at least 2 PI drugs, at least 2 IMiDs, and 1 anti-CD38 monoclonal antibody), and be refractory to at least 1 drug of each class (PI/IMiD/anti-CD38). Refractory is defined as \<=25% response to therapy or progression during therapy or progression within 60 days after completion of therapy.
* Only for arm SVd: Participants must have previously received 1 to 5 anti-MM prior therapies and have MM that is refractory to previous treatment with at least 1 PI, at least 1 IMiD, and 1 anti- CD38 monoclonal antibody.
* Eastern Cooperative Oncology Group (ECOG) performance status of \<= 2.
* Female participants of childbearing potential must agree to use dual methods of contraception and have a negative serum pregnancy test at screening, and male participants must use an effective barrier method of contraception if sexually active with a female of childbearing potential. For both male and female participants, effective methods of contraception must be used throughout the study and for 7 months for female and 4 months for male following the discontinuation of study treatment.

Exclusion Criteria:

* Active plasma cell leukemia.
* Documented systemic amyloid light chain amyloidosis.
* Active central nervous system MM.
* Only for SVd arm: Greater than Grade 2 peripheral neuropathy or Grade \>= 2 peripheral neuropathy with pain at baseline, regardless of whether or not the participant is currently receiving medication.
* Radiation, chemotherapy, immunotherapy, or any other anticancer therapy (including investigational therapies) \<= 2 weeks prior to Cycle 1 Day 1 (C1D1). (Steroids are permitted up to 1 pulse of 40 mg per day for 4 days in the 2 weeks prior to C1D1).
* Active graft vs. host disease (after allogeneic stem cell transplantation) at C1D1.
* Ongoing clinically significant non-hematological toxicities from prior treatments that are Grade greater than (\>) 2 at C1D1.
* Inadequate hepatic function defined as total bilirubin \>= 2x upper limit of normal (ULN) (\>= 3x ULN for participants with Gilbert's syndrome), aspartate transaminase (AST) \>= 2.5x ULN, and alanine transaminase (ALT) \>= 2.5x ULN.
* Inadequate renal function defined as estimated creatinine clearance of lesser than (\<) 20 milliliter per minute (mL/min), calculated using the formula of Cockroft and Gault.
* Inadequate hematopoietic function defined as the following:

  1. Absolute neutrophil count (ANC) \< 1000/cubic millimeter (mm\^3)
  2. Platelet count \< 75,000/mm\^3
  3. Hemoglobin (Hb) level \< 8.5 g/dL
* Life expectancy of \< 4 months, based on the opinion of the Investigator.
* Major surgery within 4 weeks prior to C1D1.
* Uncontrolled active infection requiring parenteral antibiotics, antivirals, or antifungals within 1 week prior to first dose.
* Active gastrointestinal dysfunction interfering with the ability to swallow tablets, or any gastrointestinal dysfunction that could interfere with absorption of the study treatment.
* Known active hepatitis A, B, or C infection; or known to be positive for hepatitis C virus RNA or hepatitis B virus surface antigen.
* Female participants who are pregnant or lactating.
* Known intolerance, hypersensitivity, or contraindication to glucocorticoid therapy at C1D1.
* Concurrent therapy with approved or investigational anticancer therapeutic including topical therapies.
* Prior exposure to a SINE compound, including selinexor.
* Serious, active psychiatric or active medical conditions which, in the opinion of the Investigator or the Sponsor, could interfere with the participation in the study.
* Contraindication to any of the required concomitant drugs or supportive treatments.

Primary outcomes:
measure: Overall Response Rate (ORR)
timeFrame: From the date of randomization up to death (approximately 60 months)
Secondary outcomes:
measure: Duration of Response (DOR)
timeFrame: From the date of randomization to first disease progression or death (approximately 60 months)
measure: Clinical Benefit Rate (CBR)
timeFrame: From the date of randomization up to death (approximately 60 months)
measure: Disease control rate (DCR)
timeFrame: From the date of randomization up to death (approximately 60 months)
measure: Progression-Free Survival (PFS)
timeFrame: From the date of randomization to first disease progression or death (approximately 60 months)
measure: Overall Survival (OS)
timeFrame: From the date of randomization up to death (approximately 60 months)
measure: Time to Next Treatment (TTNT)
timeFrame: From the date of first dose up to death (approximately 60 months)
measure: Number of Participants with Adverse Events (AE)
timeFrame: From start of study drug administration up to follow-up (approximately 60 months)
Other outcomes:
Locations:
city: Patra
country: Greece
facility: University General Hospital of Patras
state: Achaia
city: Attiki
country: Greece
facility: General Hospital of Athens "ALEXANDRA"
state: Athens
city: Athens
country: Greece
facility: General Hospital of Athens "Evaggelismos"
state: Attiki
city: Thessaloniki
country: Greece
facility: Theageneion Cancer Hospital
city: Afula
country: Israel
facility: Emek Medical Center
city: Ashdod
country: Israel
facility: Assuta Ashdod Medical Center
city: Ashkelon
country: Israel
facility: Barzilai Medical Center
city: Beer-Sheva
country: Israel
facility: Soroka University Medical Center
city: Haifa
country: Israel
facility: Bnai-Zion Medical Center
city: Haifa
country: Israel
facility: Rambam Health Care Campus
city: Jerusalem
country: Israel
facility: Shaare Zedek Medical Center
city: Jerusalem
country: Israel
facility: Hadassah Medical Center
city: Kfar Saba
country: Israel
facility: Meir Medical Center
city: Petah Tikva
country: Israel
facility: Rabin Medical Center (Beilinson Hospital)
city: Ramat Gan
country: Israel
facility: The Chaim Sheba Medical Center at Tel HaShomer
city: Tel Aviv
country: Israel
facility: Tel Aviv Sourasky Medical Center
Study officials:
References: