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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT02336815
Other study ID # KCP-330-012
Secondary ID
Status Completed
Phase Phase 2
First received
Last updated
Start date May 26, 2015
Est. completion date July 26, 2019

Study information

Verified date January 2023
Source Karyopharm Therapeutics Inc
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This is a Phase 2b, single-arm, open-label, multicenter study of selinexor 80 mg plus dexamethasone 20 mg (Sd) dosed twice weekly in four-week cycles, in patients with penta-refractory MM (Parts 1 and 2) or quad refractory MM (Part 1 only).


Description:

This is a Phase 2b, single-arm, open-label, multicenter study of selinexor 80 mg plus dexamethasone 20 mg (Sd), both dosed twice weekly in each four-week cycle, in patients with MM previously treated with lenalidomide, pomalidomide, bortezomib, carfilzomib, and daratumumab and refractory to prior treatment with glucocorticoids, an immunomodulatory agent (IMiD), a proteasome inhibitor (PI), and daratumumab. This study consists of two parts: - Part 1 enrolled patients with both quad-refractory MM and penta-refractory MM. - Part 2 will enroll patients with penta-refractory MM only.


Recruitment information / eligibility

Status Completed
Enrollment 202
Est. completion date July 26, 2019
Est. primary completion date July 26, 2019
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: Measurable MM based on modified IMWG guidelines. Defined by at least one of the following: 1. Serum M-protein = 0.5 g/dL by serum electrophoresis (SPEP) or for IgA myeloma, by quantitative IgA 2. Urinary M-protein excretion = 200 mg/24 hours 3. Free Light Chain (FLC) = 100 mg/L, provided that the FLC ratio is abnormal 4. If serum protein electrophoresis is felt to be unreliable for routine M-protein measurement, then quantitative Ig levels by nephelometry or turbidimetry are acceptable - Must have previously received = 3 anti-MM regimens including: an alkylating agent, lenalidomide, pomalidomide, bortezomib, carfilzomib, daratumumab, and a glucocorticoid. There is no upper limit on the number of prior therapies provided that all other inclusion/exclusion criteria are met. - MM refractory to previous treatment with one or more glucocorticoids, parenteral PI (i.e., bortezomib and/or carfilzomib), IMiD (i.e., lenalidomide and/or pomalidomide), and the anti-CD38 mAb, daratumumab. Refractory is defined as = 25% response to therapy, or progression during therapy or progression within 60 days after completion of therapy. Exclusion Criteria: - Active smoldering MM. - Active plasma cell leukemia. - Documented systemic amyloid light chain amyloidosis. - Active CNS MM.

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Selinexor
Fixed oral dose of 80 mg twice weekly (e.g., Monday and Wednesday or Tuesday and Thursday, etc.)
Dexamethasone
20 mg was given with each dose of Selinexor.

Locations

Country Name City State
Austria University Hospital Krems, Department of Internal Medicine II Krems
Austria Salzburg Regional Hospital Müllner Salzburg
Austria Medical University Vienna, Department of Internal Medicine I Vienna
Belgium ZNA Stuivenberg Antwerp
Belgium General Hospital Saint-Jan Brugge
Belgium Jules Bordet Institute Brussels
Belgium UCL Saint-Luc Brussels
Belgium University Hospital Ghent Ghent
Belgium University Hospital Leuven, Campus Gasthuisberg Leuven
Belgium UCL Mont-Godinne Yvoir
France Claude Huriez Hospital, Department of Blood Diseases Lille
France South Lyon Hospital Center, Department of Clinical Hematology Lyon
France Brabois Adults Hospital Nancy
France Nantes University Hospital Center Nantes
France Hopital Saint-Antoine, Service d´Hematologie Clinique et Therapie Cellulaire Paris
France La Pitie-Salpetriere University Hospital, Department of Clinical Hematology Paris
France Necker Children's Hospital Paris
Germany BAG Oncology Gemeinschaftspraxis Dresden
Germany University Hospital Freiburg, Department of Internal Medicine I Freiburg
Germany Universitätsklinikum Heidelberg Medizinische Klinik V Heidelberg
Germany Universitätsklinikum des Saarlandes Klinik für Innere Medizin I Homburg
Germany Universitätsmedizin Mainz Mainz
Germany University hospital of Tuebingen, Internal Medicine II Tübingen
Germany Med. Klinik und Poliklinik II Universitätsklinikum Würzburg
Greece National & Kapodistrain University of Athens School of Medicine, Alexandra Hospital Athens
United States University of Michigan Ann Arbor Michigan
United States Emory University / Winship Cancer Institute Atlanta Georgia
United States Northside Hospital Atlanta Georgia
United States Johns Hopkins Medicine Baltimore Maryland
United States University of Alabama Birmingham Alabama
United States Dana Farber Cancer Institute Boston Massachusetts
United States Massachusetts General Hospital Boston Massachusetts
United States Tufts Medical Center Boston Massachusetts
United States Roswell Park Cancer Institute Buffalo New York
United States Gabrail Cancer Center Canton Ohio
United States UNC-Chapel Hill Chapel Hill North Carolina
United States University of Chicago Medicine Chicago Illinois
United States Baylor Sammons Cancer Center Dallas Texas
United States Karmanos Cancer Institute / Wayne State University Detroit Michigan
United States City of Hope Duarte California
United States University of Florida Health Cancer Center- Shands Cancer Center Hospital Gainesville Florida
United States Hackensack University Medical Center / John Therurer Cancer Center Hackensack New Jersey
United States Kaiser Permanente- Hawaii Honolulu Hawaii
United States Indiana University Simon Cancer Center Indianapolis Indiana
United States University of Iowa Hospitals & Clinics Iowa City Iowa
United States Jonnsson Comprehensive Cancer Center / University of Los Angeles Los Angeles California
United States Norton Cancer Institute Louisville Kentucky
United States Sylvester, University of Miami Miami Florida
United States Vanderbilt University Ingram Cancer Center Nashville Tennessee
United States Smilow Cancer Hospital New Haven Connecticut
United States Columbia University New York New York
United States Mt Sinai NYC New York New York
United States NYU Perlmutter Cancer Center New York New York
United States Valley Hospital Paramus New Jersey
United States Abramson Cancer Center of the University of Pennsylvania Philadelphia Pennsylvania
United States Kaiser Permanente Northwest OR Portland Oregon
United States Mayo Clinic Rochester Rochester Minnesota
United States Washington University St. Louis Saint Louis Missouri
United States Mayo Clinic (AZ) Scottsdale Arizona
United States Swedish Cancer Institute Seattle Washington
United States H. Lee Moffitt Cancer Center Research Institute Tampa Florida

Sponsors (1)

Lead Sponsor Collaborator
Karyopharm Therapeutics Inc

Countries where clinical trial is conducted

United States,  Austria,  Belgium,  France,  Germany,  Greece, 

Outcome

Type Measure Description Time frame Safety issue
Primary Part 2: Percentage of Participants With Overall Response Rate (ORR) Per International MyelomaWorking Group (IMWG) as Assessed by an Independent Review Committee (IRC) IRC assessed ORR per 2016 IMWG criteria: Percentage of participants who experienced Partial response (PR): greater than or equal to (>=) 50 percent (%) reduction of serum M-Protein and reduction in 24-hour urinary M-protein by >= 90% or to lesser than (<) 200 mg per 24 hours; Very good partial response (VGPR): Serum and urine M-protein detectable by immunofixation but not on electrophoresis or 90% or greater reduction in serum M-protein plus urine M-protein level < 100 mg per 24 hours; Complete response (CR): Negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and lesser than or equal to (<=) 5% plasma cells in bone marrow; or stringent complete response (sCR): CR as defined+Normal free light chain (FLC) ratio+Absence of clonal cells in bone marrow biopsy by immunohistochemistry). Baseline until disease progression/discontinuation from the study, or death, whichever occurred first (maximum duration of 17 months)
Secondary Part 1: Duration of Response (DoR) Per IMWG as Assessed by IRC IRC assessed DoR per 2016 IMWG criteria: time (in months) from the first documentation of objective response (confirmed CR or PR) to the date of first documentation of progressive disease (PD) or death due to any cause. Partial response (PR): >= 50% reduction of serum M-Protein and reduction in 24-hour urinary M-protein by >= 90% or to < 200 mg per 24 hours; Complete response (CR): Negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and <= 5% plasma cells in bone marrow; Progressive disease (PD): Increase of 25% from lowest confirmed response value in 1 or more of the following criteria: Serum M-protein with absolute increase of >= 0.5 gram per deciliter (g/dL); Serum M-protein increase >= 1 g/dL if the lowest M-component was >=5 g/dL; Urine M-protein (absolute increase must be >= 200 mg per 24 hours). Analysis was performed using Kaplan-Meier method. First response subsequently confirmed to disease progression/discontinuation from the study, or death, whichever occurred first (maximum duration of 13 months)
Secondary Part 2: Duration of Response (DoR) Per IMWG as Assessed by an IRC IRC assessed DoR per 2016 IMWG criteria: time (in months) from the first documentation of objective response (confirmed CR or PR) to the date of first documentation of progressive disease (PD) or death due to any cause. Partial response (PR): >= 50% reduction of serum M-Protein and reduction in 24-hour urinary M-protein by >= 90% or to < 200 mg per 24 hours; Complete response (CR): Negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and <= 5% plasma cells in bone marrow; Progressive disease (PD): Increase of 25% from lowest confirmed response value in 1 or more of the following criteria: Serum M-protein with absolute increase of >= 0.5 g/dL; Serum M-protein increase >= 1 g/dL if the lowest M-component was >= 5 g/dL; Urine M-protein (absolute increase must be >= 200 mg per 24 hours). Analysis was performed using Kaplan-Meier method. First response subsequently confirmed to disease progression/discontinuation from the study, or death, whichever occurred first (maximum duration of 17 months)
Secondary Part 1: Percentage of Participants With Clinical Benefit Rate (CBR) ) Per IMWG as Assessed by IRC IRC assessed CBR per 2016 IMWG criteria: Percentage of participants with a confirmed minimal response (MR) or better (PR, VGPR, CR or sCR) before confirmed disease progression or initiating new MM treatment. Minimal response (MR): >= 25% but < 49% reduction of serum M-protein and reduction in 24-hour urinary M-protein by 50-89%. Partial response (PR): >= 50% reduction of serum M-Protein and reduction in 24-hour urinary M-protein by >= 90% or to < 200 mg per 24 hours; Very good partial response (VGPR): Serum and urine M-protein detectable by immunofixation but not on electrophoresis or 90% or greater reduction in serum M-protein plus urine M-protein level < 100 mg per 24 hours; Complete response (CR): Negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and <= 5% plasma cells in bone marrow; or stringent complete response (sCR): CR as defined+Normal free light chain (FLC) ratio+Absence of clonal cells by immunohistochemistry). Baseline up to a maximum of 13 months
Secondary Part 2: Percentage of Participants With Clinical Benefit Rate (CBR) Per IMWG as Assessed by IRC IRC assessed CBR per 2016 IMWG criteria: Percentage of participants with a confirmed minimal response (MR) or better (PR, VGPR, CR or sCR) before confirmed disease progression or initiating new MM treatment. Minimal response (MR): >= 25% but < 49% reduction of serum M-protein and reduction in 24-hour urinary M-protein by 50-89%. Partial response (PR): >= 50% reduction of serum M-Protein and reduction in 24-hour urinary M-protein by >= 90% or to < 200 mg per 24 hours; Very good partial response (VGPR): Serum and urine M-protein detectable by immunofixation but not on electrophoresis or 90% or greater reduction in serum M-protein plus urine M-protein level < 100 mg per 24 hours; Complete response (CR): Negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and <= 5% plasma cells in bone marrow; or stringent complete response (sCR): CR as defined+Normal free light chain (FLC) ratio+Absence of clonal cells by immunohistochemistry). Baseline up to a maximum of 17 months
Secondary Part 1: Duration of Clinical Benefit Per IMWG as Assessed by IRC IRC assessed duration of clinical benefit per 2016 IMWG criteria: Duration from first response (at least MR) to time of IRC-determined PD or death due to disease progression, whichever occurs first. Minimal response (MR): >= 25% but < 49% reduction of serum M-protein and reduction in 24-hour urinary M-protein by 50-89%. Progressive disease (PD): Increase of 25% from lowest confirmed response value in 1 or more of the following criteria: Serum M-protein with absolute increase of >= 0.5 g/dL; Serum M-protein increase >= 1 g/dL if the lowest M-component was >=5 g/dL; Urinary M-protein (absolute increase must be >= 200 mg per 24 hours). Analysis was performed using Kaplan-Meier method. First response subsequently confirmed to disease progression, or death, whichever occurred first (maximum duration of 13 months)
Secondary Part 2: Duration of Clinical Benefit Per IMWG as Assessed by IRC IRC assessed duration of clinical benefit per 2016 IMWG criteria: Duration from first response (at least MR) to time of IRC-determined PD or death due to disease progression, whichever occurs first. Minimal response (MR): >= 25% but < 49% reduction of serum M-protein and reduction in 24-hour urinary M-protein by 50-89%. Progressive disease (PD): Increase of 25% from lowest confirmed response value in 1 or more of the following criteria: Serum M-protein with absolute increase of >= 0.5 g/dL; Serum M-protein increase >= 1 g/dL if the lowest M-component was >=5 g/dL; Urinary M-protein (absolute increase must be >= 200 mg per 24 hours). Analysis was performed using Kaplan-Meier method. First response subsequently confirmed to disease progression, or death, whichever occurred first (maximum duration of 17 months)
Secondary Part 2: Disease Control Rate (DCR) DCR was defined as the percentage of participants who achieved stable disease (SD) or better (MR, PR, VGPR, CR, sCR) for a minimum of 12 weeks. Stable disease (SD): Not recommended for use as an indicator of response; stability of disease was best described by providing the time to progression (TTP) estimates. MR: >= 25% but < 49% reduction of serum M-protein and reduction in 24-hour urinary M-protein by 50-89%. PR: >=50% reduction of serum M-Protein and reduction in 24-hour urinary M-protein by >= 90% or to < 200 mg per 24 hours; VGPR: Serum and urine M-protein detectable by immunofixation but not on electrophoresis or 90% or greater reduction in serum M-protein plus urine M-protein level < 100 mg per 24 hours; CR: Negative immunofixation on the serum and urine and disappearance of any soft tissue plasmacytomas and <= 5% plasma cells in bone marrow; or sCR: CR as defined+Normal FLC ratio+Absence of clonal cells by immunohistochemistry). Every 12 weeks until progressive disease or death due to any cause, up to 17 months
Secondary Part 1: Progression Free Survival (PFS) Per IMWG as Assessed by IRC IRC assessed PFS per 2016 IMWG criteria: Duration from start of study treatment until IRC-determined progressive disease (PD) or death from any cause, whichever occurred first. Progressive disease (PD): Increase of 25% from lowest confirmed response value in 1 or more of the following criteria: Serum M-protein with absolute increase of >= 0.5 g/dL; Serum M-protein increase >=1 g/dL if the lowest M-component was >= 5 g/dL; Urinary M-protein (absolute increase must be >= 200 mg/24 hours). Analysis was performed using Kaplan-Meier method. From start of study treatment to progression of disease or discontinuation from the study or death, whichever occurred first (maximum duration of 13 months)
Secondary Part 2: Progression Free Survival (PFS) Per IMWG as Assessed by IRC IRC assessed PFS per 2016 IMWG criteria: Duration from start of study treatment until IRC-determined progressive disease (PD) or death from any cause, whichever occurred first. Progressive disease (PD): Increase of 25% from lowest confirmed response value in 1 or more of the following criteria: Serum M-protein with absolute increase of >= 0.5 g/dL; Serum M-protein increase >=1 g/dL if the lowest M-component was >= 5 g/dL; Urinary M-protein (absolute increase must be >= 200 mg/24 hours). Analysis was performed using Kaplan-Meier method. From start of study treatment to progression of disease or discontinuation from the study or death, whichever occurred first (maximum duration of 17 months)
Secondary Part 1: Time to Progression (TTP) Per IMWG as Assessed by IRC IRC assessed TTP per 2016 IMWG criteria: Duration from start of study treatment until PD or death due to PD (per IRC), whichever occurred first. Progressive disease (PD): Increase of 25% from lowest confirmed response value in 1 or more of the following criteria: Serum M-protein with absolute increase of >= 0.5 g/dL; Serum M-protein increase >=1 g/dL if the lowest M-component was >= 5 g/dL; Urinary M-protein (absolute increase must be >= 200 mg/24 hours). Analysis was performed using Kaplan-Meier method. From start of study treatment to progression of disease or death, whichever occurred first (maximum duration of 13 months)
Secondary Part 2: Time to Progression (TTP) Per IMWG as Assessed by IRC IRC assessed TTP per 2016 IMWG criteria: Duration from start of study treatment until PD or death due to PD (per IRC), whichever occurred first. Progressive disease (PD): Increase of 25% from lowest confirmed response value in 1 or more of the following criteria: Serum M-protein with absolute increase of >= 0.5 g/dL; Serum M-protein increase >=1 g/dL if the lowest M-component was >= 5 g/dL; Urinary M-protein (absolute increase must be >= 200 mg/24 hours). Analysis was performed using Kaplan-Meier method. From start of study treatment to progression of disease or death, whichever occurred first (maximum duration of 17 months)
Secondary Part 1: Time to Next Treatment (TTNT) TTNT was defined as the duration from start of study treatment to start of next anti-MM treatment or death due to disease progression, whichever occurred first. Analysis was performed using Kaplan-Meier method. From start of study treatment to start of next anti-MM treatment or death due to disease progression, whichever occurs first (maximum duration of 13 months)
Secondary Part 2: Time to Next Treatment (TTNT) TTNT was defined as the duration from start of study treatment to start of next anti-MM treatment or death due to disease progression, whichever occurred first. Analysis was performed using Kaplan-Meier method. From start of study treatment to start of next anti-MM treatment or death due to disease progression, whichever occurs first (maximum duration of 17 months)
Secondary Part 1: Overall Survival (OS) OS was defined as the duration (in months) from start of study treatment to death from any cause. Participants last known to be alive were censored at the date of discontinuation from the study, or database cut date, whichever was earlier. Analysis was performed using Kaplan-Meier method. From start of study treatment to death (maximum duration of 13 months)
Secondary Part 2: Overall Survival (OS) OS was defined as the duration (in months) from start of study treatment to death from any cause. Participants last known to be alive were censored at the date of discontinuation from the study, or database cut date, whichever was earlier. Analysis was performed using Kaplan-Meier method. From start of study treatment to death (maximum duration of 17 months)
Secondary Part 2: Change From Baseline in Health-related Quality of Life (HRQL) Score Based on Functional Assessment of Cancer Therapy - Multiple Myeloma (FACT-MM) Questionnaire FACT-MM combines the general version of the FACT (FACT-G) with a MM-specific sub-scale (14 items). The sub-scales for the FACT-G are Physical Well-Being (7 items), Social/Family Well-Being (7 items), Emotional Well-Being (6 items), and Functional Well-Being (7 items). The trial outcomes index (TOI); total of 41 items) is the primary measurement of interest, comprised of the Physical and Functional sub-scales plus the MM-specific sub-scale. Each item is rated on a 5-point Likert scale, ranging from 0 ("Not at all") to 4 ("Very much"), therefore the TOI has a score ranging from 0 to 120. Higher scores indicated improvement in well being. Baseline, Day 1 of Cycle 2 to Cycle 20 (up to a maximum of 17 months)
Secondary Number of Participants With Treatment-Emergent Adverse Events (TEAE) of Grade 3/4, Graded Based on National Cancer Institute Common Terminology Criteria (NCI-CTCAE), Version 4.03 An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. As per NCI-CTCAE version 4.03, Grade 1: asymptomatic or mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2: moderate, minimal, local or noninvasive intervention indicated, limiting age-appropriate instrumental activities of daily life (ADL); Grade 3: severe or medically significant but not immediately life-threatening, hospitalization or prolongation of existing hospitalization indicated, disabling, limiting self-care ADL; Grade 4: life-threatening consequence, urgent intervention indicated; Grade 5: death related to AE. Treatment-emergent events are events between first dose of study drug and up to last dose of study treatment + 30 days (inclusive) that were absent before treatment or that worsened relative to pre-treatment state. Baseline to 30 days after last dose of study treatment (maximum duration of 18 months)
Secondary Number of Participants With Treatment-Emergent Treatment-Related Adverse Events (TEAEs) of Grade 3/4, Graded Based on National Cancer Institute Common Terminology Criteria (NCI-CTCAE), Version 4.03 An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. As per NCI-CTCAE version 4.03, Grade 1: asymptomatic or mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2: moderate, minimal, local or noninvasive intervention indicated, limiting age-appropriate instrumental activities of daily life (ADL); Grade 3: severe or medically significant but not immediately life-threatening, hospitalization or prolongation of existing hospitalization indicated, disabling, limiting self-care ADL; Grade 4: life-threatening consequence, urgent intervention indicated; Grade 5: death related to AE. A treatment related AE was any untoward medical occurrence in a clinical investigation participant administered a product or medical device; the event had a causal relationship with the treatment or usage. Baseline to 30 days after last dose of study treatment (maximum duration of 18 months)
Secondary Apparent Clearance (CL/F) of Selinexor in Plasma CL/F of selinexor in plasma was reported. Cycle 1: Day 1: Pre-dose, 1, 2 and 4 hours post-dose; Day 8 and 15: Pre-dose and 1 hour post-dose; Cycle 2: Day 1: Predose, 1, 2 and 4 hours post-dose
Secondary Volume of Distribution (V/F) of Selinexor in Plasma Vz/F of selinexor in plasma was reported. Cycle 1: Day 1: Pre-dose, 1, 2 and 4 hours post-dose; Day 8 and 15: Pre-dose and 1 hour post-dose; Cycle 2: Day 1: Predose, 1, 2 and 4 hours post-dose
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