A Phase 1/2 Trial of Selinexor (KPT-330) and Radiation Therapy in Newly-Diagnosed Pediatric Diffuse Intrinsic Pontine Glioma (DIPG) and High-Grade Glioma (HGG)
Summary
This phase I/II trial tests the safety, side effects, and best dose of selinexor given in combination with standard radiation therapy in treating children and young adults with newly diagnosed diffuse intrinsic pontine glioma (DIPG) or high-grade glioma (HGG) with a genetic change called H3 K27M mutation. It also tests whether combination of selinexor and standard radiation therapy works to shrink tumors in this patient population. Glioma is a type of cancer that occurs in the brain or spine. Glioma is considered high risk (or high-grade) when it is growing and spreading quickly. The term, risk, refers to the chance of the cancer coming back after treatment. DIPG is a subtype of HGG that grows in the pons (a part of the brainstem that controls functions like breathing, swallowing, speaking, and eye movements). This trial has two parts. The only difference in treatment between the two parts is that some subjects treated in Part 1 may receive a different dose of selinexor than the subjects treated in Part 2. In Part 1 (also called the Dose-Finding Phase), investigators want to determine the dose of selinexor that can be given without causing side effects that are too severe. This dose is called the maximum tolerated dose (MTD). In Part 2 (also called the Efficacy Phase), investigators want to find out how effective the MTD of selinexor is against HGG or DIPG. Selinexor blocks a protein called CRM1, which may help keep cancer cells from growing and may kill them. It is a type of small molecule inhibitor called selective inhibitors of nuclear export (SINE). Radiation therapy uses high energy to kill tumor cells and shrink tumors. The combination of selinexor and radiation therapy may be effective in treating patients with newly-diagnosed DIPG and H3 K27M-Mutant HGG.
Detailed description
PRIMARY OBJECTIVES: I. To define toxicities and estimate the maximum tolerated dose (MTD) and recommended Phase 2 dose (RP2D) of selinexor administered as an oral formulation in combination with standard of care radiation therapy (RT), to pediatric patients with newly diagnosed high-grade glioma (HGG) or diffuse intrinsic pontine glioma (DIPG). (Dose-finding phase/phase I) II. To estimate the event-free survival (EFS) distribution for diffuse midline glioma (DMG)/HGG patients and overall survival (OS) distribution for DIPG patients associated with selinexor plus RT, followed by selinexor in patients with newly diagnosed HGG (H3 K27M mutant DMG or H3 K27-wild type HGG) or DIPG, and to compare those outcomes to historical controls. (Efficacy phase/phase II) EXPLORATORY OBJECTIVE: I. To bank tumor specimens and body fluids (blood and cerebrospinal fluid) for future studies. OUTLINE: This is a phase I dose-escalation study of selinexor followed by a phase II study. (STRATUM DIPG AND STRATUM DMG CLOSED TO ACCRUAL 02/14/2025) CHEMORADIOTHERAPY: Patients receive standard of care radiation therapy 5 days per week for 5-7 weeks. Starting on day 4 or 5 of radiation therapy, patients receive selinexor orally (PO) on days 1, 8, 15, 22, 29, 36, 43, and 50 in the absence of disease progression or unacceptable toxicity. After a 2-week rest period, patients proceed to Maintenance. Patients undergo a magnetic resonance imaging (MRI) and may undergo a biopsy during screening. MAINTENANCE: Patients receive selinexor PO on days 1, 8, 15, and 22 of each cycle. Cycles repeat every 28 days for up to 24 cycles of maintenance therapy in the absence of disease progression or unacceptable toxicity. Patients undergo a MRI on study and during follow-up. After completion of study treatment, patients are followed every 3 months for year 1 (i.e., 3, 6, 9, 12 months), then every 6 months for years 2-3 (i.e., 18, 24, 30, 36 months), and finally once yearly for years 4-5 of this study.
Arms & interventions
- ProcedureBiopsy Procedure
Undergo a biopsy
- ProcedureMagnetic Resonance Imaging
Undergo a MRI
- RadiationRadiation Therapy
Undergo radiation therapy
- DrugSelinexor
Given orally
Outcome measures
Primary
Maximum tolerated dose
Defined as the highest dose of selinexor in combination with standard of care radiation therapy (RT) that does not cause unacceptable side effects.
Time frame: From day 1 of selinexor treatment until the start of maintenance therapy, assessed up to 10 weeks from treatment start date
Event free survival (EFS)
Will be calculated for diffuse midline glioma (DMG)/ high grade glioma (HGG) patients. EFS curve will be estimated by Kaplan Meier estimates.
Time frame: From the date of enrollment until disease progression date, secondary malignant neoplasm occurrence date, death date of any cause, or last follow-up date, assessed up to 5 years
Overall Survival (OS)
Will be calculated for diffuse intrinsic pontine glioma (DIPG) patients. The OS curve will be estimated by Kaplan Meier estimates.
Time frame: From the date of enrollment until death date of any cause or last follow-up date, assessed up to 5 years
Overall response rate (ORR)
Defined as the proportion of patients whose best response is partial response or complete response.
Time frame: Up to 5 years
Eligibility criteria
Study locations (109)
Children's Hospital of Alabama
Birmingham, Alabama, 35233
Banner Children's at Desert
Mesa, Arizona, 85202
Phoenix Childrens Hospital
Phoenix, Arizona, 85016
Arkansas Children's Hospital
Little Rock, Arkansas, 72202-3591
Loma Linda University Medical Center
Loma Linda, California, 92354
Miller Children's and Women's Hospital Long Beach
Long Beach, California, 90806
Children's Hospital Los Angeles
Los Angeles, California, 90027
Cedars-Sinai Medical Center
Los Angeles, California, 90048
UCSF Benioff Children's Hospital Oakland
Oakland, California, 94609
Kaiser Permanente-Oakland
Oakland, California, 94611
Children's Hospital of Orange County
Orange, California, 92868
Lucile Packard Children's Hospital Stanford University
Palo Alto, California, 94304
Rady Children's Hospital - San Diego
San Diego, California, 92123
UCSF Medical Center-Mission Bay
San Francisco, California, 94158
Children's Hospital Colorado
Aurora, Colorado, 80045
Connecticut Children's Medical Center
Hartford, Connecticut, 06106
Yale University
New Haven, Connecticut, 06520
Alfred I duPont Hospital for Children
Wilmington, Delaware, 19803
Children's National Medical Center
Washington D.C., District of Columbia, 20010
Golisano Children's Hospital of Southwest Florida
Fort Myers, Florida, 33908
Nemours Children's Clinic-Jacksonville
Jacksonville, Florida, 32207
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
Miami Cancer Institute
Miami, Florida, 33176
Arnold Palmer Hospital for Children
Orlando, Florida, 32806
Nemours Children's Hospital
Orlando, Florida, 32827
Johns Hopkins All Children's Hospital
St. Petersburg, Florida, 33701
Saint Joseph's Hospital/Children's Hospital-Tampa
Tampa, Florida, 33607
Children's Healthcare of Atlanta - Arthur M Blank Hospital
Atlanta, Georgia, 30329
Kapiolani Medical Center for Women and Children
Honolulu, Hawaii, 96826
Saint Luke's Cancer Institute - Boise
Boise, Idaho, 83712
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, 60637
OSF Children's Hospital of Illinois
Peoria, Illinois, 61637
Riley Hospital for Children
Indianapolis, Indiana, 46202
Blank Children's Hospital
Des Moines, Iowa, 50309
University of Iowa/Holden Comprehensive Cancer Center
Iowa City, Iowa, 52242
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, 40536
Norton Children's Hospital
Louisville, Kentucky, 40202
Children's Hospital New Orleans
New Orleans, Louisiana, 70118
Eastern Maine Medical Center
Bangor, Maine, 04401
Maine Children's Cancer Program
Scarborough, Maine, 04074
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, 21287
Dana-Farber Cancer Institute
Boston, Massachusetts, 02215
C S Mott Children's Hospital
Ann Arbor, Michigan, 48109
Children's Hospital of Michigan
Detroit, Michigan, 48201
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids, Michigan, 49503
Children's Hospitals and Clinics of Minnesota - Minneapolis
Minneapolis, Minnesota, 55404
University of Minnesota/Masonic Cancer Center
Minneapolis, Minnesota, 55455
University of Mississippi Medical Center
Jackson, Mississippi, 39216
Children's Mercy Hospitals and Clinics
Kansas City, Missouri, 64108
Cardinal Glennon Children's Medical Center
St Louis, Missouri, 63104
Washington University School of Medicine
St Louis, Missouri, 63110
Mercy Hospital Saint Louis
St Louis, Missouri, 63141
Children's Hospital and Medical Center of Omaha
Omaha, Nebraska, 68114
University of Nebraska Medical Center
Omaha, Nebraska, 68198
Hackensack University Medical Center
Hackensack, New Jersey, 07601
Morristown Medical Center
Morristown, New Jersey, 07960
Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
New Brunswick, New Jersey, 08903
Newark Beth Israel Medical Center
Newark, New Jersey, 07112
Saint Joseph's Regional Medical Center
Paterson, New Jersey, 07503
Albany Medical Center
Albany, New York, 12208
Roswell Park Cancer Institute
Buffalo, New York, 14263
The Steven and Alexandra Cohen Children's Medical Center of New York
New Hyde Park, New York, 11040
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York, 10016
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York, 10032
Memorial Sloan Kettering Cancer Center
New York, New York, 10065
State University of New York Upstate Medical University
Syracuse, New York, 13210
Montefiore Medical Center - Moses Campus
The Bronx, New York, 10467
Novant Health Presbyterian Medical Center
Charlotte, North Carolina, 28204
East Carolina University
Greenville, North Carolina, 27834
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
Sanford Broadway Medical Center
Fargo, North Dakota, 58122
Children's Hospital Medical Center of Akron
Akron, Ohio, 44308
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, 45229
Rainbow Babies and Childrens Hospital
Cleveland, Ohio, 44106
Nationwide Children's Hospital
Columbus, Ohio, 43205
Dayton Children's Hospital
Dayton, Ohio, 45404
ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
Toledo, Ohio, 43606
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Legacy Emanuel Children's Hospital
Portland, Oregon, 97227
Oregon Health and Science University
Portland, Oregon, 97239
Geisinger Medical Center
Danville, Pennsylvania, 17822
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, 19104
Saint Christopher's Hospital for Children
Philadelphia, Pennsylvania, 19134
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, 15224
Rhode Island Hospital
Providence, Rhode Island, 02903
Prisma Health Richland Hospital
Columbia, South Carolina, 29203
BI-LO Charities Children's Cancer Center
Greenville, South Carolina, 29605
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
East Tennessee Childrens Hospital
Knoxville, Tennessee, 37916
Saint Jude Children's Research Hospital
Memphis, Tennessee, 38105
The Children's Hospital at TriStar Centennial
Nashville, Tennessee, 37203
Dell Children's Medical Center of Central Texas
Austin, Texas, 78723
Driscoll Children's Hospital
Corpus Christi, Texas, 78411
Medical City Dallas Hospital
Dallas, Texas, 75230
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
El Paso Children's Hospital
El Paso, Texas, 79905
Cook Children's Medical Center
Fort Worth, Texas, 76104
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Houston, Texas, 77030
UT MD Anderson Cancer Center
Houston, Texas, 77030
Children's Hospital of San Antonio
San Antonio, Texas, 78207
University of Texas Health Science Center at San Antonio
San Antonio, Texas, 78229
Primary Children's Hospital
Salt Lake City, Utah, 84113
University of Virginia Cancer Center
Charlottesville, Virginia, 22908
Children's Hospital of The King's Daughters
Norfolk, Virginia, 23507
Seattle Children's Hospital
Seattle, Washington, 98105
Providence Sacred Heart Medical Center and Children's Hospital
Spokane, Washington, 99204
Mary Bridge Children's Hospital and Health Center
Tacoma, Washington, 98405
University of Wisconsin Carbone Cancer Center - University Hospital
Madison, Wisconsin, 53792
Children's Hospital of Wisconsin
Milwaukee, Wisconsin, 53226