A Phase 1 and Randomized Phase 2 Trial of Selinexor and Temozolomide in Recurrent Glioblastoma
Summary
This phase I/II trial tests the safety, side effects and best dose of selinexor given in combination with the usual chemotherapy (temozolomide) and compares the effect of this combination therapy versus the usual chemotherapy alone (temozolomide) in treating patients with glioblastoma that has come back (recurrent). Selinexor is in a class of medications called selective inhibitors of nuclear export (SINE). It works by blocking a protein called CRM1, which may keep cancer cells from growing and may kill them. Temozolomide is in a class of medications called alkylating agents. It works by damaging the cell's deoxyribonucleic acid and may kill tumor cells and slow down or stop tumor growth. Giving selinexor in combination with usual chemotherapy (temozolomide) may shrink or stabilize the tumor better than the usual chemotherapy with temozolomide alone in patients with recurrent glioblastoma.
Detailed description
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose of temozolomide followed by selinexor in recurrent glioblastoma patients as determined by dose-limiting toxicities (DLTs) and the total toxicity profile. (Phase I) II. To evaluate the efficacy of sequentially administering temozolomide and selinexor in recurrent glioblastoma as determined by progression-free survival (PFS). (Phase II) SECONDARY OBJECTIVES: I. To evaluate overall response rate as determined by Response Assessment in Neuro-Oncology (RANO) response criteria. II. To evaluate the efficacy of sequentially administering temozolomide and selinexor in recurrent glioblastoma as determined by 6-month PFS (6mPFS) and overall survival (OS). III. To validate signatures of vulnerability to predict response to selinexor through ribonucleic acid (RNA) sequencing for 6 top-scoring gene pairs, whole exome sequencing, P53, EGFR, and Mcl-1. OUTLINE: This is a phase I, dose-escalation study of selinexor in combination with fixed dose temozolomide followed by a phase II study that compares selinexor temozolomide combination therapy vs. temozolomide monotherapy. Patients are randomized to 1 of 2 groups for the phase II part of this trial. GROUP I (Phase II): Patients receive temozolomide orally (PO) once daily (QD) on days 1-5 of each cycle and placebo PO QD on days 8 and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. GROUP II (Phase I and II): Patients receive temozolomide PO QD on days 1-5 of each cycle and selinexor PO QD on days 8 and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. (Phase I completed as of April 2024) Patients undergo magnetic resonance imaging (MRI) throughout the study and blood sample collection while on study. After completion of study treatment, patients are followed up every 2 months up to 2 years.
Arms & interventions
- ProcedureBiospecimen Collection
Undergo blood sample collection
- ProcedureMagnetic Resonance Imaging
Undergo MRI
- DrugPlacebo Administration
Given PO
- DrugSelinexor
Given PO
- DrugTemozolomide
Given PO
Outcome measures
Primary
Recommended phase 2 dose (RP2D) (Phase I)
Any eligible patient who receives at least one dose of protocol-defined therapy will be considered evaluable for dose-limiting toxicity (DLT) if either of the following occurs: (1) the patient experiences a DLT during cycle 1 of therapy; or (2) the patient receives at least 4 doses of temozolomide and 1 dose of selinexor. All other patients enrolled during the phase 1 portion of the study will be considered inevaluable for DLT and may be replaced for the purposes of establishing the RP2D.
Time frame: Up to 28 days
Progression-free survival (PFS) (Phase II)
Patients who experience disease progression or death will be considered to have experienced a PFS-event; otherwise the patient is considered censored at last contact.
Time frame: From randomization to date of disease progression (either progression of existing lesions or appearance of new lesions), death, or date of last contact, whichever occurs first, assessed up to 3 years
Secondary
Response according to response assessment in neuro-oncology criteria (RANO) criteria
Time frame: Up to 3 years
Six-month progression-free survival (PFS-6)
Time frame: At 6 months
Median overall survival
Time frame: Time between the date of randomization and the date of death or date of last contact, whichever occurs first, assessed up to 3 years
Molecular signatures of vulnerability
Time frame: Up to 3 years
Eligibility criteria
Study locations (36)
Mayo Clinic Hospital in Arizona
Phoenix, Arizona, 85054
City of Hope Comprehensive Cancer Center
Duarte, California, 91010
UC San Diego Moores Cancer Center
La Jolla, California, 92093
Keck Medicine of USC Koreatown
Los Angeles, California, 90020
Los Angeles General Medical Center
Los Angeles, California, 90033
USC / Norris Comprehensive Cancer Center
Los Angeles, California, 90033
University of California Davis Comprehensive Cancer Center
Sacramento, California, 95817
UCHealth University of Colorado Hospital
Aurora, Colorado, 80045
UM Sylvester Comprehensive Cancer Center at Coral Gables
Coral Gables, Florida, 33146
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
Deerfield Beach, Florida, 33442
Mayo Clinic in Florida
Jacksonville, Florida, 32224-9980
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
Moffitt Cancer Center
Tampa, Florida, 33612
Emory University Hospital Midtown
Atlanta, Georgia, 30308
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, 30322
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, 60637
University of Chicago Medicine-Orland Park
Orland Park, Illinois, 60462
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, 40536
Mayo Clinic in Rochester
Rochester, Minnesota, 55905
Saint Barnabas Medical Center
Livingston, New Jersey, 07039
Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, 08903
Rutgers New Jersey Medical School
Newark, New Jersey, 07101
Roswell Park Cancer Institute
Buffalo, New York, 14263
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
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati, Ohio, 45219
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, 43210
University of Cincinnati Cancer Center-West Chester
West Chester, Ohio, 45069
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, 15232
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah, 84112
University of Virginia Cancer Center
Charlottesville, Virginia, 22908
VCU Massey Comprehensive Cancer Center
Richmond, Virginia, 23298
University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
Madison, Wisconsin, 53718
University of Wisconsin Carbone Cancer Center - University Hospital
Madison, Wisconsin, 53792