Phase Ib Study of Eltanexor and Venetoclax in Relapsed or Refractory Myelodysplastic Syndrome and Acute Myeloid Leukemia
Summary
This phase I trial tests the safety, side effects, and best dose of eltanexor in combination with venetoclax for the treatment of patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) that has come back after a period of improvement (relapsed) or that has not responded to previous treatment (refractory). Eltanexor works by trapping "tumor suppressing proteins" within the cell, thus causing the cancer cells to die or stop growing. Venetoclax is in a class of medications called B-cell lymphoma-2 (BCL-2) inhibitors. It may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Giving eltanexor together with venetoclax may be safe, tolerable and/or effective in treating patients with relapsed or refractory MDS or AML.
Detailed description
Primary objective: • To establish the safe and biologically effective dose (BED) of eltanexor in combination with venetoclax in patients with R/R MDS and/or AML Secondary objectives: * To estimate the complete remission (CR) rate with eltanexor and venetoclax in patients with R/R MDS and/or AML * To assess the overall response rate (ORR) following treatment with eltanexor/venetoclax * To assess the overall survival of patients * To assess the progression free survival (PFS) and duration of response (DOR) in patients treated with eltanexor/venetoclax Exploratory objectives: * To assess differential response between MDS and AML cohorts * To develop and evaluate a phenotypic flow-based assay to predict response to eltanexor/venetoclax * To assess the effect of mutational changes on response to eltanexor/venetoclax * To measure the rates of measurable residual disease with eltanexor/venetoclax OUTLINE: This is a dose-escalation study of eltanexor in combination with venetoclax. Patients receive eltanexor orally (PO) once per day (QD) for 5 days per week for 14, 21, or 28 days every cycle, and venetoclax PO QD on days 1-14 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo bone marrow aspiration and biopsy and blood sample collection throughout the study. After completion of study treatment, patients are followed up every 3 months for up to 24 months.
Arms & interventions
- DrugEltanexor
Eltanexor will be taken by mouth
- DrugVenetoclax
Venetoclax will be taken by mouth
- ProcedureBone Marrow Aspiration and Biopsy
Undergo bone marrow aspiration and biopsy
- ProcedureBiospecimen Collection
Undergo blood sample collection
Outcome measures
Primary
Incidence of adverse events
Adverse medical events will be tabulated and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.
Time frame: Up to 2 years
Biologically effective dose (BED) of eltanexor in combination with venetoclax
Measured by complete remission
Time frame: Up to 2 years
Secondary
Complete remission
Time frame: Up to 2 years
Overall response rate
Time frame: Up to 2 years
Progression free survival
Time frame: Up to 2 years
Overall survival
Time frame: From date on study to death for any reason, up to 2 years
Duration of response
Time frame: From the date of first objective response until disease progression or death for any reason up to 2 years
Eligibility criteria
Study locations (1)
Vanderbilt University/Ingram Cancer Center
Nashville, Tennessee, 37203
References
- Ball S, Awan FT, Tomlinson BK, Stopczynski T, Fischer MA, Zhao Z, Fedorov K, Kishtagari A, Mohan SR, Ayers GD, Byrne MT, Savona MR. Selinexor and Venetoclax Combination in Patients With Relapsed or Refractory Acute Myeloid Leukemia. Am J Hematol. 2026 May;101(5):1019-1024. doi: 10.1002/ajh.70266. Epub 2026 Mar 8.(PubMed)