- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06212596
Selinexor, Cyclophosphamide and Prednisone in Myeloma (MUKtwelve)
A Randomised Phase II Trial of Selinexor, Cyclophosphamide and Prednisone vs Cyclophosphamide and Prednisone in Relapsed or Refractory Multiple Myeloma (RRMM) Patients
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The trial is designed as a randomised, controlled, open, parallel group, multi-centre phase II trial to evaluate clinical efficacy of selinexor in combination with cyclophosphamide and prednisone. Selinexor is the first-in-class selective inhibitor of nuclear export (SINE). Selinexor forms slowly reversible adducts with the substrate binding pocket of Exportin and has been demonstrated to lead to effective cell kill by causing accumulation pro-apoptotic proteins in the nucleus of myeloma cells. To maximise response to this novel drug in a relapsed-refractory setting, Selinexor will be combined with low-dose cyclophosphamide and prednisone. Lower, continuous doses of cyclophosphamide and intermittent doses of prednisone have been chosen to limit toxicity for the triplet regimen in the elderly myeloma patient population. A calibration group will receive cyclophosphamide plus prednisone alone, and will be used to evaluate the validity of the outcome in the experimental group.
Participants will be randomised on a 3:1 basis to receive either selinexor + cyclophosphamide + prednisone (SCP) or cyclophosphamide + prednisone (CP).
A maximum of 60 participants will be recruited (45 participants in the SCP arm, and 15 participants in the CP arm).
Participants who experience disease progression on the CP arm, may receive SCP, once progression has been confirmed by the CTRU and the participant has been deemed eligible to receive SCP. Patients randomised to SCP have no further trial treatment stipulated following SCP therapy. The analysis of the treatment switch phase of the trial is exploratory.
Participants will be recruited from approximately 10 NHS Hospitals throughout the UK.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
-
Birmingham, United Kingdom
- Birmingham Heartlands Hospital
-
Bournemouth, United Kingdom
- Royal Bournemouth Hospital
-
Leicester, United Kingdom
- Leicester Royal Infirmary
-
Liverpool, United Kingdom
- Royal Liverpool University Hospital
-
London, United Kingdom, W2 1NY
- Imperial College Healthcare NHS Trust
-
London, United Kingdom
- Royal Marsden Hospital
-
London, United Kingdom, EC1M 6BQ
- St Bartholomew Hospital
-
London, United Kingdom, SE1 9RT
- Guys and St Thomas NHS Foundation Trust
-
Middlesbrough, United Kingdom
- James Cook University Hospital
-
Sheffield, United Kingdom
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
-
Southampton, United Kingdom, SO16 6YD
- University Hospital Southampton
-
Stoke-on-Trent, United Kingdom
- Royal Stoke University Hospital
-
Worthing, United Kingdom
- Worthing Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Able to give informed consent and willing to follow all trial protocol assessments
- Aged 18 years or over
- Participants with confirmed myeloma based on International Myeloma Working Group (IMWG) criteria (Rajkumar et al. (2014))
Measurable disease with at least one of the following:
- Paraprotein ≥5g/L
- Serum free light chains ≥100mg/L with abnormal ratio for light chain only myeloma
- Bence Jones protein ≥200mg/L
- Participants with relapsed or relapsed refractory myeloma who have received ≥ 2 prior anti-myeloma treatments including a proteasome inhibitor and lenalidomide, and now require further treatment
- Patients for which cyclophosphamide and prednisone alone would be a suitable treatment
- Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2
Female participants of childbearing potential must agree to use two methods of contraception (including one highly effective and one effective method of contraception) and have a negative urine pregnancy test at screening.
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 trial and for at least 36 months following the last dose of trial treatment
Required laboratory values within 14 days prior to randomisation:
- Platelet count ≥50x109/L. Platelet count of 30-50 is acceptable if bone marrow aspirate or trephine shows tumour replacement of >50%. Platelet support is permitted within 14 days prior to randomisation, although platelet transfusions to help participants meet eligibility criteria are not allowed within 72 hours prior to the blood sample to confirm protocol eligibility
- Absolute neutrophil count ≥1.0 x 109/L. Growth factor support is not permitted within 14 days prior to randomisation
- Haemoglobin ≥ 8090 g/L. Blood support is permitted
- Alanine transaminase (ALT) and / or aspartate transaminase (AST) ≤3 x upper limit of normal
- Creatinine clearance ≥ 2030 ml/min (using Cockcroft Gault formula)
- Bilirubin ≤1.5 x upper limit of normal . Gilberts syndrome patients must have a total bilirubin ≤3 x upper limit of normal
Exclusion Criteria:
The following participants will be excluded:
- those with non-measurable disease
- those with a solitary bone or solitary extramedullary plasmacytoma
- plasma cell leukaemia
- Participants with a history of malignancy (other than myeloma) within 5 years before the date of randomisation (exceptions are squamous and basal cell carcinomas of the skin, carcinoma in situ of the cervix or breast, or other non-invasive lesion that, in the opinion of the investigator, with concurrence with the Chief Investigator, is considered cured with minimal risk of recurrence within 5 years)
Participants with a known or underlying uncontrolled concurrent illness that, in the investigator's opinion, would make the administration of the trial drug hazardous or circumstances that could limit compliance with the trial, including, but not limited to the following:
- acute or chronic graft versus host disease
- uncontrolled hypertension
- symptomatic congestive heart failure
- unstable angina pectoris
- myocardial infarction within past 6 months
- uncontrolled cardiac arrhythmia (National Cancer Institute Common Terminology Criteria for Adverse Events [NCI CTCAE] Version 4 GradeCTCAE grade ≥2)
- active symptomatic fungal, bacterial, and/or viral infection including known active HIV or known viral (A, B or C) hepatitis
- psychiatric or social conditions that may interfere with participant compliance
- uncontrolled (i.e., clinically unstable) infection requiring parenteral antibiotics, antivirals, or antifungals within one week prior to first dose; however, prophylactic use of these agents is acceptable even if parenteral
- or any other condition (including laboratory abnormalities) that in the opinion of the Investigator places the participant at unacceptable risk for adverse outcome if he/she were to participate in the trial
- Participants who have previously received Selinexor or any other SINE compound
Previous anti-tumour therapies including investigational medicinal products at any dose within 28 days before the start of protocol treatment.
- Prednisone up to a dose of 175 mg per week may be given between screening and the beginning of treatment if medically required but should be stopped before trial treatment starts.
- Bisphosphonates for bone disease are also permitted
- Participants with a history of a refractory nausea, diarrhoea, vomiting, malabsorption, gastrointestinal surgery or other procedures or conditions that might, in the opinion of the Investigator, interfere with the absorption or swallowing of the trial drug(s)
- Peripheral neuropathy of CTCAE grade ≥ grade 32 (or ≥ grade 21 with pain) severity (as per NCI-CTCAEv4.0 )
- Female participants who are lactating or have a positive pregnancy test at screening
- Known allergy or previous intolerance to any of the trial medications, their analogues, or excipients in the various formulations of any agent that would prevent the participant receiving these as directed in the protocol
- Major surgery within 14 days prior to randomisation
- Radiotherapy within 7 days prior to randomisation for palliative pain control or therapeutic radiotherapy within 14 days prior to randomisation
- Chemotherapy or immunotherapy or any other anticancer therapy within 2 weeks prior to Cycle 1 Day 1 or radio-immunotherapy 4 weeks prior to Cycle 1 Day 1 (NB: except steroids in the doses outlined above)
- Myeloma involving the Central Nervous System
SCP following CP Inclusion Criteria
- Randomised to CP on the MUKtwelve trial, has tolerated treatment and can continue on CP during the SCP treatment, and received at least one full cycle of treatment
- Centrally confirmed disease progression by IMWG criteria. This must be confirmed by two consecutive assessments based on local lab results. Local laboratory reports must be sent to CTRU to confirm progression and site must have received confirmation of progression from CTRU.
- ECOG performance status ≤2
Required laboratory values within 14 days prior to starting treatment on SCP:
- Platelet count ≥50x109/L. Platelet count of 30-50 is acceptable if bone marrow aspirate or trephine shows tumour replacement of >50%. Platelet support is permitted within 14 days prior to starting SCP, although platelet transfusions to help participants meet eligibility criteria are not allowed within 72 hours prior to the blood sample to confirm protocol eligibility
- Absolute neutrophil count ≥1.0 x 109/L.
- Haemoglobin ≥ 80 g/L. Blood support is permitted
- Alanine transaminase (ALT) and / or aspartate transaminase (AST) ≤3 x upper limit of normal
- Creatinine clearance ≥ 20 ml/min (using Cockcroft Gault formula)
- Bilirubin ≤1.5 x upper limit of normal. Suspected Gilberts syndrome patients must have a total bilirubin ≤3 x upper limit of normal
- B2M
- Female participants of childbearing potential must agree to use two methods of contraception (including one highly effective and one effective method of contraception) and have a negative urine pregnancy test at screening.
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 trial and for 12 months following the last dose of trial treatment
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Selinexor cylophosphamide prednisone
Participants will receive treatment with Selinexor, Cyclophosphamide and Prednisone.
|
Selinexor is a Selective Inhibitor of Nuclear Export (SINE) compound that binds and inactivates Exportin 1 (XPO1), thereby forcing the nuclear retention of key tumour suppressor proteins (TSPs).
Selinexor is an oral, first-in-class, potent, slowly reversible, covalent-binding Selective Inhibitor of Nuclear Export (SINE) compound that specifically blocks the karyopherin protein Exportin 1 (XPO1), also called chromosome region maintenance 1.
Cyclophosphamide is a long used conventional chemotherapy with potent anti-myeloma activity and low toxicity when administered at low doses as in the current protocol (Hajek et al. (2016)).
It is being extensively used in combination with novel agents, including bortezomib, lenalidomide, and pomalidomide, and provides a cost-effective and well-tolerated alternative as a combination partner (Morgan et al. (2007); Mai et al. (2015); Baz et al. (2016)).
Steroids have been a very effective backbone for every myeloma combination therapy developed so far.
Prednisone is the standard steroid in a number of widely used regimens (Mateos et al. (2010);Palumbo et al. (2006)).
Decreasing the morbidity associated with high dose steroid use by using better-tolerated regimens addresses a large unmet need of the myeloma patient population.
|
Active Comparator: Cyclophosphamide predinisone
Participants will receive treatment with Cyclophosphamide and Prednisone.
Participants who experience disease progression on the CP arm, may receive SCP.
|
Cyclophosphamide is a long used conventional chemotherapy with potent anti-myeloma activity and low toxicity when administered at low doses as in the current protocol (Hajek et al. (2016)).
It is being extensively used in combination with novel agents, including bortezomib, lenalidomide, and pomalidomide, and provides a cost-effective and well-tolerated alternative as a combination partner (Morgan et al. (2007); Mai et al. (2015); Baz et al. (2016)).
Steroids have been a very effective backbone for every myeloma combination therapy developed so far.
Prednisone is the standard steroid in a number of widely used regimens (Mateos et al. (2010);Palumbo et al. (2006)).
Decreasing the morbidity associated with high dose steroid use by using better-tolerated regimens addresses a large unmet need of the myeloma patient population.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Progression free survival at 6 months
Time Frame: 6 months
|
To determine whether the addition of selinexor to cyclophosphamide and prednisone may lead to an increased progression free survival
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of SAEs, SARs, SUSARs
Time Frame: 3 1/2 years
|
Safety will be reported based on the number of safety events seen
|
3 1/2 years
|
Progression free survival
Time Frame: 6 and 12 months
|
Progression-free survival is defined as the time from randomisation to first documented evidence of disease progression or death.
Participants who have not progressed at the time of analysis will be censored at the last date they were known to be alive and progression-free.
|
6 and 12 months
|
Maximum response
Time Frame: 6 and 12 months
|
Response to treatment is assessed as per the Modified IWG Uniform Response Criteria given in Appendix 1. Maximum response is defined as the proportion of participants achieving each of the response categories sCR, CR, VGPR, PR, MR or SD as their maximum response to treatment.
Participants who do not have at least one post-baseline response assessment will be excluded from the analysis of this endpoint.
|
6 and 12 months
|
Time to maximum response
Time Frame: 6 and 12 months
|
Time to maximum response is defined as the time from randomisation until the participant achieves any of the categories sCR, CR, VGPR, PR, MR or SD as their maximum response.
Participants who do not achieve a maximum response will either be classed as having had a competing risk or censored at the time of disease progression or death, whichever is earlier
|
6 and 12 months
|
Duration of response
Time Frame: 6 and 12 months
|
Response duration is defined as the time from the first observation of at least PR until disease progression.
Participants who die due to causes other than progression will be censored at the time of death.
Participants who, at the time of analysis, have not progressed, will be censored at the date last known to be alive and progression-free.
Participants not achieving at least a PR are not included in this analysis.
|
6 and 12 months
|
Compliance to therapy
Time Frame: 6 months
|
Compliance to therapy will be summarised by mean dose, number of doses missed and number of dose reductions and delays throughout the treatment period.
The reasons for missed and dose modifications will also be summarised.
|
6 months
|
Number of participants with treatment-related adverse events as assessed by CTCAE 4.0 (time frame: 3 ½ years)
Time Frame: 3 1/2 years
|
Toxicity analyses will summarise by trial arm and show the proportion of participants experiencing each grade of toxicity overall, and during each treatment cycle.
For more detailed summaries, this information will also be broken down into the different types of toxicity.
|
3 1/2 years
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Martin Kaiser, Institute of Cancer Research, United Kingdom
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Immune System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lymphoproliferative Disorders
- Immunoproliferative Disorders
- Hematologic Diseases
- Hemorrhagic Disorders
- Hemostatic Disorders
- Paraproteinemias
- Blood Protein Disorders
- Multiple Myeloma
- Neoplasms, Plasma Cell
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Antineoplastic Agents, Hormonal
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Cyclophosphamide
- Prednisone
Other Study ID Numbers
- HM17/95228
- 2017-001736-19 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Relapsed or Refractory Multiple Myeloma
-
BeBetter Med IncCompletedRelapsed or Refractory Multiple Myeloma | Relapsed or Refractory Non-Hodgkin's LymphomaChina
-
AmgenActive, not recruitingRelapsed or Refractory Multiple Myeloma | Relapsed or Refractory Acute Myeloid LeukemiaUnited States, Australia, Japan, Germany, Canada
-
Institut de Recherches Internationales ServierADIR, a Servier Group companyCompletedRelapsed or Refractory Multiple Myeloma | Relapsed or Refractory Acute Myeloid Leukemia | Relapsed or Refractory Non-Hodgkin Lymphoma | Relapsed or Refractory Chronic Lymphocytic LeukemiaUnited Kingdom, Spain, France, Australia
-
Oncopeptides ABTerminatedRelapsed Multiple Myeloma | Relapsed-Refractory Multiple MyelomaSerbia, Greece, Russian Federation, Czechia, Bulgaria, Georgia, Norway, Poland, Spain, Ukraine, Germany
-
Novartis PharmaceuticalsCompletedRefractory Multiple Myeloma | Multiple Myeloma in Relapse | Relapsed and Bortezomib Refractory Multiple MyelomaUnited States
-
University of NebraskaM.D. Anderson Cancer CenterTerminatedCabozantinib as a Targeted Strategy to Reverse Carfilzomib Resistance in Refractory Multiple MyelomaMultiple Myeloma | Refractory Multiple Myeloma | Relapsed/Refractory Multiple MyelomaUnited States
-
Oncopeptides ABTerminatedRelapsed and/or Relapsed-refractory Multiple MyelomaUnited States, Netherlands, Denmark, Sweden, Italy
-
Memorial Sloan Kettering Cancer CenterExelixisCompletedRelapsed or Refractory Multiple MyelomaUnited States
-
Janssen Research & Development, LLCRecruitingRelapsed or Refractory Multiple MyelomaKorea, Republic of, Sweden, Belgium, Australia, Netherlands, Canada, Poland
-
National Cancer Institute (NCI)RecruitingMultiple Myeloma | Relapsed and/or Refractory Multiple Myeloma (RRMM) | Newly Diagnosed Multiple Myeloma (NDMM)United States
Clinical Trials on Selinexor
-
Karyopharm Therapeutics IncBelgium and Luxembourg Gynaecological Oncology Group; North-Eastern German... and other collaboratorsActive, not recruitingEndometrial CancerUnited States, China, Israel, Spain, Belgium, Germany, Greece, Czechia, Italy, Canada
-
Karyopharm Therapeutics IncGOG Foundation; European Network of Gynaecological Oncological Trial Groups... and other collaboratorsRecruitingEndometrial CancerUnited States, Belgium, Spain, Israel, Australia, Italy, Georgia, Ireland, Greece, Slovakia, Canada, Hungary, Czechia
-
University of UtahKaryopharm Therapeutics IncActive, not recruitingPrimary Myelofibrosis | Post-polycythemia Vera Myelofibrosis | Post-essential Thrombocythemia MyelofibrosisUnited States
-
Memorial Sloan Kettering Cancer CenterRecruitingSolid Tumor | Rhabdoid Tumor | Wilms Tumor | Nephroblastoma | Malignant Peripheral Nerve Sheath Tumors | MPNST | XPO1 Gene MutationUnited States
-
The First Hospital of Jilin UniversityRecruitingPTCL Patients Who Achieved Complete Response From Frontline TreatmentChina
-
University of RochesterKaryopharm Therapeutics IncRecruitingSmoldering Multiple MyelomaUnited States
-
Chunrui LiNanjing IASO Biotherapeutics Co.,LtdRecruitingExtramedullary Multiple MyelomaChina
-
Karyopharm Therapeutics IncRecruitingDiffuse Large B-cell LymphomaUnited Kingdom, United States, Australia, Austria, Belgium, Bulgaria, Canada, France, Germany, Greece, Hungary, India, Israel, Italy, Netherlands, New Zealand, Poland, Serbia, Spain
-
Gabrail Cancer Center ResearchKaryopharm Therapeutics IncCompletedCarcinoma, NeuroendocrineUnited States
-
Ruijin HospitalRecruitingLymphoma | DLBCL | T Cell LymphomaChina