Selinexor and Backbone Treatments of Multiple Myeloma Patients

What this study is about

This study will independently assess the efficacy and safety of 11 combination therapies in 12 arms, in dose-escalation/-evaluation and expansion phases, for the treatment of patients with relapsed/refractory multiple myeloma (RRMM) and newly diagnosed multiple myeloma (NDMM). The combinations to be evaluated are: * Arm 1: Selinexor + dexamethasone + pomalidomide (SPd); enrollment complete * Arm 2: Selinexor + dexamethasone + bortezomib (SVd); enrollment complete * Arm 3: Selinexor + dexamethasone + lenalidomide (SRd) in RRMM; enrollment complete * Arm 4: Selinexor + dexamethasone + pomalidomide + bortezomib (SPVd); enrollment complete * Arm 5: Selinexor + dexamethasone + daratumumab (SDd); enrollment complete * Arm 6: Selinexor + dexamethasone + carfilzomib (SKd); enrollment complete * Arm 7: Selinexor + dexamethasone + lenalidomide (SRd) in NDMM; enrollment complete * Arm 8: Selinexor + dexamethasone + ixazomib (SNd); enrollment complete * Arm 9: Selinexor + dexamethasone + pomalidomide + elotuzumab (SPEd); enrollment complete * Arm 10: Selinexor + dexamethasone + belantamab mafodotin (SBd); enrollment complete * Arm 11: Selinexor + dexamethasone + pomalidomide + daratumumab (SDPd); enrollment complete * Arm 12: Selinexor + dexamethasone + mezigdomide (SMd); actively recruiting Selinexor pharmacokinetics: * PK Run-in (Days 1-14): Starting in protocol version 8.0, patients enrolled to any arm in the Dose Escalation Phase (i.e., Arm 4 \[SPVd\], Arm 6 \[SKd\], Arm 8 \[SNd\], Arm 9 \[SPEd\], Arm 10 \[SBd\], and Arm 11 \[SDPd\]) will also first be enrolled to a pharmacokinetics (PK) Run-in period until 9 patients have been enrolled to this period to evaluate the PK of selinexor before and after co-administration with a strong CYP3A4 inhibitor. This run-in period does not apply to Arm 12 (SMd).

Who can join (things the study team will check)

✅ You may be able to join if…

• Written informed consent signed in accordance with federal, local, and institutional guidelines.
• Age greater than or equal to (≥) 18 years at the time of informed consent.
• Histologically confirmed diagnosis with measurable disease for relapsed/refractory myeloma.
• Symptomatic MM, based on IMWG guidelines.
• Patients must have measurable disease as defined by at least one of the following:
  • Serum M-protein ≥ 0.5 gram per deciliter (g/dL) by serum protein electrophoresis (SPEP) or, for immunoglobulin A (IgA) myeloma, by quantitative IgA
  • Urinary M-protein excretion at least 200 mg/24 hours
  • Serum free light chain (FLC) ≥ 100 milligram per liter (mg/L), provided that FLC ratio is abnormal
  • If SPEP is felt to be unreliable for routine M-protein measurement (example, for IgA MM), then quantitative immunoglobulin (Ig) levels by nephelometry or turbidometry are acceptable
• Any non-hematological toxicities (except for peripheral neuropathy as described in exclusion criterion #22) that patients had from treatments in previous clinical studies must have resolved to less than or equal (≤) Grade 2 by C1D1.
• Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 2.
• Adequate hepatic function within 28 days prior to C1D1:
  • For SPd, SRd, and SPEd: Total bilirubin < 2* upper limit of normal (ULN) (except patients with Gilbert's syndrome [hereditary indirect hyperbilirubinemia] who must have a total bilirubin of ≤ 3* ULN) and both aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 2.5* ULN
  • For SVd, SPVd, SDd, SNd, SBd and SDPd: Total bilirubin of < 1.5* ULN (except patients with Gilbert's syndrome [hereditary indirect hyperbilirubinemia] who must have a total bilirubin of ≤ 3* ULN) and both AST and ALT < 2.0* ULN
  • For SKd and SMd: Total bilirubin < 2x ULN (except patients with Gilbert's syndrome [hereditary indirect hyperbilirubinemia] who must have a total bilirubin of ≤ 3x ULN) and both AST and ALT < 3.0x ULN
• Adequate renal function within 28 days prior to C1D1. For Arms 1-11, estimated creatinine clearance (CrCl) calculated using the formula of Cockroft and Gault (1976).
  • ≥ 20 milliliter per minute (mL/min) for SVd, SDd, and SKd arms
  • ≥ 30 mL/min for SNd, SBd, and SMd arms
  • ≥ 45 mL/min for SPd, SPVd, SPEd and SDPd arms
  • > 60 mL/min for SRd arm
• Adequate hematopoietic function within 28 days prior to C1D1: absolute neutrophil count (ANC) ≥ 1,000/mm\^3, hemoglobin (Hb) ≥ 8.0 g/dL, and platelet count ≥ 100,000/mm\^3.
  • SPVd (Arm 4) and SKd (Arm 6) only: platelet count ≥150,000.
  • SMd (Arm 12) only: platelet count ≥75,000 for subjects in whom <50% of bone marrow nucleated cells are plasma cells; or platelet count <50,000 for subjects in whom ≥50% of bone marrow nucleated cells are plasma cells.
• Female patients of childbearing potential must have a negative serum pregnancy test at Screening. Female patients of childbearing potential and fertile male patients must use highly effective methods of contraception throughout the study and for 90 days following the last dose of study treatment. For Arm 12 (SMd), all study subjects must agree and adhere to all testing and contraception requirements as specified in the mezigdomide Global Pregnancy Prevention Plan (PPP) SPd (Arm 1) Only.
• Relapsed or refractory MM with: SVd (Arm 2) Only:
  • Documented evidence of progressive disease (PD) after achieving at least stable disease (SD) for ≥ 1 cycle during a previous MM regimen (i.e., relapsed MM)
  • ≤ 25 percent (%) response (i.e., patients never achieved ≥ MR) or PD during or within 60 days from the end of the most recent MM regimen (i.e., refractory MM)
  • Previously undergone ≥ 2 cycles of lenalidomide and a PI (in separate therapeutic regimens [not for maintenance] or in combination)
  • In the expansion arm at RP2D, patients must not be pomalidomide refractory
• Relapsed or refractory MM with: SRd in RRMM (Arm 3) Only:
  • Documented evidence of relapse after ≥ 1 previous line of therapy
  • Not refractory to bortezomib in their most recent line of therapy
• Patients who received ≥ 1 prior therapeutic regimen (prior lenalidomide is allowed as long as patient's MM was not refractory to prior lenalidomide; patients whose MM was refractory to lenalidomide maintenance regimens will be allowed in this cohort). SPVd (Arm 4) Only:
• Patients who received 1- 3 prior lines of therapy, including ≥ 2 cycles of lenalidomide and have demonstrated disease progression on their last therapy (may include prior bortezomib, as long as the patient's MM was not refractory to bortezomib therapy), but patients must be pomalidomide-naïve in the Dose Expansion at RP2D (Cohort 4.3 ONLY). SDd (Arm 5) Only:
• Patients who received ≥ 3 prior lines of therapy, including a PI and an immunomodulatory agent (IMiD), or patients with MM refractory to both a PI and an IMiD.
• Patients must not have received prior anti-cluster of differentiation 38 (anti-CD38) monoclonal antibodies (Cohort 5.3 ONLY - Dose Expansion at RP2D). SKd (Arm 6) Only:
• Patients may have received prior PIs; however, their MM must NOT be refractory to carfilzomib. SRd in NDMM (Arm 7) Only:
• Patients must have symptomatic myeloma per IMWG guidelines with either CRAB criteria (calcium elevation, renal failure, anemia, lytic bone lesions) or myeloma-defining events and need systemic therapy. No prior systemic therapy for NDMM is permitted other than pulse dose dexamethasone (maximum dose of 160 mg) or corticosteroid equivalent. SNd (Arm 8) Only:
• Patients must have MM that relapsed after 1 - 3 prior lines of therapy (may not include those with MM refractory to bortezomib or carfilzomib but patients must be ixazomib-naïve). SPEd (Arm 9) Only:

+ 4 more criteria — see the full checklist in the app.

🚫 You may not be able to join if…

• Smoldering MM.
• MM that does not express M-protein or FLC (i.e., non-secretory MM is excluded), and quantitative immunoglobulin levels cannot be used instead.
• Documented active systemic amyloid light chain amyloidosis.
• Active plasma cell leukemia.
• Red Blood Cell (RBC) and platelet transfusions and blood growth factors within 14 days of C1D1 (Arms 1-11 only). Red blood cells and platelet transfusions and blood growth factors within 7 days of C1D1 (Arm 12).
• Platelet transfusion or G-CSF within 7 days or pegfilgastrim within 14 days prior to the complete blood count (CBC) used to determine eligibility.
• Radiation, chemotherapy, or immunotherapy or any other tumor-directed therapy ≤ 2 weeks prior to C1D1, and radio-immunotherapy within 6 weeks prior to C1D1. Patients on long-term glucocorticoids during Screening do not require a washout period. Spot radiation is permitted at any time for treatment of fractures or to prevent fractures as well as for pain management.
• Patients with history of spinal cord compression with residual paraplegia (Dose Escalation Phase only).
• Treatment with an investigational anti-cancer therapy within 3 weeks prior to C1D1.
• Prior autologous stem cell transplantation < 1 month, or allogeneic stem cell transplantation < 3 months prior to C1D1.
• Active graft versus host disease after allogeneic stem cell transplantation.
• Life expectancy < 3 months.
• Major surgery within 4 weeks prior to C1D1.
• Active, unstable cardiovascular function:
  • Symptomatic ischemia, or
  • Uncontrolled clinically-significant conduction abnormalities (e.g., patients with ventricular tachycardia on antiarrhythmics are excluded; patients with 1st degree atrioventricular (AV) block or asymptomatic left anterior fascicular block/right bundle branch block (LAFB/RBBB) will not be excluded), or
  • Congestive heart failure (CHF) of New York Heart Association (NYHA) Class ≥ 3, or
  • Myocardial infarction (MI) within 3 months prior to C1D1
  • Ejection fraction (EF) < 50% at Screening (Arms 1-11 only, screening echocardiogram not required for Arm 12, SMd)
• Uncontrolled active hypertension (Arms 1-11 only).
• Uncontrolled active infection requiring parenteral antibiotics, antivirals, or antifungals within one week prior to first dose.
• Known active hepatitis A, B or C.
• Known human immunodeficiency virus (HIV) infection or HIV seropositivity.
• Any active gastrointestinal dysfunction that prevents the patient from swallowing tablets or interferes with absorption of study treatment.
• Currently pregnant or breastfeeding.

+ 16 more criteria — see the full checklist in the app.

Where this trial is running

• Banner MD Anderson Cancer Center, Gilbert, Arizona, United States
• Jonnsson Comprehensive Cancer Center / University of Los Angeles, Los Angeles, California, United States
• Sarah Cannon-Colorado Blood Cancer Institute, Denver, Colorado, United States
• Massachusetts General Hospital, Boston, Massachusetts, United States
• Dana Farber Cancer Institute, Boston, Massachusetts, United States
• University of Nebraska Medical Center, Omaha, Nebraska, United States
• Hackensack University Medical Center - John Theurer Cancer Center, Hackensack, New Jersey, United States
• Columbia University, New York, New York, United States
• Weill Cornell Medicine, New York, New York, United States
• Wilmot Cancer Center/ University of Rochester, Rochester, New York, United States
• University of North Carolina - Chapel Hill Comprehensive Cancer Center, Chapel Hill, North Carolina, United States
• Duke Institute of Cancer/ Duke University, Durham, North Carolina, United States

+ 13 more sites.

Who to contact

Karyopharm Medical Information · (888) 209-9326 · clinicaltrials@karyopharm.com

It's completely normal to call and ask questions before deciding anything. Mention the study ID: NCT02343042.