Bortezomib, Selinexor, and Dexamethasone in Patients With Multiple Myeloma (BOSTON)
Multiple Myeloma
About this trial
This is an interventional treatment trial for Multiple Myeloma focused on measuring Relapsed or Refractory Multiple Myeloma, RRMM, Bortezomib, Dexamethasone
Eligibility Criteria
Inclusion Criteria:
Histologically confirmed MM with measurable disease per IMWG guidelines as defined by at least 1 of the following:
- Serum M-protein ≥ 0.5 g/dL (> 5 g/L) by serum protein electrophoresis (SPEP) or for immunoglobulin (Ig) A myeloma, by quantitative serum IgA levels; or
- Urinary M-protein excretion at least 200 mg/24 hours; or
- Serum free light chain (FLC) ≥ 100 mg/L, provided that the serum FLC ratio is abnormal.
- Had at least 1 prior anti-MM regimen and no more than 3 prior anti-MM regimens. Induction therapy followed by stem cell transplant and consolidation/maintenance therapy will be considered as 1 anti-MM regimen.
- Documented evidence of progressive MM (based on the Investigator's determination according to the modified IMWG response criteria) on or after their most recent regimen.
Prior treatment with bortezomib or other Proteasome Inhibitor (PI) is allowed, provided all of the following criteria are met:
- Best response achieved with prior bortezomib at any time was ≥ PR and with the last PI (PI therapy (alone or in combination) was ≥ PR, AND
- Participant did not discontinue bortezomib due to ≥ Grade 3 related toxicity, AND
- Must have had at least a 6-month PI-treatment-free interval prior to Cycle 1 Day 1 (C1D1) of study treatment.
- Must have an ECOG Status score of 0, 1, or 2.
- Written informed consent in accordance with federal, local, and institutional guidelines.
- Age ≥18 years.
- Resolution of any clinically significant non-hematological toxicities (if any) from previous treatments to ≤ Grade 1 by C1D1.
- Adequate hepatic function within 28 days prior to C1D1.
- Adequate renal function within 28 days prior to C1D1.
- Adequate hematopoietic function within 7 days prior to C1D1.
- Female patients of childbearing potential must have a negative serum pregnancy test at Screening. Female patients of childbearing potential and fertile male patients who are sexually active with a female of childbearing potential must use highly effective methods of contraception throughout the study and for 3 months following the last dose of study treatment.
Exclusion Criteria:
- Prior exposure to a SINE compound (i.e. an XPO-1 inhibitor), including selinexor.
- Prior malignancy that required treatment, or has shown evidence of recurrence (except for non-melanoma skin cancer or adequately treated cervical carcinoma in situ) during the 5 years prior to randomization.
- Any concurrent medical condition or disease (e.g., uncontrolled active hypertension, uncontrolled active diabetes, active systemic infection, etc.) that is likely to interfere with study procedures.
- Uncontrolled active infection requiring parenteral antibiotics, antivirals, or antifungals within 1 week prior to C1D1.
- Active plasma cell leukemia.
- Documented systemic light chain amyloidosis.
- MM involving the central nervous system.
- Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome.
- Spinal cord compression.
- Greater than Grade 2 neuropathy or ≥ Grade 2 neuropathy with pain at baseline, regardless of whether or not the patient is currently receiving medication
- Known intolerance, hypersensitivity, or contraindication to glucocorticoids.
- Radiation, chemotherapy, or immunotherapy or any other anticancer therapy (including investigational therapies) ≤ 2 weeks prior to C1D1. Localized radiation to a single site at least 1 week before C1D1 is permitted. Glucocorticoids within 2 weeks of C1D1 are permitted. Patients on long-term glucocorticoids during Screening do not require a washout period but must be able to tolerate the specified dexamethasone dose in this study.
- Prior autologous stem cell transplantation < 1 month or allogeneic stem cell transplantation < 4 months prior to C1D1.
- Active graft versus host disease (after allogeneic stem cell transplantation) at C1D1.
- Pregnant or breastfeeding females.
- Body Surface Area < 1.4 m² at baseline, calculated by the Dubois or Mosteller method.
- Life expectancy of < 4 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 anti-arrhythmics are excluded; patients with first-degree atrioventricular block or asymptomatic left anterior fascicular block/right bundle branch block will not be excluded), or
- Congestive heart failure of New York Heart Association Class ≥ 3 or known left ventricular ejection fraction < 40%, or
- Myocardial infarction within 3 months prior to C1D1.
- Known active human immunodeficiency virus (HIV) infection or HIV seropositivity
- Known active hepatitis A, B, or C infection; or known to be positive for hepatitis C virus ribonucleic acid (RNA) or hepatitis B virus surface antigen.
- Any active gastrointestinal dysfunction interfering with the patient's ability to swallow tablets, or any active gastrointestinal dysfunction that could interfere with absorption of study treatment.
- Any active, serious psychiatric, medical, or other conditions/situations that, in the opinion of the Investigator, could interfere with treatment, compliance, or the ability to give informed consent.
- Contraindication to any of the required concomitant drugs or supportive treatments.
- Patients unwilling or unable to comply with the protocol, including providing 24-hour urine samples for urine protein electrophoresis at the required time points.
Sites / Locations
- Boca Raton Clinical Research (BRCR) Medical Center
- Emory University
- Kaiser Permanente Hawaii
- McFarland Clinic
- Stormont Vail Health Care (Cotton O'Neil Cancer Center )
- Commonwealth Hematology
- Norton Cancer Institute
- University of Maryland
- Central Care Cancer Center
- The Valley Hospital Luckow Pavilion
- Mount Sinai
- The Cancer Institute at St. Francis Hospital
- Novant-Forsyth Memorial Hospital
- University of Cincinnati Health
- Southwest Cancer Center of Oklahoma
- Kaiser Permanente Northwest OR
- SCOR AnMed Health Cancer Center
- Prairie Lakes Healthcare
- Baylor Sammons Cancer Center
- University of Texas Southwestern
- Calvary Mater Newcastle
- Royal Brisbane and Women's Hospital
- Mater Misericordiae Limited and Mater Medical Research
- Gold Coast University Hospital
- Royal Adelaide Hospital
- Flinders Medical Centre
- St. Vincent's Hospital Melbourne
- The Alfred Hospital
- Medical University Innsbruck, Department of Internal Medicine V (Hematology and Oncology)
- University Hospital Krems, Department of Internal Medicine II
- Medical University of Vienna
- General Hospital Hietzing
- Wilhelminen Hospital, Department of Internal Medicine I, Center for Oncology & Hematology
- Jules Bordet Institute
- UCL Saint-Luc
- University Hospital Ghent
- General Hospital Delta
- St. Augustinus Hospital
- University Multiprofile Hospital for Active Treatment, Sveti Georgi Clinic of Clinical Hematology
- University Multiprofile Hospital for Active Treatment, Sveti Ivan Rilski Clinic of Hematology
- Specialized Hospital for Active Treatment of Hematological Diseases, Clinic of Hematology, Dept. of Clinical Hematology
- Tom Baker Cancer Center/ Alberta Health Services
- Cross Cancer Institute / University of Alberta
- Vancouver General Hospital
- Queen Elizabeth II Health Sciences Center
- North East Cancer Centre Sudbury
- Princess Margaret Cancer Research
- Maisonneuve-Rosemont Hospital
- Royal Victoria Hospital / McGill University
- L'Hôtel-Dieu de Québec
- Saskatchewan Cancer Agency-Allan Blair Cancer Centre
- Saskatoon Cancer Center
- General University Hospital in Prague
- University Hopsital Brno
- University Hospital Hradec Kralove
- University Hospital Olomouc
- University Hospital Ostrava, Dept. of Hematooncology
- University Hospital Kralovske Vinohrady, Clinic of Internal Hematology
- Necker Children's Hospital, Department of Adult Hematology
- Hospital Center Departmental La Roche-Sur-Yon
- Claude Huriez Hospital
- South Lyon Hospital Center
- Brabois Adults Hospital, University Hospital Center of Nancy
- Nantes University Hospital Center
- Saint-Louis Hospital
- Miletrie Hospital, University Hospital Center of Poitiers
- University Hospital Freiburg, Department of Internal Medicine I
- Klinikum Leverkusen gGmbH Medizinisxhe Klinik 3
- Group Practice for Hematology and Oncology
- Alexandra General Hospital, Therapeutic Clinic
- General Hospital of Athens "Evangelismos", Department of Hematology and Lymphoma
- University General Hospital of Patra
- Theageneion Cancer Hospital, Hematology Department
- Semmelweis University, 1st Department of Internal Medicine
- Integrated Szent Istvan and Szent laszlo Hospital, Department of Hematology and Stem Cell Transplantation
- Semmelweis University, 3rd Department of Internal Medicine
- Kaposi Mor Teaching Hospital, 2nd Department of Internal Medicine
- Medical Center of the University of Pecs, Department of Hematology
- Regional Cancer Centre
- Regional Cancer Centre
- Prince Aly Khan Hospital
- Jaslok Hospital and Research Centre
- Bhaktivedanta Hospital
- IMS & SUM Hospital
- Postgraduate Institute of Medical Education & Research (PGIMER)
- Dayanand Medical College & Hospital
- Cancer Institute
- SRM Institute of Medical Sciences
- Saveetha Medical College Hospital
- G. Kuppuswamy Naidu Hospital
- Asviratham Speciality Hospital
- Meenakshi Mission Hospital
- Yashoda Hospital
- King George's Medical University
- Netaji Subhash Chandra Bose Cancer Research Institute
- Nil Ratan Sircar (NRS) Medical College
- TATA Memorial Centre
- Rajiv Gandhi Cancer Hospital
- Barzilai Medical Center
- Rambam Health Care Campus
- Hadassah Medical Center
- Rabin Medical Center
- Hospital Santa Maria of Terni
- Azienda Ospedaliero-Universitaria Ospedali Riuniti
- ASST Papa Giovanni XXIII
- Polyclinic S. Orsola-Malpighi, Department of Hematology, Oncology and Laboratory Medicine, Operative Unit of Hematology - Cavo
- University Hospital Careggi, Department of Hematology
- University Hospital San Martino, IRCCA, Dept. of Integrative Cancer Therapies, Operative Unit of Clinical Hematology
- Hospital Niguerda Ca Granda, Department of Hematology and Oncology, Hematology Unit
- Umberto I Polyclinic of Rome, Department of Cellular Biotechnology and Hematology, Hematology Center
- University Hospital San Giovanni Battista of Turin
- Jan Biziel University Hospital #2 in Bydgoszcz, Department of Hematology
- Independent Public Healthcare Facility Municipal Hospital Group in Chorzow, Department of Hematology
- University Hospital in Krakow, Teaching Unit of the Hematology Department
- Independent Public Teaching Hospital No.1 in Lublin, Department of Hematology-Oncology and Bone Marrow Transplantation
- St. John of Dukla Oncology Center of Lublin, Department of Hematology
- Military Institute of Medicine, Department of Internal Medicine and Hematology
- Nicolaus Copernicus Memorial Provincial Specialist Hospital in Lodz, Department of Hematology
- Hyperclnical MedLife PDR Vulturului Brasov, Hematology Department
- Colentina Clinical Hospital, Department of Hematology
- Bucharest University Emergency Hospital, Department of Hematology
- S.P. Botkin City Clinical Hospital
- N.A. Semashko Central Clinical Hospital #2 under OJSC Russian Railways
- First I.P. Pavlov State Medical University of St. Petersburg
- V.A. Almazov North-West Federal Medical Research Center, Chemotherapy of Oncohematology Diseases and Bone Marrow Transplantation Department #1
- Clinical Center of Serbia, Clinic of Hematology
- Institute of Oncology and Radiology of Serbia, Clinic of Medical Oncology
- Clinical Center Kragujevac, Clinic of Hematology
- Clinical Center Nis, Clinic of Hematology and Clinical Immunology
- Clinical Center of Vojvodina, Clinic of Hematology
- University Hospital of the Canary Islands
- Catalan Institute of Oncology (ICO) Badalona
- University Hospital of Vall d'Hebron
- University Hospital Infanta Leonor, Department of Hematology
- University Clinical Hospital of Salamanca, Department of Hematology
- University Hospital Virgen del Rocio (HUVR)
- Cherkasy Regional Oncology Center, Regional Treatment and Diagnostic Hematology Center, Department of Hematology
- City Clinical Hospital No.4 of Dnipro City Council, City hematology center
- BMT Kiev Center
- Kiev Cancer Institute
- Institute of Blood Pathology and Transfusion Medicine, Department of Hematology with Laboratory Group
- Vinnytsia M.I. Pyrohov Regional Clinical Hospital, Department of Hematology
- O.F. Herbachevskyi Regional Clinical Hospital, Hematology Department with Intensive Therapy Wards
- Belfast Heatlh & Social Care Trust Belfast City Hospital
- NHS Tayside Ninewells Hospital
- Cardiff & Vale University Health Board University Hospital of Wales
- University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital
- The Leeds Teaching Hospitals NHS Trust St. James University Hospital
- University Hospitals of Leicester NHS Trust Royal Leicester Infirmary
- Royal Liverpool & Broadgreen University Hospital NHS Trust Royal Liverpool University Hospital
- London North West Healthcare NHS Trust Northwick Park Hospital
- University College London
- King's College Hospital NHS Foundation Trust
- Imperial College Healthcare NHS Trust Hammersmith Hospital
- The Christie NHS Foundation Trust
- Freeman Hospital
- The Royal Wolverhampton NHS Trust New Cross Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
selinexor+bortezomib+dexamethasone (SVd)
bortezomib+dexamethasone (Vd)
Selinexor will be given on Days 1, 8, 15, 22, and 29 of each 35-day cycle. Bortezomib will be given Days 1, 8, 15, and 22 of each 35-day cycle. Dexamethasone will be given Days 1, 2, 8, 9, 15, 16, 22, 23, 29, and 30 of each 35-day cycle.
Bortezomib will be given Days 1, 4, 8, and 11 of each 21-day cycle for the first 8 cycles. For cycles ≥ 9, bortezomib will be given on Days 1, 8, 15, and 22 of each 35-day cycle. Dexamethasone will be given on Days 1, 2, 4, 5, 8, 9, 11, and 12 of each 21-day cycle for the first 8 cycles. For cycles ≥ 9, dexamethasone will be given on Days 1, 2, 8, 9, 15, 16, 22, 23, 29, and 30 of each 35-day cycle.