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KPT-330 Plus RICE for Relapsed/Refractory Aggressive B-Cell Lymphoma (KPT-330+RICE)

Primary Purpose

Diffuse Large B-Cell Lymphoma

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
KPT-330
Rituximab
Etoposide
Carboplatin
Ifosfamide
Dexamethasone
Sponsored by
Weill Medical College of Cornell University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diffuse Large B-Cell Lymphoma focused on measuring DLBCL, Aggressive, Diffuse, Large

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients must have histologically confirmed aggressive B-cell non-Hodgkin lymphomas:

    • DLBCL including ABC, GCB or PMBCL subtypes
    • Double/triple hit lymphomas
    • Indolent lymphomas transformed to aggressive lymphomas
    • Follicular lymphomas grade 3B
  • Patients must have received at least two cycles of anthracycline based chemotherapy administered with curative intent and one of the following:

    • failed to have achieve at least a partial response after 2 or more cycles
    • failed to achieve a complete response after 6 or more cycles
    • progressed after an initial response
  • Patients must be age ≥18 years.
  • Patients must have at least one site of measurable disease, 1.5 cm in diameter or greater.
  • Patients must have ECOG performance status of 0-2.
  • Patients must have laboratory test results within these ranges:

    • Absolute neutrophil count ≥ 1500/mm³
    • Platelet count ≥ 100,000/mm³
    • Serum creatinine clearance ≥40 mL/min
    • Total bilirubin ≤ 1.5x ULN. Higher levels are acceptable if these can be attributed to active hemolysis or ineffective erythropoiesis.
    • AST (SGOT) and ALT (SGPT) ≤ 2x ULN
  • Women of childbearing potential must agree to use dual methods of contraception and have a negative serum pregnancy test prior to selinexor treatment. Male patients must use an effective barrier method of contraception if sexually active with a female of child-bearing potential.

    • Acceptable methods of contraception are condoms with contraceptive foam, oral, implantable or injectable contraceptives, contraceptive patch, intrauterine device, diaphragm with spermicidal gel, or a sexual partner who is surgically sterilized or post-menopausal.
    • For both male and female patients, effective methods of contraception must be used throughout the study and for three months following the last dose.
  • Patients must be able to understand and willing to sign a written informed consent document.
  • Patients must be able to adhere to the study visit schedule and other protocol requirements.
  • Patients must not have any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
  • Patients must not have any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.

Exclusion Criteria:

  • Patients with hyperuricemia or other potential signs of tumor lysis syndrome
  • Patients with more than minimally symptomatic disease (i.e. > grade 1), high tumor burden, or other indication for urgent treatment.
  • Patients who have had prior malignancies (other than B-cell lymphomas) for ≤5 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast.
  • Patients who have had other anti-cancer therapy, including radiation or experimental drug or therapy, within 28 days of enrollment.
  • Patients with known HIV, active hepatitis B, active hepatitis C.
  • Patients with known central nervous system involvement by lymphoma.

Sites / Locations

  • Weill Cornell Medical College

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

All subjects

Arm Description

All subjects will receive KPT-330 (selinexor) on days -5 and -3 starting one week before RICE chemotherapy is started. Once chemotherapy starts, selinexor will be given on days 1, 3, and 5 of each chemotherapy cycle. RICE chemotherapy will consist of Rituximab, ifosfamide, carboplatin, etoposide, and dexamethasone.

Outcomes

Primary Outcome Measures

Maximum Tolerated Dosage (MTD) of Selinexor/KPT-330 when combined with RICE chemo in a relapsed/refractory aggressive b-cell lymphoma setting.
The highest dose level at which no more than 1 or 6 patients presents with a dose-limiting toxicity (DLT) during the first 6 cycles of treatment

Secondary Outcome Measures

Survival of subjects treated with KPT-330 + RICE
Overall survival of patients enrolled on KPT-330 + RICE
Progression-Free Survival of subjects treated with KPT-330 + RICE
Progression-free survival of patients enrolled on KPT-330+RICE
Number of patients who demonstrate a Response to KPT-330+RICE
The efficacy (as assessed by clinical response) of the combination of KPT-330 + RICE in patients with Rel/Ref b-cell lymphoma
Number of patients who undergo stem cell collection after induction therapy with KPT-330 + RICE
The number of patients who can feasibly undergo a stem cell transplant after treatment with KPT-330+RICE

Full Information

First Posted
June 11, 2015
Last Updated
April 10, 2022
Sponsor
Weill Medical College of Cornell University
Collaborators
Karyopharm Therapeutics Inc, The Leukemia and Lymphoma Society, FDA Office of Orphan Products Development
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1. Study Identification

Unique Protocol Identification Number
NCT02471911
Brief Title
KPT-330 Plus RICE for Relapsed/Refractory Aggressive B-Cell Lymphoma
Acronym
KPT-330+RICE
Official Title
A Phase I Investigator-Initiated Study of Selinexor (KPT-330) Plus RICE in Patients With Relapsed or Refractory Aggressive B-cell Lymphomas
Study Type
Interventional

2. Study Status

Record Verification Date
April 2022
Overall Recruitment Status
Completed
Study Start Date
December 11, 2015 (Actual)
Primary Completion Date
October 31, 2019 (Actual)
Study Completion Date
October 14, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Weill Medical College of Cornell University
Collaborators
Karyopharm Therapeutics Inc, The Leukemia and Lymphoma Society, FDA Office of Orphan Products Development

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study evaluates the addition of selinexor (KPT-330) to RICE chemotherapy in the treatment of relapsed and refractory aggressive B-Cell Lymphoma, with the goal of improved response rates (as compared to RICE chemotherapy alone).
Detailed Description
Although aggressive B-cell lymphomas are potentially curable with front-line chemotherapy, at least one-third of patients experience progression or relapse. Second-line regimens such as rituximab, ifosfamide, carboplatin, and etoposide (RICE) are administered with the goal of cytoreduction prior to autologous stem cell transplantation (ASCT) in eligible patients. However, half of patients who receive salvage treatment and ASCT are still not cured. Selinexor is a Selective Inhibitor of Nuclear Export / SINE compound, which is a new class of molecule. SINE compounds have been shown to induce apoptotic cell death in pre-clinical models of AML, CLL, T-ALL, and Ph+ ALL as well as B and T-cell non-Hodgkin lymphomas. Preliminarily, selinexor has demonstrated promising single-agent clinical activity in patients with previously treated NHL including DLBCL, warranting further investigation. Based on promising preclinical and clinical data, selinexor is currently under evaluation in combination with chemotherapy for solid tumors. The investigators hypothesize that the combination of selinexor plus RICE will be well-tolerated and clinically active in participants with previously treated aggressive B-cell lymphomas and propose a phase I trial to evaluate this combination. Moreover, Investigators will evaluate primary patient samples before and after selinexor to investigate the mechanisms of action of selinexor, including the mechanisms by which selinexor sensitizes cells to chemotherapy, and evaluate other novel drug combinations in aggressive B-cell lymphomas.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diffuse Large B-Cell Lymphoma
Keywords
DLBCL, Aggressive, Diffuse, Large

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
22 (Actual)

8. Arms, Groups, and Interventions

Arm Title
All subjects
Arm Type
Experimental
Arm Description
All subjects will receive KPT-330 (selinexor) on days -5 and -3 starting one week before RICE chemotherapy is started. Once chemotherapy starts, selinexor will be given on days 1, 3, and 5 of each chemotherapy cycle. RICE chemotherapy will consist of Rituximab, ifosfamide, carboplatin, etoposide, and dexamethasone.
Intervention Type
Drug
Intervention Name(s)
KPT-330
Other Intervention Name(s)
Selinexor
Intervention Description
KPT-330 administered orally on days -5 and -3 prior to starting chemotherapy. Once chemotherapy starts, KPT-330 will be administered on days 1, 3, and 5 of each cycle. Dose levels will range from 20 mg to 100mg with a standard 3+3 escalation schema.
Intervention Type
Drug
Intervention Name(s)
Rituximab
Other Intervention Name(s)
Rituxan
Intervention Description
IV Rituximab 375 mg/m2 on D1
Intervention Type
Drug
Intervention Name(s)
Etoposide
Intervention Description
IV Etoposide 100 mg/m2 on D1-3
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Intervention Description
IV Carboplatin AUC 5 on D2
Intervention Type
Drug
Intervention Name(s)
Ifosfamide
Intervention Description
IV Ifosfamide 5 g/m2 on D2
Intervention Type
Drug
Intervention Name(s)
Dexamethasone
Intervention Description
20 mg qd on Days -5 and -3. 20 mg qd on Days 1-5
Primary Outcome Measure Information:
Title
Maximum Tolerated Dosage (MTD) of Selinexor/KPT-330 when combined with RICE chemo in a relapsed/refractory aggressive b-cell lymphoma setting.
Description
The highest dose level at which no more than 1 or 6 patients presents with a dose-limiting toxicity (DLT) during the first 6 cycles of treatment
Time Frame
approximately 24 months
Secondary Outcome Measure Information:
Title
Survival of subjects treated with KPT-330 + RICE
Description
Overall survival of patients enrolled on KPT-330 + RICE
Time Frame
approximately 24 months per patient
Title
Progression-Free Survival of subjects treated with KPT-330 + RICE
Description
Progression-free survival of patients enrolled on KPT-330+RICE
Time Frame
approximately 24 months per patient
Title
Number of patients who demonstrate a Response to KPT-330+RICE
Description
The efficacy (as assessed by clinical response) of the combination of KPT-330 + RICE in patients with Rel/Ref b-cell lymphoma
Time Frame
approximately 24 months per patient
Title
Number of patients who undergo stem cell collection after induction therapy with KPT-330 + RICE
Description
The number of patients who can feasibly undergo a stem cell transplant after treatment with KPT-330+RICE
Time Frame
approximately 24 months per patient

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have histologically confirmed aggressive B-cell non-Hodgkin lymphomas: DLBCL including ABC, GCB or PMBCL subtypes Double/triple hit lymphomas Indolent lymphomas transformed to aggressive lymphomas Follicular lymphomas grade 3B Patients must have received at least two cycles of anthracycline based chemotherapy administered with curative intent and one of the following: failed to have achieve at least a partial response after 2 or more cycles failed to achieve a complete response after 6 or more cycles progressed after an initial response Patients must be age ≥18 years. Patients must have at least one site of measurable disease, 1.5 cm in diameter or greater. Patients must have ECOG performance status of 0-2. Patients must have laboratory test results within these ranges: Absolute neutrophil count ≥ 1500/mm³ Platelet count ≥ 100,000/mm³ Serum creatinine clearance ≥40 mL/min Total bilirubin ≤ 1.5x ULN. Higher levels are acceptable if these can be attributed to active hemolysis or ineffective erythropoiesis. AST (SGOT) and ALT (SGPT) ≤ 2x ULN Women of childbearing potential must agree to use dual methods of contraception and have a negative serum pregnancy test prior to selinexor treatment. Male patients must use an effective barrier method of contraception if sexually active with a female of child-bearing potential. Acceptable methods of contraception are condoms with contraceptive foam, oral, implantable or injectable contraceptives, contraceptive patch, intrauterine device, diaphragm with spermicidal gel, or a sexual partner who is surgically sterilized or post-menopausal. For both male and female patients, effective methods of contraception must be used throughout the study and for three months following the last dose. Patients must be able to understand and willing to sign a written informed consent document. Patients must be able to adhere to the study visit schedule and other protocol requirements. Patients must not have any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form. Patients must not have any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study. Exclusion Criteria: Patients with hyperuricemia or other potential signs of tumor lysis syndrome Patients with more than minimally symptomatic disease (i.e. > grade 1), high tumor burden, or other indication for urgent treatment. Patients who have had prior malignancies (other than B-cell lymphomas) for ≤5 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast. Patients who have had other anti-cancer therapy, including radiation or experimental drug or therapy, within 28 days of enrollment. Patients with known HIV, active hepatitis B, active hepatitis C. Patients with known central nervous system involvement by lymphoma.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Peter Martin, MD
Organizational Affiliation
Weill Medical College of Cornell University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Weill Cornell Medical College
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States

12. IPD Sharing Statement

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KPT-330 Plus RICE for Relapsed/Refractory Aggressive B-Cell Lymphoma

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