Safety Study of the Selective Inhibitor of Nuclear Export (SINE) KPT-330 in Patients With Advanced Hematological Cancer

Status: Recruiting
Phase: Phase 1
Diagnosis: Leukemia/MDS
NCT ID: NCT01607892 (View complete trial on ClinicalTrials.gov)
DFCI Protocol ID:

 

The purpose of this research study are to find out more information such as: the highest dose of KPT-330 that can be given safely, the side effects it may cause, to examine how the body affects the study drug concentrations in the blood (pharmacokinetics or PK), to examine the effects of this study drug on the body (pharmacodynamics or PDn) and to gain some information on its effectiveness in treating cancer.

 

Conducting Institutions:
Brigham and Women's Hospital, Dana-Farber Cancer Institute

Overall PI:
Richard Stone, MD, Dana-Farber Cancer Institute

Site-responsible Investigators:

Contacts:
Dana-Farber Cancer Institute: Ilene Galinsky, 617-632-3902, igalinsky@partners.org

Eligibility Criteria

Inclusion Criteria 1. Written informed consent in accordance with federal, local, and institutional guidelines 2. Age ≥18 years 3. Patients with malignancies that are refractory to or who are intolerant of established therapy known to provide clinical benefit for their condition. Patients must not be candidates for anti-tumor regimens known to provide clinical benefit 4. Arm 1 Dose Escalation Phase: Histologically confirmed diagnosis, and evidence of disease progression, of Multiple Myeloma (MM), Non-Hodgkin's Lymphoma (NHL), Chronic Lymphocytic Leukemia (CLL), or Waldenstrom's Macroglobulinemia (WM) as described below: Multiple Myeloma (MM): Symptomatic disease previously treated with ≥3 prior regimens (lines of therapy) that included at least one of each of the following: an alkylating agent, an immunomodulatory drug, a proteasome inhibitor, and a steroid. Patients must have measurable disease as defined by at least one of the following: 1. Serum M-protein ≥ 0.5 g/dL by serum electrophoresis (SPEP) or for IgA myeloma, by quantitative IgA; or 2. Urinary M-protein excretion at least 200 mg/24 hours; or 3. Serum Free Light Chain (SFLC) whereby the involved light chain measures ≥ 10 mg/dL and with an abnormal ratio Non-Hodgkin's Lymphoma (NHL): Advanced indolent or aggressive NHL according to the WHO classification, having been treated with ≥2 prior regimens including rituximab (for B cell NHL only), an alkylating agent, and steroids. Patients with cutaneous T cell lymphoma (CTCL) or Peripheral T Cell Leukemia (PTCL) are excluded from this study. Chronic Lymphocytic Leukemia (CLL): advanced, relapsed CLL after having received fludarabine (if medically appropriate), an alkylating agent, and rituximab as part of one or more of their previous regimens. Waldenström's Macroglobulinemia (WM): relapsed WM after at least 2 prior regimens (lines of therapy) that included at least one proteasome inhibitor and at least one steroid. Arm 1: Dose Expansion Phase: - Up to 10 patients with MM or WM: Symptomatic disease previously treated with, and relapsed or refractory to, ≥3 prior regimens (lines of therapy) that included at least one of each of the following: an alkylating agent, an immunomodulatory drug, a proteasome inhibitor, and a steroid. Patients must have measurable disease as defined by at least one of the following: 1. Serum M-protein ≥ 0.5 g/dL by serum electrophoresis (SPEP) or for IgA myeloma, by quantitative IgA; or 2. Urinary M-protein excretion at least 200 mg/24 hours; or 3. Serum Free Light Chain (SFLC) whereby the involved light chain measures ≥ 10 mg/dL and with an abnormal ratio. - Up to 15 patients with relapsed or refractory Diffuse Large B Cell Lymphoma (DLBCL): 1. Biopsy-proven aggressive Diffuse Large B-Cell Lymphoma of any genetic subtype. 2. Relapsed or refractory to previous therapy for lymphoma. 3. Must have received at least one prior combination chemotherapy regimen. There is no limit on the number of prior therapies. 4. Patients must have an autologous stem cell transplant if they were eligible for it. 5. Patients must have measurable disease on cross sectional imaging that is at least 2 cm in the longest diameter. Arm 2 Dose Escalation and Expansion Phases: Histologically confirmed diagnosis of AML according to the WHO classification (any subtype except for Acute Promyelocytic Leukemia (APL)) with disease progression after chemotherapy, or not a chemotherapy candidate as defined as: - Refractory disease as defined: Persistent disease after at least two induction cycles (e.g., 3+7 and 2+5), or at least one high dose arabinoside-C (Ara-C) containing regimen; or - Relapsed AML: unlikely to benefit from chemotherapy (second or subsequent relapse, any relapse patients failing salvage chemotherapy, or patients in first relapse with less than one year disease free interval; or - Non-chemotherapy candidates: Previously untreated older adults (> age 60) with at least one of the following risk factors: age >70 years, antecedent hematological disease, non-favorable chromosome analysis. Dose Expansion Cohort Approximately 25 eligible patients with MM or WM (N=10) and DLBCL (N=15) will be enrolled into the dose expansion cohort in Arm 1 as described above Approximately 24 eligible patients AML as described in the escalation cohort above will be enrolled into the dose expansion cohort in Arm 2. Arm 3 Dose Expansion Phase: Histologically confirmed diagnosis of CTCL or PTCL (any subtype) following treatment with at least two prior therapies. - PTCL: patients must have relapsed or refractory to at least one prior chemotherapy regimen, and have relapsed from, or are intolerant to, both romidepsin and pralatrexate. - CTCL: patients must extensive disease and have relapsed after at least one prior chemotherapy regimen as well as from romidepsin. 5. All patients on this study must have evidence of progressive disease on study entry. Previously untreated patients who are not chemotherapy candidates on Arm 2 may have advanced disease (without clear progression). There is no upper limit on the number of prior treatments provided all inclusion/exclusion criteria are met. 6. Dose Escalation Phase: Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 1 (Appendix 1). Dose Expansion Phase: Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 1 (Appendix 1). 7. Adequate hepatic function within 14 days prior to C1D1: total bilirubin <2 times the upper limit of normal (ULN) (except patients with Gilbert's syndrome who must have a total bilirubin of < 3 times ULN), asparate aminotransferase (AST) <2.5 times ULN and alanine aminotransferase (ALT) <2.5 times ULN. In the case of known (radiological and/or biopsy documented) liver metastasis, AST <5.0 times ULN and ALT <5.0 times ULN is acceptable; 8. Adequate renal function within 14 days prior to C1D1: estimated creatinine clearance of ≥ 30 mL/min, calculated using the formula of Cockcroft and Gault: (140-Age) • Mass (kg)/(72 • creatinine mg/dL); multiply by 0.85 if female. 9. Female patients of child-bearing potential must agree to use dual methods of contraception and have a negative serum pregnancy test at screening, and 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. 10. Arm 1 & 3 only: Patients receiving hematopoietic growth factor support including erythropoietin, darbepoetin, G-CSF, GM-CSF, and platelet stimulators can continue to do so, but must be transfusion independent for at least 3 weeks prior to registration in the dose escalation phase of the study. Elective transfusions are permitted for transfusion independent patients during the 3-week period prior to dosing. There are no restrictions on transfusions for enrollment into and during the dose expansion phase of the study. Screening absolute neutrophil count (ANC) should be independent of growth factor support for at least 1 week prior to registration for all patients. 11. Arm 1 & 3 only: Adequate hematopoietic function (excluding patients with acute leukemia) within 14 days prior to C1D1: total white blood cell (WBC) count ≥1,500/mm3, absolute neutrophil count (ANC) ≥800/mm3, hemoglobin (Hb) ≥8.0gm/dL, and platelet count ≥30,000/mm3. Screening ANC should be independent of growth factor support for >1 week for all patients. Exclusion Criteria 1. Patients who are pregnant or lactating; 2. Radiation, chemotherapy, or immunotherapy or any other anticancer therapy ≤2 weeks prior to cycle 1 day 1 and mitomycin C and radioimmunotherapy 6 weeks prior to cycle 1 day 1. For CLL and NHL palliative steroids for disease related symptoms are allowed up to 3 days prior to starting therapy. For patients in Arm 2, Hydroxyurea may be given prior to, and during the first cycle of treatment with KPT-330; 3. Patients with active graft versus host disease after allogeneic stem cell transplantation. At least 3 months must have elapsed since completion of allogeneic stem cell transplantation except for patients with AML, where at least 2 months must have elapsed; 4. Major surgery within four weeks before Day 1; 5. Unstable cardiovascular function: - symptomatic ischemia, or - uncontrolled clinically significant conduction abnormalities (ie: ventricular tachycardia on antiarrhythmics are excluded and 1st degree AV block or asymptomatic LAFB/RBBB will not be excluded), or - congestive heart failure (CHF) of NYHA Class ≥3, or - myocardial infarction (MI) within 3 months; 6. Uncontrolled active infection requiring parenteral antibiotics, antivirals, or antifungals within one week prior to first dose; 7. Known to be HIV seropositive; 8. Known active hepatitis A, B, or C infection; or known to be positive for HCV RNA or HBsAg (HBV surface antigen); 9. Patients with active CNS malignancy. Asymptomatic small lesions are not considered active. Treated lesions may be considered inactive if they are stable for at least 3 months. Patient with malignant cells in their cerebrospinal fluid (CSF) without CNS symptom may be included. 10. Patients with significantly diseased or obstructed gastrointestinal tract or uncontrolled vomiting or diarrhea. 11. Grade ≥2 peripheral neuropathy at baseline (within 14 days prior to cycle 1 day 1). 12. History of seizures, movement disorders or cerebrovascular accident within the past 5 years prior to cycle 1 day 1. 13. Patients with macular degeneration, uncontrolled glaucoma, or markedly decreased visual acuity. 14. In the opinion of the investigator, patients who are significantly below their ideal body weight. 15. Serious psychiatric or medical conditions that could interfere with treatment. 16. Participation in an investigational anti-cancer study within 3 weeks prior to first dose of study drug; 17. Concurrent therapy with approved or investigational anticancer therapeutic other than steroids or hydroxyurea as specified above.
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