A Study of Selinexor in People With Wilms Tumors and Other Solid Tumors

Sponsor

Memorial Sloan Kettering Cancer Center (Other)

Overall Status

Recruiting

CT.gov ID

NCT05985161

Collaborator

(none)

Enrollment

Locations

Arms

Anticipated Duration (Months)

3.3

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose of this study is to find out whether selinexor is an effective treatment for people under the age of 51 who have a relapsed/refractory Wilms tumor, rhabdoid tumor, MPNST, or another solid tumor that makes a higher than normal amount of XPO1 or has genetic changes that increase the activity of XP01.

Condition or Disease	Intervention/Treatment	Phase
Wilms Tumor Rhabdoid Tumor Malignant Peripheral Nerve Sheath Tumors MPNST Nephroblastoma XPO1 Gene Mutation Solid Tumor	Drug: Selinexor	Phase 2

Study Design

Study Type:

Interventional

Anticipated Enrollment :

36 participants

Allocation:

Non-Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Multi-Center Phase II Study of Selinexor in Treating Recurrent or Refractory Wilms Tumor and Other Pediatric Solid Tumors

Actual Study Start Date :

Aug 1, 2023

Anticipated Primary Completion Date :

Aug 1, 2029

Anticipated Study Completion Date :

Aug 1, 2029

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Cohort A.1 Wilms Tumor Participants will have any type of Wilms tumor or nephroblastoma	Drug: Selinexor This phase II study will initially treat all patients, including adult patients, at the pediatric Selinexor RP2D of 35 mg/m2 (no maximum dose) once weekly using a liquid suspension .
Experimental: Cohort B.1 Rhabdoid Tumor Participants will have any Rhabdoid tumor	Drug: Selinexor This phase II study will initially treat all patients, including adult patients, at the pediatric Selinexor RP2D of 35 mg/m2 (no maximum dose) once weekly using a liquid suspension .
Experimental: Cohort C.1 MPNST Participants will have progressive, relapsed, unresectable or metastatic MPNST	Drug: Selinexor This phase II study will initially treat all patients, including adult patients, at the pediatric Selinexor RP2D of 35 mg/m2 (no maximum dose) once weekly using a liquid suspension .
Experimental: Cohort D.1 Other Solid Tumor Participants must not qualify for Cohorts A, B, or C but have a solid tumor (no hematologic malignancies including lymphoma) for which there is specific evidence that this particular patient's tumor may benefit from selinexor.	Drug: Selinexor This phase II study will initially treat all patients, including adult patients, at the pediatric Selinexor RP2D of 35 mg/m2 (no maximum dose) once weekly using a liquid suspension .

Outcome Measures

Primary Outcome Measures

Overall Response Rate [1 year]
To define the antitumor activity of Selinexor in relapsed and refractory Wilms tumor by measuring the Overall Response Rate, defined as Complete Response + Partical Response

Eligibility Criteria

Criteria

Ages Eligible for Study:

12 Months and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Age:

Age ≥ 6 at the time of informed consent
Age ≥ 2 years to < 6 years at time of informed consent (Refer to Section 4.3): If PK cohort 1 is open, patients in this age range may enroll onto this cohort. If PK cohort 1 has been completed and deemed sufficient to proceed, then such patients may enroll onto the phase 2.
Age ≥ 12 months to < 2 years at time of informed consent (Refer to Section 4.3):

If PK cohort 2 is open, patients in this age range may enroll onto this cohort. If PK cohort 2 has been completed and deemed sufficient to proceed, then such patients may enroll onto the phase 2.

Consent: All patients and/or their parents or legally authorized representatives must sign a written informed consent. Assent, when appropriate, will be obtained according to institutional guidelines.
Performance: Karnofsky ≥ 60% for patients > 16 years of age and Lansky ≥ 60 for patients ≤ 16 years of age.
Diagnosis: Patients must enroll into one of the following cohorts:

Cohort A: Any type of Wilms tumor or nephroblastoma is eligible for this study provided they meet at least one of these criteria: (1) in their second or greater relapse, (2) refractory or in their first relapse with high risk histology (i.e., any anaplastic or blastemal-type after neoadjuvant chemotherapy), or (3) refractory or in first relapse without high risk histology but after having received chemotherapies other than the initial 4 agents used as current standard of care in the up-front setting for non-high risk cases - specifically vincristine, dactinomycin, doxorubicin, and irinotecan (i.e., any patient who relapses following an initial regimen more intense than EE4A, DD4A, VAD, AVD, or VIVA; for example, those including cyclophosphamide/etoposide - such as Regimen I, M, or MVI - or those additionally including carboplatin - such as Regimens UH-1, UH-2, or UH-3).
Cohort B: Any Rhabdoid tumor is eligible for this cohort. This includes, but is not limited to, related subtypes of rhabdoid tumors such as atypical teratoid rhabdoid tumors (ATRT), malignant rhabdoid tumors of the kidney (MRTK), malignant rhabdoid tumors of the soft tissue and liver, small cell undifferentiated hepatoblastomas (SCUH), and small-cell carcinoma of the ovary of hypercalcemic type (SCCOHT). Patients must have failed to respond to at least

1 line of systemic therapy prior to enrollment.

Cohort C: Patients with progressive, relapsed, unresectable or metastatic MPNST, are eligible for this cohort. Patients must have failed to respond to at least 1 line of systemic therapy prior to enrollment.
Cohort D: Patients must not qualify for Cohorts A, B, or C but have a solid tumor (no hematologic malignancies including lymphoma) for which there is specific evidence that this particular patient's tumor may benefit from selinexor.

Patients must have failed to respond to at least 1 line of systemic therapy prior to enrollment. Examples of evidence are listed below. All patients in this cohort require approval of study principal investigator and must provide documentation of specific supporting evidence. i. Tumor XPO1 Dependency: Defined as either Darwin OncoTarget demonstrating XPO1 as aberrantly activated or Darwin OncoTreat demonstrating context-specific tumor checkpoint inversion with Selinexor, both of which must be significant at a -log10 (Bonferroni corrected p-value) of 5 or greater. ii. Tumor XPO1 Activation: Defined as the detection of a gain of function mutation in XPO1, specifically E571K. Additionally, detection of elevated transcriptomic or proteomic expression of XPO1 in the tumor via RNAseq or IHC, respectively, would be considered sufficient for treatment.

Preclinical Tumor Testing: Defined as testing of Selinexor on patient derived cell line, organoid, or xenograft models of the patient's tumor (or other related tumors) performed in a laboratory context and for which, in the investigator's opinion, demonstrates promising activity. Testing may include commercial testing as well as academic laboratory testing.

Disease Status: Patients on the phase II portion of the study must have measurable disease whereas patients on the PK cohorts can have either evaluable or measurable disease as measured by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (Version 1.1).

Primary Brain Tumors: Patients with primary brain tumors are eligible and must also have measurable disease for the phase II (as well as evaluable or measurable for the PK cohorts), but this can be defined as at least equal or greater than twice the slice thickness in two perpendicular diameters on MRI OR diffuse leptomeningeal disease OR clear MRI evidence of disease that may not be measurable in two perpendicular diameters OR positive CSF cytology alone.

Prior Therapy: Patients must have fully recovered from the acute toxic effects of all prior anti-cancer therapy and meet minimum washout durations (shown below) from prior therapy.

Anti-cancer agents not known to be myelosuppressive: ≥ 7 days
Anti-cancer and cytotoxic agents known to be myelosuppressive: ≥ 21 days
Immunotherapies (including antibodies, interleukins, interferons, etc.): ≥ 21 days
Adoptive cellular therapies (including modified T cells, vaccines, etc.): ≥ 42 days
Autologous stem cell infusion (boost, no conditioning): ≥ 21 days
Autologous stem cell transplantation (with conditioning): ≥ 42 days
Allogeneic bone marrow transplantation: ≥ 84 days
Focal external beam radiation (e.g., limited sites of disease): ≥ 14 days
Substantial external beam radiation (e.g. whole lung or abdomen): ≥ 42 days
Radiopharmaceutical therapy (e.g., radiolabeled antibody or MIBG): ≥ 42 days

Hepatic Function: Adequate function (within 14 days prior to C1D1), defined as:

Total bilirubin < 1.5 × upper limit of normal (ULN) (except patients with Gilbert's syndrome, who must have a total bilirubin of <3 × ULN)
Alanine aminotransferase (ALT) < 3 × ULN
Serum albumin ≥ 2 g/dL

Renal Function: Adequate function (within 14 days prior to C1D1) defined as a GFR

≥ 50 ml/min/1.73 m2 determined via any of these methods:

Nuclear radioisotope
24 hr urine creatinine clearance
Serum cystatin c
Serum creatinine using the Schwartz formula for estimating creatinine clearance (Schwartz et al. J Peds, 106:522, 1985)

Hematologic Function: Adequate function (within 14 days prior to C1D1), defined as:

Absolute neutrophil count (ANC) ≥ 1000/mm3
Platelet count ≥ 100,000/mm3
Note: patients may not receive platelet transfusions nor hematopoietic growth factor support, including granulocyte-colony stimulating factor (e.g. filgrastim) and platelet stimulators (e.g. romiplostim) for at least 7 days prior to demonstrating adequate hematologic function.

Exclusion Criteria:

Prior Therapy: Has received selinexor or another XPO1 inhibitor previously.
Infection: Patients who have an uncontrolled infection are not eligible. Patients on prophylactic antibiotics or with a controlled infection within 1 week prior to C1D1 are acceptable
Transplants: Patients who have received allogeneic bone marrow transplant are potentially eligible unless they are being actively treated for GvHD. Patients who have had a prior solid organ transplantation are not eligible.
Compliance: Patients who as a result of serious medical, psychiatric, and/or social situation(s), in the opinion of the investigator, may not be able to comply with supportive care, safety monitoring, or any other key requirements of the study protocols are not eligible.
Pregnancy and Breast-feeding: Pregnant or breast-feeding women will not be entered on this study because there is yet no available information regarding human fetal or teratogenic toxicities. Pregnancy tests must be obtained in girls who are post-menarchal.
Contraception: Males or females of reproductive potential may not participate unless they have agreed to use two effective methods of birth control, including a medically accepted barrier or contraceptive method (e.g., male or female condom) for the duration of the study. Abstinence is an acceptable method of birth control.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Children's Hospital of Los Angeles (Data Collection Only)	Los Angeles	California	United States	90027
2	Children's Healthcare of Atlanta (Data Collection and Specimen Analysis)	Atlanta	Georgia	United States	30322
3	Dana Farber Cancer Institute (Data Collection Only)	Boston	Massachusetts	United States	02115
4	Memorial Sloan Kettering at Basking Ridge (Limited Protocol Activities)	Basking Ridge	New Jersey	United States	07920
5	Memorial Sloan Kettering Monmouth (Limited Protocol Activities)	Middletown	New Jersey	United States	07748
6	Memorial Sloan Kettering Bergen (Limited protocol activities)	Montvale	New Jersey	United States	07645
7	Memorial Sloan Kettering Suffolk-Commack (Limited Protocol Activities )	Commack	New York	United States	11725
8	Memorial Sloan Kettering Westchester (Limited Protocol Activities)	Harrison	New York	United States	10604
9	Memorial Sloan Kettering Cancer Center (All protocol activites)	New York	New York	United States	10065
10	Memorial Sloan Kettering Nassau (Limited protocol activities)	Rockville Centre	New York	United States	11553
11	Cincinnati Children's Hospital Medical Center (Data collection only)	Cincinnati	Ohio	United States	45229