Combination Therapies with Selinexor for Multiple Myeloma
(STOMP Trial)
What You Need to Know Before You Apply
What is the purpose of this trial?
This trial aims to evaluate the safety and effectiveness of different combinations of the drug selinexor for people with multiple myeloma, a type of blood cancer. Researchers are testing several combinations of selinexor with other medications to treat both newly diagnosed and previously treated cases. Currently, the trial seeks participants with relapsed or refractory multiple myeloma who have undergone at least two prior treatments, including specific drug types, and who are ineligible for T-cell therapies like CAR-T. As a Phase 1 and Phase 2 trial, it focuses on understanding the treatment's mechanism and measuring its effectiveness in an initial, smaller group of participants.
Will I have to stop taking my current medications?
The trial protocol does not specify if you need to stop taking your current medications. However, if you are taking strong CYP3A4 inhibitors or inducers, you may need to stop them before participating in the PK Run-in period for certain trial arms.
Is there any evidence suggesting that this trial's treatments are likely to be safe?
Research has shown that selinexor, when combined with other drugs, generally maintains a known safety profile. The FDA has approved selinexor, often used with dexamethasone and other medications, for treating multiple myeloma, supporting its safety for patients.
Studies have found the combination of selinexor, dexamethasone, and pomalidomide to be generally tolerable for patients with relapsed or refractory multiple myeloma. Common side effects include nausea and fatigue, which are usually manageable.
The combination of selinexor, dexamethasone, and belantamab mafodotin also maintains a known safety profile. However, belantamab can cause eye-related side effects, so patients receive close monitoring for any vision issues.
For the combination of selinexor, dexamethasone, and mezigdomide, selinexor and dexamethasone have been used safely together in other treatments. Mezigdomide, when combined with dexamethasone, has shown promising safety data, indicating it is well-tolerated, especially in patients who have tried other treatments.
Overall, while side effects can occur, they are often manageable, and previous studies have shown a good safety profile for these treatments. Patients should discuss any concerns with their healthcare providers to understand what to expect and how to handle potential side effects.12345Why are researchers excited about this trial's treatments?
Researchers are excited about these combination therapies for multiple myeloma because they incorporate Selinexor, which works uniquely by blocking the protein XPO1, leading to cancer cell death. This mechanism is different from many standard treatments like proteasome inhibitors or immunomodulatory drugs. Additionally, combinations involving novel agents like Belantamab Mafodotin and Mezigdomide bring fresh approaches by targeting different pathways, potentially enhancing effectiveness and offering new hope for patients with resistant disease. Overall, these treatments aim to provide more options and improve outcomes for difficult-to-treat myeloma cases.
What evidence suggests that this trial's treatments could be effective for multiple myeloma?
Research has shown that combinations using selinexor are promising for treating multiple myeloma, especially in patients unresponsive to other treatments. In this trial, participants may receive different combinations of selinexor. For example, the combination of selinexor with pomalidomide and dexamethasone (SPd) reduced cancer in nearly 40% of patients. Another combination in this trial, selinexor with dexamethasone and daratumumab (SDd), proved very effective, benefiting 74% of patients whose cancer returned. Selinexor with carfilzomib and dexamethasone (SKd) also shows high success rates in patients who have undergone many previous treatments. While specific results for selinexor with dexamethasone and belantamab mafodotin (SBd) aren't detailed, studies suggest it could be beneficial. Lastly, the new combination of selinexor, dexamethasone, and mezigdomide (SMd) is under study for its unique effects, and early signs suggest it might help those with recurring or resistant multiple myeloma.12678
Who Is on the Research Team?
Michael Kauffman, MD, Ph.D
Principal Investigator
Karyopharm Therapeutics Inc
Are You a Good Fit for This Trial?
Adults over 18 with symptomatic multiple myeloma, either newly diagnosed or relapsed/refractory, can join. They must have measurable disease and be in good enough health to swallow pills and handle treatment side effects. Pregnant women, those with severe liver/kidney issues, recent major surgery patients, or individuals with certain infections or heart problems cannot participate.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
PK Run-in
Selinexor pharmacokinetics run-in period to evaluate PK before and after co-administration with a strong CYP3A4 inhibitor
Dose-Escalation
Patients undergo dose-escalation to determine the maximum tolerated dose and recommended phase-2 dose
Expansion
Phase 2 expansion to assess efficacy and safety of combination therapies
Follow-up
Participants are monitored for safety and effectiveness after treatment
What Are the Treatments Tested in This Trial?
Interventions
- Belantamab Mafodotin
- Bortezomib
- Carfilzomib
- Daratumumab
- Dexamethasone
- Elotuzumab
- Ixazomib
- Lenalidomide
- Pomalidomide
- Selinexor
Trial Overview
The trial is testing Selinexor combined with other drugs like dexamethasone and chemotherapy agents in different mixtures across 11 groups for treating multiple myeloma. Some groups are closed to new participants. The study includes initial phases to determine safe dosages followed by expansions to assess effectiveness.
How Is the Trial Designed?
12
Treatment groups
Experimental Treatment
PK Run-in Period: Selinexor and Clarithromycin: * For the first 9 patients enrolled into this dose escalation arm * 14 day run-in period after which patient will proceed to Dose-Escalation Phase C1D1 Selinexor 40 mg will be dosed on Days 1 and 8. Clarithromycin 500 mg will be dosed twice daily on Days 2-8. PK samples will be collected on Days 1 and 8 at 1, 1.5, 2, 3, 4, 5, 6, 8, and 24 hours post dose. Dose-Escalation Phase: * All patients enrolled into this Arm * Each cycle is of 28 days Cohort 9.1: SEL 20/40/60 mg PO once weekly; DEX 28/20 mg PO twice weekly; POM 4 mg PO QD Days 1-21; Elotuzumab (ELO) 10/20 mg/kg IV will be given once weekly on Days 1,8, 15 and 22 of Cycles 1-2. Starting on Cycle 3 and continuing for future cycles, elotuzumab will be dosed at 20 mg/kg on Day 1 of each cycle only. Cohort 9.3: Selinexor, Dexamethasone, Pomalidomide and Elotuzumab will be dosed at RP2D-9.
PK Run-in Period: Selinexor \& Clarithromycin: * For the first 9 patients enrolled into this dose escalation arm * 14 day run-in period after which patient will proceed to Dose-Escalation Phase C1D1 Selinexor 40 mg will be dosed on Days 1 and 8. Clarithromycin 500 mg will be dosed twice daily on Days 2-8. PK samples will be collected on Days 1 and 8 at 1, 1.5, 2, 3, 4, 5, 6, 8, and 24 hours post dose. Dose-Escalation Phase: * All patients enrolled into this Arm * Each cycle is of 28 days Cohort 8.1: SEL 40/60/80/100 mg PO once weekly; DEX 20 mg PO twice weekly; IXA 3/4 mg PO once weekly. Cohort 8.3: Selinexor, Dexamethasone and Ixazomib will be dosed at RP2D-8.
Each cycle is of 28 days Cohort 7.1: SEL 40/60/80 mg PO once weekly; DEX 40 mg PO once weekly; LEN 25 mg PO Days 1-21. Cohort 7.3: Selinexor, Dexamethasone and Lenalidomide will be dosed at RP2D-7.
PK Run-in Period: Selinexor and Clarithromycin: * For the first 9 patients enrolled into this dose escalation arm * 14 day run-in period after which patient will proceed to Dose-Escalation Phase C1D1 Selinexor 40 mg will be dosed on Days 1 and 8. Clarithromycin 500 mg will be dosed twice daily on Days 2-8. PK samples will be collected on Days 1 and 8 at 1, 1.5, 2, 3, 4, 5, 6, 8, and 24 hours post dose. Dose-Escalation Phase: * All patients enrolled into this Arm * Each cycle is of 28 days Cohort 6.1: SEL 40/60/80/100 mg PO once weekly on days 1, 8, 15, and 22; DEX 40 mg IV or PO once weekly; Carfilzomib (CAR) 56 or 70 mg/m\^2 IV infusion once weekly on days 1, 8, and 15. Cohort 6.2: SEL 60/80/100 mg PO once weekly on days 1, 8, and 15; DEX 40 mg IV or PO once weekly; CAR 56 or 70 mg/m\^2 IV infusion once weekly on days 1, 8, and 15. Cohort 6.3: Selinexor, Dexamethasone and Carfilzomib will be dosed at RP2D-6.
Each cycle is of 28 days Cohort 5.1: SEL 80/100 mg PO once weekly; DEX 40 mg once weekly (IV or PO); DARA: 16 mg/kg IV infusion Cycle 1-2: Once weekly, Cycle 3-6: Every other week, Cycle 6 and greater: Once a month. Cohort 5.2: SEL: 60 mg PO twice weekly; DEX: 40 mg weekly (IV or PO); DARA: 16 milligram per kilogram (mg/kg) IV infusion Cycle 1-2: Once. weekly, Cycle 3-6: Every other week, Cycle 6 and greater: Once a month. Cohort 5.3: Selinexor, Dexamethasone and Daratumumab will be dosed at RP2D-5.
PK Run-in Period: Selinexor and Clarithromycin: * For the first 9 patients enrolled into this dose escalation arm * 14 day run-in period after which patients will proceed to Dose-Escalation Phase C1D1 Selinexor 40 mg will be dosed on Days 1 and 8. Clarithromycin 500 mg will be dosed twice daily on Days 2-8. PK samples will be collected on Days 1 and 8 at 1, 1.5, 2, 3, 4, 5, 6, 8, and 24 hours post dose. Dose-escalation Phase: * All patients enrolled into this Arm * Each cycle is of 28 days. Cohort 4.1: SEL 40/60 mg PO once weekly; DEX 40 mg PO once weekly; POM 4 mg PO Days 1-21; BOR 1.3 mg/m\^2 subcutaneous (SC) once weekly. Cohort 4.3: Selinexor, Dexamethasone, Pomalidomide, Velcade (Bortezomib) will be dosed at RP2D-4.
Each cycle is of 28 days Cohort 3.1: SEL 40/60/80/100 mg PO once weekly; DEX 40 mg PO once weekly; Lenalidomide (LEN) 15/25 mg PO Days 1-21. Cohort 3.2: SEL 40/60/80 mg PO twice weekly; DEX 20 mg PO twice weekly; LEN 15/25 mg PO Days 1-21. Cohort 3.3: Selinexor, Dexamethasone and Lenalidomide will be dosed at RP2D-3.
Each cycle is of 35 days Cohort 2.1: SEL 60/80/100 mg PO once weekly; DEX 40 mg PO once weekly; Bortezomib (BOR) 1.3 milligram per meter square (mg/m\^2) subcutaneous (SC) once weekly. Cohort 2.2: SEL 40/60/80 mg PO twice weekly; DEX 20 mg PO twice weekly; BOR 1.3 mg/m\^2 subcutaneous (SC) once weekly. Cohort 2.3: Selinexor, Dexamethasone and Bortezomib will be dosed at RP2D-2.
Each cycle is of 28 days Cohort 1.1: Selinexor (SEL) 60/80/100 mg orally (PO) once weekly (QW); Dexamethasone (DEX) 40 mg PO once weekly; Pomalidomide (POM) 2/3/4 mg PO Days 1-21. Cohort 1.2: SEL 40/60/80 mg PO twice weekly (BIW); DEX 20 mg PO twice weekly; POM 3/4 mg PO Days 1-21. Cohort 1.3: Selinexor, Dexamethasone and Pomalidomide will be dosed at RP2D-1. Cohort 1.4: SEL 40 mg PO QW; DEX 40 mg PO QW; POM 4mg PO once daily (QD) Days 1-21.
The dose of selinexor will be formally escalated from 40 mg QW to 60 mg QW in combination with mezigdomide 0.6 mg daily. Mezigdomide dosing may be de-escalated as per 3+3 criteria to 0.3 mg or escalated to 1.0 mg. The dose level that passes DLT evaluation will be considered the MTD for the cohort.
Each Cycle is of 28 days Cohort 11.1 SEL 40/60 mg PO once weekly on Days 1, 8, and 15; DEX total 40 mg weekly (IV or PO) single or divided doses on Days 1, 8, 15, and 22; POM 4 mg PO QW Days 1-21; DARA 16 mg/kg IV or SC QW on Days 1, 8, 15 and 22 of Cycles 1-2 and on Days 1 and 15 of Cycles 3-6, Day 1 of every Cycle greater than (\>6). Cohort 11.3 Selinexor, Dexamethasone, Pomalidomide, and Daratumumab will be dosed at RP2D-11.
Each cycle is of 21 days Cohort 10.1: SEL 40/60/80 mg PO once weekly on Days 1, 8, and 15; DEX 40 mg PO QW on Days 1, 8, and 15; Belantamab Mafodotin (BEL) 2.5 mg/kg IV infusion every 3 weeks (Q3W) Day 1 of each cycle. Cohort 10.3: Selinexor, Dexamethasone, and Belantamab Mafodotin will be dosed at RP2D-10.
Belantamab Mafodotin is already approved in European Union, United States for the following indications:
- Relapsed or refractory multiple myeloma
- Relapsed or refractory multiple myeloma
Find a Clinic Near You
Who Is Running the Clinical Trial?
Karyopharm Therapeutics Inc
Lead Sponsor
Richard Paulson
Karyopharm Therapeutics Inc
Chief Executive Officer since 2021
MBA from the University of Toronto's Rotman School of Management
Reshma Rangwala
Karyopharm Therapeutics Inc
Chief Medical Officer since 2023
MD, PhD
Bristol-Myers Squibb
Industry Sponsor
Christopher Boerner
Bristol-Myers Squibb
Chief Executive Officer since 2023
PhD in Business Administration from the Haas School of Business, University of California, Berkeley; BA in Economics and History from Washington University in St. Louis
Deepak L. Bhatt
Bristol-Myers Squibb
Chief Medical Officer since 2024
MD from Yale University; MSc in Clinical Epidemiology from the University of Pennsylvania
Published Research Related to This Trial
Citations
DREAMM-2: Indirect Comparisons of Belantamab Mafodotin ...
Single-agent belantamab mafodotin (belamaf; BLENREP) demonstrated deep and durable responses in patients with relapsed/refractory multiple myeloma and ≥ 3 prior ...
Study Details | NCT02343042 | Selinexor and Backbone ...
This study will independently assess the efficacy and safety of 11 combination therapies in 12 arms, in dose-escalation/-evaluation and expansion phases.
Treatment of Myeloma Early Relapse –Non CAR-T Cell
DREAMM-7 demonstrated the superior efficacy of the combination of belantamab mafodotin, bortezomib and dexamethasone (BelaVd) compared to DaraVd ...
Results from the randomized phase III DREAMM-7 study of ...
DREAMM-2: Assessing efficacy via indirect comparison of single-agent belantamab mafodotin versus selinexor plus dexamethasone combination in ...
Selinexor in combination with dexamethasone with or ...
This report describes the characteristics and outcomes of 18 heavily pretreated patients with multiple myeloma (MM) who were subsequently treated with ...
Profile and Management of Toxicity of Selinexor and ...
Selinexor (Sel) and belantamab mafodotin (belamaf) were recently approved by the US FDA for treatment of RRMM. The toxicity profile of these ...
901P Matching-adjusted indirect comparisons (MAIC) of ...
901P Matching-adjusted indirect comparisons (MAIC) of safety between single-agent belantamab mafodotin versus selinexor plus dexamethasone in relapsed/ ...
Belantamab mafodotin in patients with relapsed/refractory ...
In summary, belantamab mafodotin showed significant ORR, including those of patients with prior BCMA exposure. Ocular toxicity was similar to that in previous ...
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