SPd vs EloPd Chemotherapy for Multiple Myeloma

Not currently recruiting at 108 trial locations

Overseen By European Myeloma Network (EMN)

Age: 18+

Sex: Any

Trial Phase: Phase 3

Sponsor: European Myeloma Network B.V.

Must be taking: Anticoagulants

Must not be taking: Pomalidomide, Elotuzumab

Disqualifiers: Smoldering MM, Plasma cell leukemia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Pivotal Trial (Near Approval) This treatment is in the last trial phase before FDA approval

Prior Safety Data This treatment has passed at least one previous human trial

Breakthrough Therapy This drug has been fast-tracked for approval by the FDA given its high promise

Compensation: Varies

Number of Visits: 4

Duration: up to 2 years

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two different chemotherapy combinations to determine which is more effective for treating multiple myeloma, a type of blood cancer. The trial will evaluate the treatments' safety, effectiveness, and impact on participants' quality of life. Individuals who have previously received multiple myeloma treatments, but not the specific drugs in this trial, and are currently experiencing a relapse, may be suitable candidates. As a Phase 3 trial, this study is the final step before FDA approval, offering participants an opportunity to contribute to potentially groundbreaking treatment advancements.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify if you must stop taking your current medications. However, you cannot have had radiation, chemotherapy, or immunotherapy within 2 weeks prior to starting the trial. It's best to discuss your specific medications with the trial team.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that the combination of selinexor, pomalidomide, and dexamethasone (SPd) is generally manageable for patients with relapsed or refractory multiple myeloma. While side effects might occur, they are usually controllable. Common issues include nausea or tiredness, typical in cancer treatments.

For the elotuzumab, pomalidomide, and dexamethasone (EloPd) treatment, safety data from previous studies, such as ELOQUENT-3, indicate it is well-tolerated. Elotuzumab, the main drug in this combination, is already approved for multiple myeloma, so its safety is well-known. Patients might experience side effects like low blood cell counts or infections, but these are also common in similar treatments.

Both treatment options have been tested in many patients and have shown a balance between benefits and manageable side effects, making them promising options for those considering joining a clinical trial. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about these treatments for multiple myeloma because they offer promising new approaches compared to standard therapies like lenalidomide, bortezomib, and carfilzomib. Selinexor, used in the SPd regimen, is unique because it works by selectively inhibiting nuclear export, which can lead to cancer cell death. On the other hand, Elotuzumab, part of the EloPd regimen, targets the SLAMF7 protein on myeloma and immune cells, enhancing the body's immune response against the cancer. These innovative mechanisms of action provide hope for better outcomes in multiple myeloma patients who may not respond well to existing treatments.

What evidence suggests that this trial's treatments could be effective for multiple myeloma?

Research has shown that the combination of selinexor, pomalidomide, and dexamethasone (SPd), which participants in this trial may receive, holds promise for treating relapsed or refractory multiple myeloma (RRMM). This combination can lead to longer-lasting and deeper responses, providing better disease control than some other treatments. Meanwhile, another treatment option in this trial, the combination of elotuzumab, pomalidomide, and dexamethasone (EloPd), has proven effective and well-tolerated, even in everyday medical settings. Studies have demonstrated its benefits for patients who have already tried other treatments. Both treatment options in this trial have shown effectiveness for multiple myeloma, offering hope for better patient outcomes. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

This trial is for adults with previously treated multiple myeloma who've had 1-4 prior treatments but haven't used selinexor, pomalidomide, or elotuzumab. They should have adequate organ function and no major health issues that could affect the study. People with certain infections or recent transplants can't join.

Inclusion Criteria

I can take aspirin or am fully anticoagulated if I have a history of blood clots.

I might be using alternative blood thinners as decided by my doctor.

I have had 1 to 4 treatments for my multiple myeloma.

Exclusion Criteria

I have been treated with a drug like selinexor before.

In the opinion of the Investigator, patients who are below their ideal body weight and would be unduly impacted by changes in their weight

Known intolerance, hypersensitivity, or contraindication to any of the study treatments

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either SPd or EloPd treatment in 28-day cycles

up to 2 years

Day 1 of each 28-day cycle

Follow-up

Participants are monitored for safety and effectiveness after treatment

up to 3 years

Every 3 months

Long-term follow-up

Progression-free survival and overall survival are assessed

up to 5 years

What Are the Treatments Tested in This Trial?

Interventions

• Dexamethasone Oral
• Elotuzumab
• Pomalidomide
• Selinexor

Trial Overview

The trial compares two drug combinations: Selinexor, Pomalidomide, and Dexamethasone (SPd) versus Elotuzumab, Pomalidomide, and Dexamethasone (EloPd). It aims to see which combo is safer and more effective for treating multiple myeloma while also looking at how they impact quality of life.

How Is the Trial Designed?

Group I: Selinexor, pomalidomide and dexamethasone (SPd) Experimental Treatment 3 Interventions

Selinexor will be given as an oral dose: 40 mg (2 20 mg tablets) once weekly (QW) on Days 1, 8, 15, and 22 of each 28-day cycle. * Pomalidomide will be given as an oral 4 mg dose QD on Days 1 to 21 of each 28-day cycle. * Patients ≤75 years: o Dexamethasone will be given as an oral 40 mg dose QW on Days 1, 8, 15, and 22 of each 28-day cycle. Dose may be divided over 2 days at the Investigator's discretion. * Patients \> 75 years: * Dexamethasone will be given as an oral 20 mg dose QW on Days 1, 8, 15, and 22 of each 28-day cycle. Dose may be divided over 2 days at the Investigator's discretion.

Group II: Elotuzumab, Pomalidomide and Dexamethasone (EloPd) Active Control 3 Interventions

Elotuzumab will be given IV 10 mg/kg on Days 1, 8, 15, and 22 of cycle 1 and 2 then 20 mg/kg on Day 1 of cycles ≥3 of each 28-day cycle. * Pomalidomide will be given as an oral 4 mg dose once a day (QD) on Days 1 to 21 of each 28-day cycle. * Patients ≤75 years: * Dexamethasone 28 mg PO + 8 mg IV on days of elotuzumab dosing * Dexamethasone 40 mg PO on non-elotuzumab days (e.g., days 8, 15, and 22 of cycle 3 and beyond). Dose may be divided over 2 days at the Investigator's discretion. * Patients \>75 years: * Dexamethasone 8 mg PO + 8 mg IV on days of elotuzumab dosing * Dexamethasone 20 mg PO on non-elotuzumab dosing weeks (e.g., days 8, 15, and 22 of cycle 3 and beyond). Dose may be divided over 2 days at the Investigator's discretion.

Elotuzumab is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Empliciti for:

• Multiple myeloma

Approved in European Union as Empliciti for:

• Multiple myeloma

Approved in Canada as Empliciti for:

• Multiple myeloma

Who Is Running the Clinical Trial?

European Myeloma Network B.V.

Lead Sponsor

Trials

17

Recruited

7,300+

Stichting European Myeloma Network

Lead Sponsor

Trials

28

Recruited

18,600+

European Myeloma Network

Lead Sponsor

Trials

27

Recruited

12,600+

Karyopharm Therapeutics Inc

Industry Sponsor

Trials

89

Recruited

7,200+

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

Published Research Related to This Trial

Selinexor, a first-in-class selective inhibitor of nuclear export (XPO1), has shown significant efficacy in treating relapsed refractory multiple myeloma (RRMM), leading to its FDA approval in combination with dexamethasone based on results from the pivotal phase II STORM trial.

The phase III BOSTON trial demonstrated that selinexor combined with bortezomib and dexamethasone is superior to the standard treatment of bortezomib and dexamethasone alone, although it is associated with a predictable toxicity profile that requires careful management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Targeting Nuclear Export Proteins in Multiple Myeloma Therapy. Richard, S., Jagannath, S.[2022]

In a phase 2 study involving 82 patients with newly diagnosed multiple myeloma (NDMM), the combination of elotuzumab, lenalidomide, and dexamethasone (ELd) showed a high overall response rate (ORR) of 88%, suggesting it is an effective treatment option for patients ineligible for stem cell transplantation.

The safety profile of ELd was favorable, with no infusion reactions reported at the accelerated infusion rate of 5 mL/min, indicating that this treatment can be well-tolerated in patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Elotuzumab plus lenalidomide and dexamethasone for newly diagnosed multiple myeloma: a randomized, open-label, phase 2 study in Japan. Kubo, K., Hori, M., Ohta, K., et al.[2020]

Nuclear export inhibitors (SINEs), particularly selinexor, have emerged as a promising treatment for relapsed/refractory multiple myeloma, showing cytotoxic effects on myeloma cells and potential to resensitize them to therapy.

Selinexor was approved in July 2019 based on the STORM trial, and ongoing studies are exploring its combination with standard treatments, while a second-generation SINE, eltanexor, is also being investigated for its efficacy and improved safety profile.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Targeting Nuclear Export Proteins in Multiple Myeloma Therapy. Theodoropoulos, N., Lancman, G., Chari, A.[2022]

Selinexor, an oral treatment that inhibits nuclear export of tumor suppressor proteins, showed efficacy in a case series of 3 heavily treated multiple myeloma patients, achieving partial or very good partial responses despite their advanced disease status.

The combination of selinexor with bortezomib and dexamethasone (XVd) resulted in positive outcomes similar to those seen in less heavily pretreated patients, indicating its potential as a valuable option for relapsed or refractory multiple myeloma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Selinexor in Patients from Argentina with Multiple Myeloma Treated with Multiple Prior Therapies: A Case Series. Remaggi, G., Ochoa, PA., Garate, GM.[2022]

Selinexor, an exportin-1 inhibitor, has received regulatory approval for treating multiple myeloma and non-Hodgkin lymphomas based on pivotal trials, including the SADAL and BOSTON trials, demonstrating its potential as a monotherapy or in combination regimens.

While selinexor shows promise in overcoming treatment resistance and may have synergistic effects with other therapies, it has consistent tolerability issues, necessitating improved management strategies to enhance its efficacy compared to newer cellular and immunotherapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Selinexor therapy for multiple myeloma and non-Hodgkin lymphomas. Goldsmith, SR., Liu, L., Shiah, K.[2023]

Selinexor, a selective inhibitor of nuclear export (SINE) compound, has shown promising efficacy in treating multiple myeloma (MM), particularly in patients with 'penta-refractory' MM, which is resistant to the five most effective current treatments.

Early phase clinical trials have established a safety profile for selinexor, especially when used in combination with low-dose dexamethasone, indicating it could be a valuable addition to existing treatment strategies for MM.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Implications of Targeting XPO1-mediated Nuclear Export in Multiple Myeloma. Gandhi, UH., Senapedis, W., Baloglu, E., et al.[2023]

In the phase III ELOQUENT-2 trial involving adults with relapsed multiple myeloma, elotuzumab combined with lenalidomide and dexamethasone significantly improved progression-free survival and overall response rates compared to the standard treatment alone.

The addition of elotuzumab did not negatively affect health-related quality of life and had a manageable safety profile, with the most common serious side effects being blood-related issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Elotuzumab: A Review in Relapsed and/or Refractory Multiple Myeloma. Lamb, YN.[2019]

Elotuzumab combined with pomalidomide and dexamethasone (E-Pd) was shown to effectively prolong progression-free survival (PFS) in patients with relapsed and refractory multiple myeloma (RRMM), based on data from 440 patients in the ELOQUENT-3 study.

The pharmacokinetics of elotuzumab were well-characterized, revealing that its exposure did not lead to an increase in severe adverse events (grade 3+ AEs), indicating a favorable safety profile when used with the Pd regimen.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Population pharmacokinetic and exposure-response analyses of elotuzumab plus pomalidomide and dexamethasone for relapsed and refractory multiple myeloma. Ide, T., Osawa, M., Sanghavi, K., et al.[2022]

In the phase II ELOQUENT-3 trial, the combination of elotuzumab with pomalidomide and dexamethasone (EPd) significantly improved overall survival (OS) in patients with relapsed/refractory multiple myeloma, with a median OS of 29.8 months compared to 17.4 months for the pomalidomide/dexamethasone (Pd) group.

The safety profile of EPd was consistent with previous studies, showing no new safety concerns, indicating that this treatment is both effective and safe for patients who have already undergone multiple lines of therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Elotuzumab Plus Pomalidomide and Dexamethasone for Relapsed/Refractory Multiple Myeloma: Final Overall Survival Analysis From the Randomized Phase II ELOQUENT-3 Trial. Dimopoulos, MA., Dytfeld, D., Grosicki, S., et al.[2023]

The combination treatment of elotuzumab, pomalidomide, and dexamethasone (EloPd) demonstrated a 55.4% overall response rate in a real-world study of 200 patients with relapsed/refractory multiple myeloma, aligning with results from the ELOQUENT-3 trial.

The safety profile of EloPd in this cohort was manageable and similar to that observed in clinical trials, indicating it is a viable treatment option for patients who have undergone at least two prior therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Elotuzumab plus pomalidomide and dexamethasone in relapsed/refractory multiple myeloma: a multicenter, retrospective real-world experience with 200 cases outside of controlled clinical trials. Gentile, M., Vigna, E., Palmieri, S., et al.[2023]

In a study involving 122 patients with triple-class refractory myeloma, the combination of selinexor and dexamethasone resulted in a partial response or better in 26% of patients, demonstrating its potential efficacy as a treatment option for those who have not responded to existing therapies.

While selinexor was associated with common side effects like fatigue and nausea, it also led to significant thrombocytopenia in 73% of patients, highlighting the need for careful monitoring of blood cell counts during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Oral Selinexor-Dexamethasone for Triple-Class Refractory Multiple Myeloma. Chari, A., Vogl, DT., Gavriatopoulou, M., et al.[2023]

Selinexor, a first-in-class oral medication that inhibits the nuclear export protein XPO-1, has been granted accelerated FDA approval for treating patients with penta-refractory multiple myeloma, showing promise in a challenging patient population.

Clinical data indicates that selinexor, particularly in combination with dexamethasone, represents a significant advancement in treatment options for heavily pretreated multiple myeloma patients, with ongoing studies exploring its use in earlier treatment lines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Selinexor for the treatment of multiple myeloma. Podar, K., Shah, J., Chari, A., et al.[2023]

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