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Selinexor combined with radiation for newly diagnosed DIPG and high-grade glioma

A Phase 1/2 Trial of Selinexor (KPT-330) and Radiation Therapy in Newly-Diagnosed Pediatric Diffuse Intrinsic Pontine Glioma (DIPG) and High-Grade Glioma (HGG)

Phase1; Phase2 Interventional National Cancer Institute (NCI) · NCT05099003

This trial tries adding the oral drug selinexor to standard radiation to see if it is safe and can shrink tumors in children and young adults newly diagnosed with DIPG or H3 K27M‑mutant high‑grade glioma.

Quick facts

PhasePhase1; Phase2
Study typeInterventional
Enrollment132 (estimated)
Ages12 Months to 21 Years
SexAll
SponsorNational Cancer Institute (NCI) NIH
Drugs / interventionsradiation
Locations127 sites (Birmingham, Alabama and 126 other locations)
Trial IDNCT05099003 on ClinicalTrials.gov

What this trial studies

This phase I/II trial enrolls children and young adults with newly diagnosed diffuse intrinsic pontine glioma (DIPG) or high‑grade glioma (HGG), including tumors with the H3 K27M mutation. In phase I, selinexor dose is escalated to define the maximum tolerated dose and recommended phase II dose when given alongside standard focal radiation delivered 5 days per week for 5–7 weeks. Selinexor is given orally on a weekly schedule beginning in the second week of radiation, followed by a maintenance period after a two‑week break, with MRI and optional biopsy for response assessment. The phase II portion estimates event‑free and overall survival compared with historical controls and collects tumor and fluid specimens for future studies.

Who should consider this trial

Good fit: Ideal candidates are children and young adults (pre‑enrollment age ≤25) with newly diagnosed DIPG or high‑grade glioma who can start standard radiation, take oral selinexor, and meet protocol screening requirements.

Not a fit: Patients with metastatic disease, prior cranial radiation, non‑eligible molecular profiles for specific arms (including certain non‑H3K27M tumors for adults), or those unable to tolerate oral therapy are unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, adding selinexor to upfront radiation could improve tumor control and survival or delay progression in newly diagnosed DIPG or HGG with H3 K27M mutation.

How similar studies have performed: Selinexor has shown early‑phase activity and manageable safety in other solid tumor and brain tumor trials, but combining it with upfront radiation in newly diagnosed DIPG/HGG is relatively novel and not yet proven.

Eligibility criteria

Show full inclusion / exclusion criteria 
Inclusion Criteria:

* PRE ENROLLMENT: Patients must be =\< 25 years of age at the time of enrollment on APEC14B1 part A central nervous system (CNS)/high grade glioma (HGG) pre-enrollment eligibility screening

  * Please note:

    * This required age range applies to pre-enrollment eligibility for all HGG patients. Individual treatment protocols may have different age criteria.
    * Non-DIPG patients with tumors that do not harbor an H3K27M-mutation and are \>= 18 years of age will not be eligible to enroll on ACNS1821 (Step 1).
* PRE ENROLLMENT: Patient is suspected of having localized, newly diagnosed HGG, excluding metastatic disease, OR patient has an institutional diagnosis of DIPG

  * Please note: there are specific radiographic criteria for DIPG patient enrollment on ACNS1821 (Step 1)
  * As of February 14, 2025, stratum DIPG and stratum DMG have closed to accrual, and no patients will be enrolled on these strata after Amendment #4.
* PRE ENROLLMENT:

  * For patients with non-pontine tumors: Patients and/or their parents or legal guardians must have signed informed consent for eligibility screening on APEC14B1 Part A.
  * For patients with DIPG: Patients and/or their parents or legal guardians must have signed informed consent for ACNS1821.
  * Note: As of February 14, 2025, stratum DIPG and stratum DMG have closed to accrual, and no patients will be enrolled on these strata after Amendment #4.
* PRE ENROLLMENT:

  * For patients with non-pontine tumors only, the specimens obtained at the time of diagnostic biopsy or surgery must be submitted through APEC14B1 ASAP, preferably within 5 calendar days of definitive surgery
* STEP 1: Patients must be \>= 12 months and =\< 21 years of age at the time of enrollment
* STEP 1: Patients must have newly-diagnosed DIPG or HGG (including DMG).
* STEP 1: Stratum DIPG (Closed with Amendment #4)

  * As of February 14, 2025, stratum DIPG and stratum DMG have closed to accrual, and no patients will be enrolled on these strata after Amendment #4.
  * Patients with newly-diagnosed typical DIPG, defined as tumors with a pontine epicenter and diffuse involvement of at least 2/3 of the pons on at least 1 axial T2 weighted image, are eligible. No histologic confirmation is required.
  * Patients with pontine tumors that do not meet radiographic criteria for typical DIPG (e.g., focal tumors or those involving less than 2/3 of the pontine cross-sectional area with or without extrapontine extension) are eligible if the tumors are biopsied and proven to be high-grade gliomas (such as anaplastic astrocytoma, glioblastoma, high-grade glioma not otherwise specified \[NOS\], and/or H3 K27M-mutant) by institutional diagnosis.
* STEP 1: Stratum DMG (with H3 K27M mutation) (Closed with Amendment #4)

  * As of February 14, 2025, stratum DIPG and stratum DMG have closed to accrual, and no patients will be enrolled on these strata after Amendment #4.
  * Patients must have newly-diagnosed non-pontine H3 K27M-mutant HGG without BRAF V600 or IDH1 mutations as confirmed by Rapid Central Pathology and Molecular Screening Reviews performed on APEC14B1
  * Note: Patients need not have either measurable or evaluable disease, i.e., DMG patients may have complete resection of their tumor prior to enrollment. Primary spinal tumors are eligible for enrollment. For rare H3 K27M-mutant HGG in non-midline structures (e.g., cerebral hemispheres), these patients will be considered part of Stratum DMG.
* STEP 1: Stratum HGG (without H3 K27M mutation)

  * Patients must have newly-diagnosed non-pontine H3 K27M-wild type HGG without BRAF V600 or IDH1 mutations as confirmed by Rapid Central Pathology and Molecular Screening Reviews performed on APEC14B1
  * Please note:

    * Patients who fall in this category and who are \>= 18 years of age are not eligible due to another standard-of-care regimen (radiation/temozolomide) that is available
    * Patients need not have either measurable or evaluable disease, i.e., HGG patients may have complete resection of their tumor prior to enrollment. Primary spinal tumors are eligible for enrollment
* STEP 1: Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1 or 2. Use Karnofsky for patients \> 16 years of age and Lansky for patients =\<16 years of age. Patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score.
* STEP 1: Peripheral absolute neutrophil count (ANC) \>= 1000/uL (within 7 days prior to step 1 enrollment)
* STEP 1: Platelet count \>= 100,000/uL (transfusion independent) (within 7 days prior to step 1 enrollment)
* STEP 1: Hemoglobin \>= 8.0 g/dL (may receive red blood cell \[RBC\] transfusions) (within 7 days prior to step 1 enrollment)
* STEP 1: Creatinine clearance or radioisotope glomerular filtration rate (GFR) \>= 70 mL/min/1.73 m\^2 (within 7 days prior to step 1 enrollment) or

A serum creatinine based on age/sex as follows (within 7 days prior to step 1 enrollment):

* Age / Maximum Serum Creatinine (mg/dL)

  * 1 to \< 2 years / male: 0.6; female: 0.6
  * 2 to \< 6 years / male: 0.8; female: 0.8
  * 6 to \< 10 years / male: 1; female: 1
  * 10 to \< 13 years / male: 1.2; female: 1.2
  * 13 to \< 16 years / male: 1.5; female: 1.4
  * \>= 16 years / male: 1.7; female: 1.4

    * STEP 1: Total bilirubin =\< 1.5 x upper limit of normal (ULN) for age
    * STEP 1: Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase \[ALT\]) =\< 135 U/L. For the purpose of this study, the ULN for SGPT is 45 U/L.
    * STEP 1: Serum amylase =\< 1.5 x ULN
    * STEP 1: Serum lipase =\< 1.5 x ULN
    * STEP 1: No evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry \> 94% if there is clinical indication for determination.
    * STEP 1: Patients with seizure disorder may be enrolled if on anticonvulsants and well controlled.
    * STEP 1: Patients must be enrolled and protocol therapy must begin no later than 31 days after the date of radiographic diagnosis (in the case of non-biopsied DIPG patients only) or definitive surgery, whichever is the later date (Day 0).

For patients who have a biopsy followed by resection, the date of resection will be considered the date of definitive diagnostic surgery. If a biopsy only was performed, the biopsy date will be considered the date of definitive diagnostic surgery.

Exclusion Criteria:

* STEP 1: Patients must not have received any prior therapy for their central nervous system (CNS) malignancy except for surgery and steroid medications.
* STEP 1: Patients who are currently receiving another investigational drug are not eligible.
* STEP 1: Patients who are currently receiving other anti-cancer agents are not eligible.
* STEP 1: Patients \>=18 years of age who have H3 K27M-wild type HGG.
* STEP 1: Patients who have an uncontrolled infection.
* STEP 1: Patients who have received a prior solid organ transplantation.
* STEP 1: Patients with grade \> 1 extrapyramidal movement disorder.
* STEP 1: Patients with known macular degeneration, uncontrolled glaucoma, or cataracts.
* STEP 1: Patients with metastatic disease are not eligible; MRI of spine with and without contrast must be performed if metastatic disease is suspected by the treating physician.
* STEP 1: Patients with gliomatosis cerebri type 1 or 2 are not eligible, with the exception of H3 K27M-mutant bithalamic tumors.
* STEP 1: Patients who are not able to receive protocol specified radiation therapy.
* STEP 1:

  * Female patients who are pregnant are ineligible since there is yet no available information regarding human fetal or teratogenic toxicities.
  * Lactating females are not eligible unless they have agreed not to breastfeed their infants. It is not known whether selinexor is excreted in human milk.
  * Female patients of childbearing potential are not eligible unless a negative pregnancy test result has been obtained.
  * Sexually active patients of reproductive potential are not eligible unless they have agreed to use two effective methods of birth control (including a medically accepted barrier method of contraception, e.g., male or female condom) for the duration of their study participation and for 90 days after the last dose of selinexor. Abstinence is an acceptable method of birth control.

Where this trial is running

Birmingham, Alabama and 126 other locations

+77 more sites — see ClinicalTrials.gov for the full list.

Study contacts

How to participate

  1. Review the eligibility criteria above with your treating physician.
  2. Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
  3. Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.
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Conditions Malignant Glioma
Last reviewed 2026-06-10 by the Find a Trial editorial team. Information on this page is for educational purposes and is not medical advice. Always consult qualified healthcare professionals about clinical trial participation.