Using selinexor with temozolomide and anti-PD-1 antibody for treating relapsed primary central nervous system lymphoma

The Efficiency and Safety of Selinexor in Combination With Temozolomide and Anti-PD-1 Antibody in Patients With Relapsed/Refractory Primary Central Nervous System Lymphoma: A Prospective, Single-arm, Open, Phase Ib/II Clinical Study

This study is testing a new combination of treatments, including selinexor, temozolomide, and an anti-PD-1 antibody, to see if it can help people with relapsed primary central nervous system lymphoma feel better.

Quick facts

• Phase: Phase1; Phase2
• Study type: Interventional
• Enrollment: 38 (estimated)
• Ages: 18 Years to 75 Years
• Sex: All
• Sponsor: Second Affiliated Hospital, School of Medicine, Zhejiang University (Academic / other)
• Drugs / interventions: chemotherapy, immunotherapy, methotrexate
• Locations: 1 site (Hanzhou, Zhejiang)
• Trial ID: NCT06556199 on ClinicalTrials.gov

What this trial studies

This clinical trial evaluates the safety and efficacy of selinexor in combination with temozolomide and an anti-PD-1 monoclonal antibody in patients with relapsed or refractory primary central nervous system lymphoma (PCNSL). It employs a Phase Ib/II design, where the Phase Ib component focuses on determining the maximum tolerated dose and safety profile, while the Phase II component assesses the overall efficacy of the treatment regimen. Participants who achieve remission will continue with maintenance therapy using the anti-PD-1 antibody until disease progression or other specified endpoints occur.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 to 75 with confirmed B-cell origin PCNSL who have experienced recurrence after prior methotrexate-based treatments.

Not a fit: Patients with non-B-cell origin PCNSL or those who have not received prior systemic treatment may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment combination could provide a new therapeutic option for patients with relapsed or refractory PCNSL.

How similar studies have performed: While this approach is innovative, similar combinations of therapies have shown promise in other hematological malignancies, suggesting potential for success.

Eligibility criteria

Inclusion Criteria:

* Aged between 18 and 75 (inclusive).
* Participants must be able to understand and be willing to sign a written informed consent document.
* Eastern Cooperative Oncology Group performance status 0 to 3.
* Life expectancy of ≥ 3 months (in the opinion of the investigator).
* Primary central nervous system lymphoma (PCNSL) of B-cell origin confirmed by pathology (histology or cytology)
* Measurable disease was defined as at least ≥1.0cm in short-diameter by enhanced MRI.
* Recurrent/refractory PCNSL: Must have received at least one systemic treatment with methotrexate-based treatment.
* Any non-hematological toxicity associated with previous treatment should return to grade 1 or normal (except hair loss according to NCI CTCAE version 5.0)
* Bone marrow and organ function meet the following criteria (no blood transfusion within 14 days prior to screening, no G-CSF, no medication correction) :

  1. Bone marrow function: absolute value of neutrophils ≥1.5×10\^9/L, platelets ≥80×10\^9/L, hemoglobin ≥80 g/L;
  2. Liver function: serum total bilirubin ≤1.5×ULN (≤3.0×ULN, if there is liver metastasis); Glutamic oxalic aminotransferase (AST) and glutamic pyruvic aminotransferase (ALT) ≤2.5×ULN (≤5.0×ULN, if there is liver metastasis);
  3. Coagulation function: International standardized ratio (INR) and activated partial thrombin time ≤1.5×ULN;
  4. Renal function: serum creatinine ≤1.5×ULN or estimated creatinine clearance ≥60 mL/min (male: Cr (ml/min) = (140-age) × body weight (kg) /72× serum creatinine concentration (mg/dl); Female: Cr (ml/min) = (140- age) × body weight (kg) /85× serum creatinine concentration (mg/dl)
* Women of reproductive potential must agree to use highly effective methods of birth control during the period of therapy and for 6 months after the last dose of the study drug. Men who are sexually active must agree to use highly effective contraception during the period of therapy and for 6 months after the last dose.
* Can accept multiple MRI/CT and lumbar puncture examination.
* Swallowing oral tablets/capsules without difficulty.
* Good compliance, willing to follow the visit schedule, dosing schedule, laboratory examination and other test procedure.

Exclusion Criteria:

* Pathological diagnosis was T cell lymphoma.
* Anti-tumor therapy with chemotherapy, radiotherapy, immunotherapy or antibody drugs, or Chinese herbal medicine with anti-tumor indications, small-molecule targeted therapy within 2 weeks, monoclonal antibody-coupled drugs or cytotoxin therapy within 10 weeks, and autologous stem cell transplantation within 6 months before the first administration.
* Participation in another clinical study with an investigational product during the 4 weeks prior to the first day of study treatment.
* Patients who use systemic adrenal corticosteroids for more than 5 days within 14 days prior to medication or who need to take \>10mg of dexamethasone or equivalent drugs daily to control CNS disease.
* Active concurrent malignancy requiring active therapy.
* Prior treatment with temozolomide or anti-PD-1, anti-PD-L1, or anti-PD-L2 drugs within 6 months prior to initial administration
* Have uncontrolled or significant cardiovascular disease, including (but not limited to) : Any of the following: congestive heart failure (NYHA Class III or IV);myocardial infarction; unstable angina; or the presence of an arrhythmia requiring treatment at the time of screening with a left ventricular ejection fraction (LVEF) \< 50% in the 6 months prior to initial dosing; Primary cardiomyopathy (e.g., dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, restricted cardiomyopathy, undefined cardiomyopathy); A clinically significant history of prolonged QTc, grade II type II atrioventricular block or grade III atrioventricular block, or QTc interphase (method F) \> 470 msec (female) or \> 480msec (male);Atrial fibrillation (EHRA grade ≥2b);Patients with unmanageable hypertension were deemed unsuitable for participation in the study.
* Uncontrolled infections or infections that require intravenous antibiotic treatment.
* Chronic hepatitis B carriers with active hepatitis B or C infection (hepatitis B: acute hepatitis B, untreated chronic hepatitis B virus infection, HBV-DNA≥ the detection limit of each center; Hepatitis C: HCV RNA positive) or syphilis. Notes: Non-active HBV surface antigen (HBsAg) carriers, subjects with active HBV infection and persistent anti-HBV inhibition (HBV DNA \< each center detection limit), and subjects cured of HCV can be enrolled.
* Human immunodeficiency virus (HIV) infection
* Clinically significant gastrointestinal abnormalities that may affect drug intake, transport, or absorption (such as active gastrointestinal inflammation, chronic diarrhea, intestinal obstruction, etc.), or total gastrectomy or gastric banding surgery.
* Prior allogenic stem cell transplant.
* For female subjects, they are currently pregnant or breastfeeding.
* Allergy to the investigational drug or excipient.
* The patient has active mental illness, alcohol, drug or substance abuse.
* The presence of any life-threatening disease, medical condition, or organ system dysfunction that the investigator believes may affect the patient's safety or compliance with the study procedure.
* There are other conditions that the investigator considers inappropriate to participate in this clinical trial.

Where this trial is running

Hanzhou, Zhejiang

• 2nd Affiliated Hospital, School of Medicine, Zhejiang University — Hanzhou, Zhejiang, China (Recruiting)

Study contacts

• Study coordinator: Xianggui Yuan

Conditions Relapsed/Refractory Primary Central Nervous System Lymphoma