This phase I trial studies the side effects and best dose of selinexor and carfilzomib when
given together with dexamethasone in treating patients with multiple myeloma that has
returned or does not respond to treatment. Drugs used in chemotherapy, such as selinexor and
dexamethasone, work in different ways to stop the growth of cancer cells, either by killing
the cells, by stopping them from dividing, or by stopping them from spreading. Carfilzomib
may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
Giving selinexor, carfilzomib, and dexamethasone may be a better treatment for multiple
myeloma.
Minimum age: 18 Years.
Maximum age: N/A.
Gender(s): Both.
Inclusion Criteria:
- Written informed consent in accordance with federal, local, and institutional
guidelines
- Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
- Diagnosis of multiple myeloma as per International Myeloma Working Group (IMWG)
uniform criteria
- Measurable disease by IMWG as defined by at least one of the following:
- Serum M-protein >= 0. 5 g/dL
- Urine M-protein >= 200 mg in a 24-hour collection
- Serum free light chain level >= 10 mg/dL provided the free light chain ratio is
abnormal
- Measurable plasmacytoma; if plasmacytoma measurement is the only measurable
disease, subject eligibility must be reviewed with lead principal investigator
(PI) prior to signing consent
- Relapsed/refractory multiple myeloma with progressive disease at study entry
- Subjects must have been treated with at least 2 prior therapies including a
proteasome inhibitor and a cereblon-binding agent
- Subjects who are refractory to carfilzomib may enroll throughout the trial;
carfilzomib refractory status is defined by IMWG criteria: disease that is
nonresponsive while on salvage therapy, or progresses within 60 days of last
therapy in patients who have achieved minimal response (MR) or better at some
point previously before then progressing in their disease course
- In the expansion cohort of the study, enrollment will be limited to patients
meeting carfilzomib refractory status
- Ability to adhere with the study visit schedule and other protocol procedures
- Absolute neutrophil count (ANC) >= 1. 0 x 10^9/L; screening ANC should be independent
of growth factor support for over one week for all patients
- Hemoglobin >= 8 g/dL; subjects may receive red blood cell transfusions as clinically
indicated per institutional guidelines but screening hemoglobin should be independent
of red blood cell transfusion for at least 3 days prior to cycle 1 day 1
- Platelet count >= 50,000mm^3; platelet count should be independent of transfusions
for at least 14 days for eligibility
- Total bilirubin =< 2 times the upper limit of normal (ULN) (except patients with
Gilbert's syndrome who must have a total bilirubin of < 3 times ULN)
- Alanine aminotransferase (ALT) =< 2. 5 times ULN; in the case of known (radiological
and/or biopsy documented) liver metastasis, ALT =< 2. 5 times ULN is acceptable
- Estimated creatinine clearance of >= 30 mL/min, calculated using the formula of
Cockroft and Gault
- Female patients of child-bearing potential must agree to use dual methods of
contraception and have a negative serum pregnancy test at screening, and male
patients must use an effective barrier method of contraception if sexually active
with a female of child-bearing potential; acceptable methods of contraception are
condoms with contraceptive foam, oral, implantable or injectable contraceptives,
contraceptive patch, intrauterine device, diaphragm with spermicidal gel, or a sexual
partner who is surgically sterilized or post-menopausal; for both male and female
patients, effective methods of contraception must be used throughout the study and
for three months following the last dose
Exclusion Criteria:
- Patients who are pregnant or lactating
- Radiation, chemotherapy, or immunotherapy or any other anticancer therapy =< 2 weeks
prior to cycle 1 day 1
- Participation in an investigational anti-cancer study within 30 days prior to cycle 1
day 1
- Concurrent therapy with approved or investigational anticancer therapeutic other than
steroids
- Major surgery within four weeks before cycle 1 day 1
- Unstable angina or myocardial infarction within 4 months prior to randomization, New
York Heart Association (NYHA) class III or IV heart failure, left ventricular
ejection fraction (LVEF) < 40%, uncontrolled angina, history of severe coronary
artery disease, severe uncontrolled ventricular arrhythmias including uncontrolled
chronic atrial fibrillation/atrial flutter, history of torsades de pointe, sick sinus
syndrome, or electrocardiographic evidence of acute ischemia or grade 3 conduction
system abnormalities unless subject has a pacemaker
- Uncontrolled hypertension or uncontrolled diabetes within 14 days prior to
randomization
- Uncontrolled infection requiring parenteral antibiotics, antivirals, or antifungals
within 14 days prior to first dose; patients with controlled infection or on
prophylactic antibiotics are permitted in the study
- Known to be human immunodeficiency virus (HIV) seropositive
- Known active hepatitis A, B, or C infection; or known to be positive for hepatitis C
virus (HCV) ribonucleic acid (RNA) or HBsAg (hepatitis B virus [HBV] surface antigen)
- Non-hematologic malignancy within the past 3 years with the exception of a)
adequately treated basal cell carcinoma, squamous cell skin cancer, or thyroid
cancer; b) carcinoma in situ of the cervix or breast; c) prostate cancer of Gleason
grade 6 or less with stable prostate-specific antigen levels; or d) cancer considered
cured by surgical resection or unlikely to impact survival during the duration of the
study, such as localized transitional cell carcinoma of the bladder or benign tumors
of the adrenal or pancreas
- Patients with markedly decreased visual acuity in the opinion of the treating
investigator after completion of screening ophthalmologic exam
- Significant neuropathy (grades 3-4, or grade 2 with pain) within 14 days prior to
randomization
- Known history of allergy to Captisol® (a cyclodextrin derivative used to solubilize
carfilzomib)
- Any underlying condition that would significantly interfere with the absorption of an
oral medication
- Serious psychiatric or medical conditions that could interfere with treatment
- Contraindication to any of the required concomitant drugs or supportive treatments,
including hypersensitivity to all anticoagulation and antiplatelet options, antiviral
drugs, or intolerance to hydration due to preexisting pulmonary or cardiac impairment
- Subjects with pleural effusions requiring thoracentesis or ascites requiring
paracentesis within 14 days prior to randomization
- Patients with coagulation problems and active bleeding in the last month prior to
cycle 1 day 1 (peptic ulcer, epistaxis, spontaneous bleeding)