Clinical trial of selinexor plus gemcitabine in selected advanced soft-tissue sarcomas

Prior treatment

• Phase II: Major surgery within 4 weeks prior to C1D1.
• Phase II: Inability or unwillingness to take supportive medications such as anti-nausea and anti-anorexia agents as recommended by the NCCN CPGO for antiemesis and anorexia/cachexia (palliative care).
• Phase II: Patients who have received any other anti-cancer therapy or investigational product in the last 21 days prior to enrollment.
• Phase II: Prior selinexor or another XPO1 inhibitor treatment.
• Phase II: Administration of a previous gemcitabine-containing treatment.
• Phase II: Any concurrent medical condition or disease (e.g. uncontrolled active hypertension, uncontrolled active diabetes, active systemic infection, etc.) that is likely to interfere with study procedures.
• Phase II: Uncontrolled active infection requiring parenteral antibiotics, antivirals, or antifungals within 1 week prior to Cycle 1 Day 1 (C1D1). Patients on prophylactic antibiotics or with a controlled infection within 1 week prior to C1D1 are acceptable.

Other illness

• Phase II: Three or more systemic treatment lines (including both chemotherapy and targeted therapy) for advanced disease (localized unresectable or metastatic).
• Phase II: Any active, serious psychiatric, medical, or other conditions/situations that, in the opinion of the Investigator, could interfere with treatment, compliance, or the ability to give informed consent.

Age

• Phase II: Prior malignancy that required treatment or has shown evidence of recurrence (except for non-melanoma skin cancer, adequately treated cervical carcinoma in situ, superficial bladder carcinoma) during the 5 years prior to randomization. Cancer treated with curative intent for >5 years previously and without evidence of recurrence will be allowed.

Other

• Phase II: Life expectancy of less than 3 months.
• Phase II: Any active gastrointestinal dysfunction interfering with the patient’s ability to swallow tablets, or dysfunction that could interfere with absorption of study treatment.
• Phase II: Presence of brain or central nervous system metastases, unless they are controlled (patients with treated and stable metastasis are eligible).
• Phase II: Pregnant or breastfeeding females.
• Phase II: Body surface area (BSA) <1.4 m2 at baseline, calculated by the Du Bois(25) or Mosteller(26) method.

• Phase II: Patients must provide written informed consent prior to performance of any study-specific procedures and must be willing to comply with treatment and follow-up. Informed consent must be obtained prior to start of the screening process. Procedures conducted as part of the patient’s routine clinical management (e.g. imaging tests), obtained prior to signature of informed consent may be used for screening or baseline purposes as long as these procedures are conducted as specified in the protocol.
• Phase II: Left ventricular ejection fraction ≥ 50% by echocardiogram or MUGA scan.
• Phase II: Females of childbearing potential must have a negative serum or urine pregnancy test within 72 hours prior to enrollment and agree to use birth control measures during study treatment and for 3 months after its completion. Patients must not be pregnant or nursing at study entry. Women/men of reproductive potential must have agreed to use an effective contraceptive method.
• Phase II: Age: 18-80 years.
• Phase II: Histologic diagnosis of soft tissue sarcoma (leiomyosarcoma or malignant peripheral nerve sheath tumor) confirmed by central pathology review prior to enrollment with an archive tumor sample. A fresh paraffin embedded tumor tissue block must be provided for all subjects for biomarker analysis before and (when feasible) after treatment with investigational products.
• Phase II:Metastatic/advanced disease in progression in the last 6 months.
• Phase II:Patients have previously received at least one previous line of systemic therapy.
• Phase II: Measurable disease according to RECIST 1.1 criteria.
• Phase II: Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-1.
• Phase II:Adequate hepatic, renal, cardiac, and hematologic function.
• Phase II:Laboratory tests as follows: • Absolute neutrophil count ≥ 1,500/mm³ • Platelet count ≥ 100,000/mm³ • Bilirubin ≤ 1.5 mg/dL • AST and ALT ≤ 2.5 times upper limit of normal • Creatinine ≤ 1.5 mg/dL