E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
|
E.1.1.1 | Medical condition in easily understood language |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10028537 |
E.1.2 | Term | Myelofibrosis |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10074689 |
E.1.2 | Term | Post polycythemia vera myelofibrosis |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10074690 |
E.1.2 | Term | Post essential thrombocythemia myelofibrosis |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10074691 |
E.1.2 | Term | Post polycythaemia vera myelofibrosis |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10077161 |
E.1.2 | Term | Primary myelofibrosis |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To determine the clinical activity of selinexor monotherapy compared with physician’s choice (PC) in patients with previously treated myelofibrosis (MF). |
|
E.2.2 | Secondary objectives of the trial |
Key Secondary • To evaluate additional measures of clinical activity of selinexor compared to physician’s choice (PC) in patients with myelofibrosis (MF).
Other Secondary • To assess the survival outcome of patients with myelofibrosis (MF) receiving selinexor compared with physician’s choice (PC). • To evaluate additional measures of clinical activity of selinexor compared to physician’s choice (PC) in patients with myelofibrosis (MF). • To determine the safety profile of selinexor and compare to physician’s choice (PC) in patients with myelofibrosis (MF). • To characterize pharmacokinetics (PK) of selinexor in patients with myelofibrosis (MF).
Exploratory: • To evaluate patient reported outcomes in patients with MF receiving selinexor compared to PC. • To identify predictive biomarkers of response to treatment and explore treatment mechanism of action in patients with MF. • Assess changes in transfusion requirements • Assess changes in serum LDH levels |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Patients are eligible to be included in the study only if they meet all of the following criteria: Main Inclusion Criteria 1. A diagnosis of primary MF or post-ET or post-PV MF according to the 2016 WHO classification of MPN (Protocol Appendix 2), confirmed by the most recent local pathology report. 2. Previous treatment with JAK inhibitors for at least 6 months. 3. Measurable splenomegaly during the screening period as demonstrated by spleen volume of ≥450 cm3 by MRI or CT scan 4. Relapsed, refractory or intolerant to JAK inhibitors as defined as meeting one of the criteria below: a. <35% spleen volume reduction by MRI or CT-scan (from baseline) or b. <50% decrease in spleen size by palpation (from baseline) or an increase of at least 3 cm with the spleen at least 5 cm below the left costal margin or c. Spleen volume increase >25% from nadir or a return to within 10% of baseline after any initial response or d. Treatment with JAK inhibitor was complicated by development of RBC transfusion requirement (2 units per month for 2 month); or grade 3 thrombocytopenia, anemia, hematoma/hemorrhage; or Grade 2 non- hematologic toxicity while on JAK inhibitors 5. Patients ≥18 years of age 6. ECOG ≤2 7. Platelet count ≥100 × 109/L 8. Absolute neutrophil count (ANC) ≥1.5 × 109/L 9. Serum direct bilirubin ≤1.5 × ULN; AST and ALT ≤ 2.5 × ULN 10. Calculated creatinine clearance (CrCl) >15 mL/min based on the Cockcroft and Gault formula. 11. Patients with active hepatitis B virus (HBV) are eligible if antiviral therapy for hepatitis B has been given for >8 weeks and viral load is <100 IU/mL. 12. Patients with untreated hepatitis C virus (HCV) are eligible if there is a documentation of negative viral load per institutional standard. 13. Patients with history of human immunodeficiency virus (HIV) are eligible if they have CD4+ T-cell counts ≥350 cells/μL, negative viral load per institutional standard, and no history of acquired immunodeficiency syndrome (AIDS)-defining opportunistic infections in the last year. 14. Female patients of childbearing potential must have a negative serum pregnancy test at screening and agree to use highly effective methods of contraception throughout the study and for one month following the last dose of study treatment. Childbearing potential excludes: Age >50 years and naturally amenorrhoeic for >1 year, or previous bilateral salpingo-oophorectomy, or hysterectomy. 15. Male patients who are sexually active must use highly effective methods of contraception throughout the study and for one month following the last dose of study treatment. Male patients must agree not to donate sperm during the study treatment period. 16. Patients must sign written informed consent in accordance with federal, local and institutional guidelines.
Crossover from physician’s choice (PC) arm to selinexor (S) arm will be allowed for patients who develop progressive disease (>25% increase from nadir) or for those with <35% reduction at the Week 36 MRI assessment. Patients should meet all inclusion and exclusion criteria prior to crossover. • Patients who crossover due to PD (>25% increase from nadir) confirmed by IRC or due to <35% reduction in spleen size at Week 36 MRI assessment confirmed by IRC, should have a wash-out of 10 days from last dose in Arm PC. Informed consent for participation in crossover part should be obtained prior to any key assessments are performed for the crossover part of the study. The consent can be obtained anytime between EoT in Arm PC to CID1 of the crossover part. |
|
E.4 | Principal exclusion criteria |
Patients are excluded from the study if any of the following criteria apply: 1. >5% blasts in peripheral blood or >10% blasts in bone marrow (i.e., accelerated phase). 2. Previous treatment with selinexor or other XPO1 inhibitors. 3. Use of any standard or experimental anti-MF therapy <21 days prior to Cycle 1 Day 1 (hydroxyurea is allowed). 4. Impairment of gastrointestinal (GI) function or GI disease that could significantly alter the absorption of selinexor (Example: vomiting, or diarrhea that is CTCAE grade >1). 5. Received strong cytochrome P450 3A (CYP3A) inhibitors ≤7 days prior to selinexor dosing OR strong CYP3A inducers ≤14 days prior to selinexor dosing (Protocol Appendix 3). 6. Major surgery <28 days prior to C1D1. 7. Uncontrolled (i.e., clinically unstable) infection requiring parenteral antibiotics, antivirals, or antifungals within 7 days prior to first dose of study treatment; however, prophylactic use of these agents is acceptable (including parenteral). 8. Any life-threatening illness, medical condition, or organ system dysfunction which, in the Investigator’s opinion, could compromise the patient’s safety, prevent the patient from giving informed consent, or being compliant with the study procedures. 9. Female patients who are pregnant or lactating. |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Rate of Spleen Volume Reduction of ≥35% (SVR35) based on the response assessment by the Independent Radiology Committee (IRC)
|
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
From Baseline up to Week 48 |
|
E.5.2 | Secondary end point(s) |
Key Secondary • Rate of Total Symptom Score reduction of ≥50% (TSS50) in the myelofibrosis symptom assessment form (MFSAF) V4.0, based on local assessment • Rate of Spleen Volume Reduction of ≥25% (SVR25) based on the response assessment by the Independent Radiology Committee (IRC)
Other Secondary • Overall survival (OS) • Anemia response as defined per the IWG-MRT (International Working Group – Myeloproliferative Neoplasms Research and Treatment) criteria, based on local assessment • Duration of SVR35 and SVR25, based on IRC assessment • Duration of TSS50, based on local assessment • ORR (Complete Response [CR] + Partial Response [PR] + Clinical Improvement [CI]) by IWG-MRT criteria, based on local assessment
The occurrence, nature, and severity of AEs
Population PK derived parameters: • AUC • Cmax |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
Key Secondary Endpoints • From Baseline up to end of last cycle (approximately 48 months) • From Baseline up to Week 48
Other Secondary Endpoints • From Baseline up to 12 months after end of treatment (approximately 60 months) • From Baseline up to 28 Days after last dose (approximately 48 months) • From Baseline up to 28 Days after last dose (approximately 48 months) • From Baseline up to 28 Days after last dose (approximately 48 months) • From Baseline up to 28 Days after last dose (approximately 48 months)
From first dose of study treatment up to 30 days after end of treatment (approximately 48 months) ]
PK parameter: Cycle 2 Day 1: 1, 2, 4, 6, and 24 hours post dose (each cycle is 28 days) |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | Yes |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
physician’s choice as per clinical practice |
|
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 24 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
United States |
Austria |
France |
Hungary |
Italy |
Poland |
|
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
The end of study (Last Patient, Last Visit) (EoS) will occur upon completion of the Survival Follow-up period for the last patient treated who remains on treatment in the study. Completion of follow-up for the last patient will occur when this patient has been followed for up to 1 year after the End of Treatment (EoT) visit (discontinuation of treatment, patient has withdrawn consent, has been withdrawn from the study, has died, or has been lost to follow-up, whichever occurs first). |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 4 |