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Open Access 01-12-2018 | Research

A phase I study of selinexor in combination with high-dose cytarabine and mitoxantrone for remission induction in patients with acute myeloid leukemia

Authors: Amy Y. Wang, Howard Weiner, Margaret Green, Hua Chang, Noreen Fulton, Richard A. Larson, Olatoyosi Odenike, Andrew S. Artz, Michael R. Bishop, Lucy A. Godley, Michael J. Thirman, Satyajit Kosuri, Jane E. Churpek, Emily Curran, Kristen Pettit, Wendy Stock, Hongtao Liu

Published in: Journal of Hematology & Oncology | Issue 1/2018

Abstract

Background

Novel therapies for patients with acute myeloid leukemia (AML) are imperative, particularly for those with high-risk features. Selinexor, an exportin 1 (XPO1/CRM1) inhibitor, has demonstrated anti-leukemia activity as a single agent, as well as in combination with anthracyclines and/or DNA-damaging agents.

Methods

We report the findings of a phase I dose escalation trial with cohort expansion in 20 patients with newly diagnosed or relapsed/refractory AML that combined selinexor with age-adjusted high-dose cytarabine and mitoxantrone (HiDAC/Mito).

Results

Three (15%) patients received the initial dose of 60 mg of selinexor (~ 35 mg/m²), and 17 (85%) received the target level of 80 mg (~ 50 mg/m²). No dose-limiting toxicities were observed. Common adverse events included febrile neutropenia (70%), diarrhea (40%), anorexia (30%), electrolyte abnormalities (30%), bacteremia (25%), cardiac toxicities (25%), fatigue (25%), and nausea/vomiting (25%). None were unexpected given the HiDAC/Mito regimen. Serious adverse events occurred in 6 (30%) patients; one was fatal. Ten (50%) patients achieved a complete remission (CR), 3 (15%) achieved CR with incomplete recovery (CRi), 1 (5%) achieved partial remission (PR), and 6 (30%) had progressive disease for an overall response rate (ORR) of 70%. Eight of 14 (57%) responders proceeded to allogeneic stem cell transplantation. Correlative studies of WT1 levels showed persistently detectable levels in patients who either did not respond or relapsed quickly after induction.

Conclusion

The selinexor/HiDAC/Mito regimen is feasible and tolerable at selinexor doses of 80 mg/day (~ 50 mg/m²/day) twice weekly. The recommended phase II dose is 80 mg and warrants further study in this combination.

Trial registration

ClinicalTrials.gov, NCT02573363. Registered October 5, 2015

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Title: A phase I study of selinexor in combination with high-dose cytarabine and mitoxantrone for remission induction in patients with acute myeloid leukemia
Authors: Amy Y. Wang
Howard Weiner
Margaret Green
Hua Chang
Noreen Fulton
Richard A. Larson
Olatoyosi Odenike
Andrew S. Artz
Michael R. Bishop
Lucy A. Godley
Michael J. Thirman
Satyajit Kosuri
Jane E. Churpek
Emily Curran
Kristen Pettit
Wendy Stock
Hongtao Liu
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Hematology & Oncology / Issue 1/2018
Electronic ISSN: 1756-8722
DOI: https://doi.org/10.1186/s13045-017-0550-8

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