This phase I trial tests the safety, side effects, and best dose of eltanexor in combination with venetoclax for the treatment of patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) that has come back after a period of improvement (relapsed) or that has not responded to previous treatment (refractory). Eltanexor works by trapping "tumor suppressing proteins" within the cell, thus causing the cancer cells to die or stop growing. Venetoclax is in a class of medications called B-cell lymphoma-2 (BCL-2) inhibitors. It may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Giving eltanexor together with venetoclax may be safe, tolerable and/or effective in treating patients with relapsed or refractory MDS or AML.
Primary objective: • To establish the safe and biologically effective dose (BED) of eltanexor in combination with venetoclax in patients with R/R MDS and/or AML Secondary objectives: * To estimate the complete remission (CR) rate with eltanexor and venetoclax in patients with R/R MDS and/or AML * To assess the overall response rate (ORR) following treatment with eltanexor/venetoclax * To assess the overall survival of patients * To assess the progression free survival (PFS) and duration of response (DOR) in patients treated with eltanexor/venetoclax Exploratory objectives: * To assess differential response between MDS and AML cohorts * To develop and evaluate a phenotypic flow-based assay to predict response to eltanexor/venetoclax * To assess the effect of mutational changes on response to eltanexor/venetoclax * To measure the rates of measurable residual disease with eltanexor/venetoclax OUTLINE: This is a dose-escalation study of eltanexor in combination with venetoclax. Patients receive eltanexor orally (PO) once per day (QD) for 5 days per week for 14, 21, or 28 days every cycle, and venetoclax PO QD on days 1-14 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo bone marrow aspiration and biopsy and blood sample collection throughout the study. After completion of study treatment, patients are followed up every 3 months for up to 24 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Eltanexor will be taken by mouth
Venetoclax will be taken by mouth
Undergo bone marrow aspiration and biopsy
Undergo blood sample collection
Baptist Health Care Corporation
Memphis, Tennessee, United States
RECRUITINGVanderbilt University/Ingram Cancer Center
Nashville, Tennessee, United States
RECRUITINGIncidence of adverse events
Adverse medical events will be tabulated and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.
Time frame: Up to 2 years
Biologically effective dose (BED) of eltanexor in combination with venetoclax
Measured by complete remission
Time frame: Up to 2 years
Complete remission
By 95% (e.g. based on standard Gaussian methods or bootstrap methods, as appropriate) confidence intervals.
Time frame: Up to 2 years
Overall response rate
By 95% (e.g. based on standard Gaussian methods or bootstrap methods, as appropriate) confidence intervals.
Time frame: Up to 2 years
Progression free survival
Will be estimated using the method of Kaplan and Meier accompanied by 95% (e.g. based on standard Gaussian methods or bootstrap methods, as appropriate) confidence intervals.
Time frame: Up to 2 years
Overall survival
Will be estimated using the method of Kaplan and Meier accompanied by 95% (e.g. based on standard Gaussian methods or bootstrap methods, as appropriate) confidence intervals.
Time frame: From date on study to death for any reason, up to 2 years
Duration of response
Will be estimated using the method of Kaplan and Meier accompanied by 95% (e.g. based on standard Gaussian methods or bootstrap methods, as appropriate) confidence intervals.
Time frame: From the date of first objective response until disease progression or death for any reason up to 2 years
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