Promising treatment for deadly brain cancer

NEW YORK, NY (Feb. 4, 2022)--A clinical trial has found that selinexor, the first of a new class of anti-cancer drugs, was able to shrink tumors in almost a third of patients with recurrent glioblastoma, an aggressive brain cancer. 

“Glioblastoma is an incurable brain cancer that needs new therapeutic approaches. Considering that few treatments have any measurable effect on recurrent glioblastomas, the results are encouraging,” says the study’s leader, Andrew B. Lassman, MD, the John Harris Associate Professor of Neurology at Columbia University Vagelos College of Physicians and Surgeons and chief of the Neuro-Oncology Division at Columbia University Irving Medical Center/NewYork-Presbyterian.

“The drug induces a response in certain patients, and several trial patients stayed on selinexor for more than 12 months, including one for over 42 months,” Lassman adds.

The study was published January 10, 2022 in Clinical Cancer Research.

Glioblastomas are typically treated with a combination of surgery, radiation therapy, chemotherapy, and sometimes an electrical device, but the average survival time is just 12 to 18 months. 

Selinexor, an oral medication, inhibits, exportin-1 (XPO-1), a major exporter of proteins from the nucleus to cytoplasm that is overexpressed in many cancers, including glioblastoma. Exportin inhibition results in retention of various tumor suppressor proteins in the nucleus, inducing reactivation of tumor suppressor function as well as other antineoplastic effects. Selinexor was approved by the FDA for the treatment of refractory multiple myeloma and relapsed/refractory diffuse large B-cell lymphoma and showed preclinical activity against glioblastoma models. 

Lassman led the international phase 2 trial to identify the optimal dosing schedule and evaluate the safety and efficacy of selinexor in adults with recurrent glioblastomas whose cancer had progressed following initial treatment. 

Reduction in tumor size was observed in 28% of patients, and a tolerable dose was identified for future human trials already ongoing at Columbia and collaborating sites. 

The most common treatment-related side effects were fatigue (61%), nausea (59%), decreased appetite (43%), and low platelet counts (43%). All these side effects were manageable with supportive care and dose modification. 

A robust series of molecular studies also were performed, including an effort led by Andrea Califano, Dr., chair of the Department of Systems Biology at Columbia University Vagelos College of Physicians and Surgeons, to identify a molecular signature in tumor tissue that may predict which patients would benefit from selinexor. Lassman, Califano, and others are planning a subsequent study to validate this signature in a subsequent trial of patients with newly diagnosed glioblastoma. 

“Taken together, we believe that our findings show that selinexor is an active drug in some patients with glioblastoma and is worthy of further study,” says Lassman, who also is associate director for clinical trials at the Herbert Irving Comprehensive Cancer Center.

A clinical trial at Columbia is currently evaluating the safety and efficacy of selinexor in combination with other therapies for patients with newly diagnosed or recurrent glioblastoma.

More information

The paper is titled “A Phase 2 Study of the Efficacy and Safety of Oral Selinexor in Recurrent Glioblastoma.” 

All authors: Andrew Lassman (Columbia), Patrick Y. Wen (Dana Farber Cancer Institute), Martin van den Bent (Erasmus MC Cancer Institute), Scott R. Plotkin (Massachusetts General Hospital), Annemiek M. E. Walenkamp (University Medical Center Groningen), Adam L. Green (University of Colorado and Children’s Hospital Colorado), Kai Li (Karyopharm Therapeutics), Christopher J. Walker (Karyopharm Therapeutics), Hua Chang (Karyopharm Therapeutics), Sharon Tamir (Karyopharm Therapeutics), Leah Henegar (Karyopharm Therapeutics), Yao Shen (DarwinHealth Inc), Mariano J. Alvarez (DarwinHealth Inc and Columbia), Andrea Califano (Columbia), Yosef Landesman (Karyopharm Therapeutics), Michael G. Kauffman (Karyopharm Therapeutics), Sharon Shacham (Karyopharm Therapeutics), and Morten Mau-Soerensen (Copenhagen University Hospital, Denmark).

The study was funded by Karyopharm Therapeutics and the investigators were also supported by  the William Rhodes and Louise Tilzer-Rhodes Center for Glioblastoma at NewYork-Presbyterian, and the National Institutes of Health (U01 CA217858, P30CA013696, UG1CA189960, S10 OD012351, and S10 OD021764.)

Author disclosures are listed in the study. 

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Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cuimc.columbia.edu or columbiadoctors.org.