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Clinical Trial 21178

Cancer Type: Gastrointestinal Tumor
Study Type: Treatment
NCT#: NCT05093608

Phase: Phase I
Principal Investigator: Mehta, Rutika

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Study Title

An investigator-initiated Phase I study of SELINEXOR in combination with Bevacizumab and Atezolizumab in newly diagnosed advanced Hepatocellular Carcinoma


The goal of this clinical research study is to find out if the oral drug Selinexor taken along with bevacizumab and atezolizumab is effective in treating advanced Hepatocellular Carcinoma.


Primary Objective: To determine the safety and tolerability of SELINEXOR with bevacizumab and atezolizumab as first-line treatment of advanced HCC Secondary Objectives: To evaluate the efficacy of the combination of SELINEXOR with bevacizumab and atezolizumab as first-line treatment of HCC.



Immunotherapy; Therapy (NOS)


Atezolizumab (Tecentriq); Avastin (Bevacizumab); Bevacizumab (); KPT-330 (Selinexor); Selinexor ()

Inclusion Criteria

Inclusion Criteria:

  • Written informed consent in accordance with federal, local, and institutional guidelines. Participants must provide informed consent prior to the first screening procedure.
  • Ability to comply with the study protocol, in the investigator's judgment.
  • Locally advanced or metastatic and/or unresectable Hepatocellular Carcinoma (HCC) with diagnosis confirmed by histology/cytology or clinically by American Association for the Study of Liver Diseases (AASLD) criteria in cirrhotic patients. Participants without cirrhosis require histological confirmation of diagnosis.
  • Disease that is not amenable to curative surgical and/or locoregional therapies, or progressive disease after surgical and/or locoregional therapies.
  • No prior anti-neoplastic systemic therapy (including systemic investigational agents) for HCC
  • At least 1 measurable (per RECIST v1.1) untreated lesion.
  • Participants who received prior local therapy (e.g., radiofrequency ablation, percutaneous ethanol or acetic acid injection, cryoablation, high-intensity focused ultrasound, transarterial chemoembolization, transarterial embolization, etc.) are eligible provided the target lesion(s) have not been previously treated with local therapy or the target lesion(s) within the field of local therapy have subsequently progressed in accordance with RECIST version 1.1.
  • Participants must undergo an esophagogastroduodenoscopy (EGD), and all size of varices (small to large) must be assessed and treated per local standard of care prior to enrollment. Participants who have undergone an EGD within 6 months of prior to initiation of study treatment do not need to repeat the procedure.
  • Eastern Cooperative Oncology Group (ECOG ) Performance Status (PS) of ≤ 2
  • Participants with brain metastases must have treated and stable brain metastases.
  • Child-Pugh Class A within 7 days prior to Cycle 1 Day 1.
  • Adequate hepatic function at screening
  • Adequate renal function within 28 days prior to cycle 1 day 1
  • Adequate hematopoietic function within 7 days prior to cycle 1 day 1
  • Urine dipstick for proteinuria > No known history of human immunodeficiency virus.
  • Documented virology status of hepatitis, as confirmed by screening HBV and HCV serology test. For patients with active hepatitis B virus (HBV): HBV DNA ≤ 500 IU/mL obtained within 28 days prior to initiation of study treatment, and Anti-HBV treatment (per local standard of care, e.g., entecavir) for a minimum of 14 days prior to study entry.
  • Participants may have a past or ongoing hepatitis C virus (HCV) infection. For participants not on anti-HCV therapy at the time of study enrollment, direct-acting agents (DAAs) for treatment of HCV infection can be initiated as per discretion.
  • Female participants of childbearing potential must agree to use 2 methods of contraception (including 1 highly effective and 1 effective method of contraception) and have a negative serum pregnancy test at Screening. Male participants must use an effective barrier method of contraception if sexually active with a female of childbearing potential. For both male and female participants, effective methods of contraception must be used throughout the study and for 6 months following the last dose of study treatment. Women of childbearing potential must have a negative serum pregnancy test result within 14 days prior to initiation of study treatment.

  • Exclusion Criteria

    Exclusion Criteria:

  • History of leptomeningeal disease
  • Active or history of autoimmune disease or immune deficiency, including, but not limited to, myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, antiphospholipid antibody syndrome, Wegener granulomatosis, Sjögren syndrome, Guillain Barré syndrome, or multiple sclerosis, with exceptions outlined in protocol.
  • Prior exposure to a SINE compound, including SELINEXOR.
  • History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography (CT) scan. History of radiation pneumonitis in the radiation field (fibrosis) is permitted.
  • Known active tuberculosis
  • Significant cardiovascular disease (such as New York Heart Association Class II or greater cardiac disease, myocardial infarction, or cerebrovascular accident within 3 months prior to initiation of study treatment), unstable arrhythmia, or unstable angina
  • History of congenital long QT syndrome or corrected QT interval >500msec (calculated with use of the Fridericia method) at screening
  • Prior allogeneic stem cell or solid organ transplantation
  • Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that contraindicates the use of an investigational drug, may affect the interpretation of the results, or may render the patient at high risk from treatment complications
  • Treatment with a live, attenuated vaccine within 4 weeks prior to initiation of study treatment, or anticipation of need for such a vaccine during atezolizumab treatment or within 5 months after the last dose of atezolizumab
  • History of severe allergic anaphylactic reactions to chimeric or humanized antibodies or fusion proteins
  • Known fibrolamellar HCC, sarcomatoid HCC, or mixed cholangiocarcinoma and HCC
  • Untreated or incompletely treated esophageal and/or gastric varices with bleeding or high risk for bleeding. A prior bleeding event due to esophageal and/or gastric varices within 6 months prior to initiation of study treatment
  • Uncontrolled tumor-related pain, pleural effusion, pericardial effusion or ascites requiring recurrent drainage procedures. Participants with indwelling catheters are allowed.
  • Treatment with investigational therapy within 28 days prior to initiation of study treatment
  • Treatment with strong CYP3A4 inducers within 14 days prior to initiation of study treatment, including rifampin (and its analogues) or St. John's wort.
  • Prior treatment with CD137 agonists or immune checkpoint blockade therapies, including anti-CTLA-4, anti PD-1, and anti-PD-L1 therapeutic antibodies
  • Treatment with systemic immunostimulatory agents (including, but not limited to, interferon and interleukin 2 [IL-2]) within 4 weeks or 5 half-lives of the drug (whichever is longer) prior to initiation of study treatment
  • Treatment with systemic immunosuppressive medication (including, but not limited to, corticosteroids, cyclophosphamide, azathioprine, methotrexate, thalidomide, an anti-Tumor Necrosis Factor [TNF] -α agents) within 2 weeks prior to initiation of study treatment, or anticipation of need for systemic immunosuppressive medication during study treatment, with the following exceptions: If patient is on chronic steroid prednisone equivalent less than 15 mg/day are allowed.
  • Other exclusions apply

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