Selinexor with Radiation for Newly Diagnosed DIPG and High-Grade Glioma
This study is testing a new combination treatment for children and young adults (ages 12 months to 21 years) with newly diagnosed diffuse intrinsic pontine glioma (DIPG) or high-grade glioma (HGG). These are types of brain or spine cancer that grow quickly. The study is combining a drug called selinexor, given by mouth, with standard radiation therapy. Researchers want to find the safest and most effective dose of selinexor when given with radiation. They also want to see if this combination can shrink tumors and improve how long patients live without their cancer getting worse (event-free survival) or overall (overall survival). You would need to have a specific genetic change called H3 K27M mutation if you have HGG.
- Study design
- This is a Phase 1/2 interventional study, planning to enroll 132 participants. It starts by finding the best dose of selinexor, then looks at how well the treatment works.
- What's involved
- You would undergo a biopsy and MRI scans. You would receive radiation therapy for 5-7 weeks, and take selinexor by mouth during and after radiation, as long as the treatment is working and you tolerate it.
- Compensation
- Not stated in the trial record.
- Follow-up
- Your event-free survival and overall survival will be assessed for up to 5 years after enrollment.
AI-generated from the public study record. Only the study team can confirm whether you're eligible — confirm details with them before making decisions.
NCT05099003
A Study of the Drug Selinexor With Radiation Therapy in Patients With Newly-Diagnosed Diffuse Intrinsic Pontine (DIPG) Glioma and High-Grade Glioma (HGG)
Recruiting
PHASE1Ages 12–21InterventionalTreatmentNational Cancer Institute (NCI)Government-funded
~132 participants
Updated 2026-08-28 on ClinicalTrials.gov
What's tested:Biopsy ProcedureMagnetic Resonance ImagingRadiation TherapySelinexor
At a glance
Recruiting sites
119 of 127 listed sites are recruiting right now
RecruitingSuspended, closed, or not yet open
What they're measuring
Maximum tolerated dose
Measured over From day 1 of selinexor treatment until the start of maintenance therapy, assessed up to 10 weeks from treatment start date
+3 more outcomes measured
Conditions
Where it's being run
127 sites across 56 statesCalifornia10
Texas10
Florida8
New York8
Ohio6
New Jersey5
Missouri4
Pennsylvania4
Study leadership
- Adam L Green · PRINCIPAL_INVESTIGATOR · Children's Oncology Group
Who to contact
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Do you actually qualify for this trial?
Add a private profile and we'll compare every criterion below against your situation — and tell you which ones are met, uncertain, or excluding.
Eligibility criteria
Inclusion
PRE ENROLLMENT: Patients must be =\< 25 years of age at the time of enrollment on APEC14B1 part A central nervous system (CNS)/high grade glioma (HGG) pre-enrollment eligibility screening
Please note:
This required age range applies to pre-enrollment eligibility for all HGG patients. Individual treatment protocols may have different age criteria.
Non-DIPG patients with tumors that do not harbor an H3K27M-mutation and are \>= 18 years of age will not be eligible to enroll on ACNS1821 (Step 1).
PRE ENROLLMENT: Patient is suspected of having localized, newly diagnosed HGG, excluding metastatic disease, OR patient has an institutional diagnosis of DIPG
Please note: there are specific radiographic criteria for DIPG patient enrollment on ACNS1821 (Step 1)
As of February 14, 2025, stratum DIPG and stratum DMG have closed to accrual, and no patients will be enrolled on these strata after Amendment #4.
PRE ENROLLMENT:
For patients with non-pontine tumors: Patients and/or their parents or legal guardians must have signed informed consent for eligibility screening on APEC14B1 Part A.
For patients with DIPG: Patients and/or their parents or legal guardians must have signed informed consent for ACNS1821.
Note: As of February 14, 2025, stratum DIPG and stratum DMG have closed to accrual, and no patients will be enrolled on these strata after Amendment #4.
PRE ENROLLMENT:
For patients with non-pontine tumors only, the specimens obtained at the time of diagnostic biopsy or surgery must be submitted through APEC14B1 ASAP, preferably within 5 calendar days of definitive surgery
STEP 1: Patients must be \>= 12 months and =\< 21 years of age at the time of enrollment
STEP 1: Patients must have newly-diagnosed DIPG or HGG (including DMG).
STEP 1: Stratum DIPG (Closed with Amendment #4)
As of February 14, 2025, stratum DIPG and stratum DMG have closed to accrual, and no patients will be enrolled on these strata after Amendment #4.
Patients with newly-diagnosed typical DIPG, defined as tumors with a pontine epicenter and diffuse involvement of at least 2/3 of the pons on at least 1 axial T2 weighted image, are eligible. No histologic confirmation is required.
Patients with pontine tumors that do not meet radiographic criteria for typical DIPG (e.g., focal tumors or those involving less than 2/3 of the pontine cross-sectional area with or without extrapontine extension) are eligible if the tumors are biopsied and proven to be high-grade gliomas (such as anaplastic astrocytoma, glioblastoma, high-grade glioma not otherwise specified \[NOS\], and/or H3 K27M-mutant) by institutional diagnosis.
STEP 1: Stratum DMG (with H3 K27M mutation) (Closed with Amendment #4)
As of February 14, 2025, stratum DIPG and stratum DMG have closed to accrual, and no patients will be enrolled on these strata after Amendment #4.
Patients must have newly-diagnosed non-pontine H3 K27M-mutant HGG without BRAF V600 or IDH1 mutations as confirmed by Rapid Central Pathology and Molecular Screening Reviews performed on APEC14B1
Note: Patients need not have either measurable or evaluable disease, i.e., DMG patients may have complete resection of their tumor prior to enrollment. Primary spinal tumors are eligible for enrollment. For rare H3 K27M-mutant HGG in non-midline structures (e.g., cerebral hemispheres), these patients will be considered part of Stratum DMG.
STEP 1: Stratum HGG (without H3 K27M mutation)
Patients must have newly-diagnosed non-pontine H3 K27M-wild type HGG without BRAF V600 or IDH1 mutations as confirmed by Rapid Central Pathology and Molecular Screening Reviews performed on APEC14B1
Please note:
Patients who fall in this category and who are \>= 18 years of age are not eligible due to another standard-of-care regimen (radiation/temozolomide) that is available
Patients need not have either measurable or evaluable disease, i.e., HGG patients may have complete resection of their tumor prior to enrollment. Primary spinal tumors are eligible for enrollment
STEP 1: Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1 or 2. Use Karnofsky for patients \> 16 years of age and Lansky for patients =\<16 years of age. Patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score.
STEP 1: Peripheral absolute neutrophil count (ANC) \>= 1000/uL (within 7 days prior to step 1 enrollment)
STEP 1: Platelet count \>= 100,000/uL (transfusion independent) (within 7 days prior to step 1 enrollment)
STEP 1: Hemoglobin \>= 8.0 g/dL (may receive red blood cell \[RBC\] transfusions) (within 7 days prior to step 1 enrollment)
STEP 1: Creatinine clearance or radioisotope glomerular filtration rate (GFR) \>= 70 mL/min/1.73 m\^2 (within 7 days prior to step 1 enrollment) or
Age / Maximum Serum Creatinine (mg/dL)
1 to \< 2 years / male: 0.6; female: 0.6
2 to \< 6 years / male: 0.8; female: 0.8
6 to \< 10 years / male: 1; female: 1
10 to \< 13 years / male: 1.2; female: 1.2
13 to \< 16 years / male: 1.5; female: 1.4
\>= 16 years / male: 1.7; female: 1.4
STEP 1: Total bilirubin =\< 1.5 x upper limit of normal (ULN) for age
STEP 1: Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase \[ALT\]) =\< 135 U/L. For the purpose of this study, the ULN for SGPT is 45 U/L.
STEP 1: Serum amylase =\< 1.5 x ULN
STEP 1: Serum lipase =\< 1.5 x ULN
STEP 1: No evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry \> 94% if there is clinical indication for determination.
STEP 1: Patients with seizure disorder may be enrolled if on anticonvulsants and well controlled.
STEP 1: Patients must be enrolled and protocol therapy must begin no later than 31 days after the date of radiographic diagnosis (in the case of non-biopsied DIPG patients only) or definitive surgery, whichever is the later date (Day 0).
Exclusion
STEP 1: Patients must not have received any prior therapy for their central nervous system (CNS) malignancy except for surgery and steroid medications.
STEP 1: Patients who are currently receiving another investigational drug are not eligible.
STEP 1: Patients who are currently receiving other anti-cancer agents are not eligible.
STEP 1: Patients \>=18 years of age who have H3 K27M-wild type HGG.
STEP 1: Patients who have an uncontrolled infection.
STEP 1: Patients who have received a prior solid organ transplantation.
STEP 1: Patients with grade \> 1 extrapyramidal movement disorder.
STEP 1: Patients with known macular degeneration, uncontrolled glaucoma, or cataracts.
STEP 1: Patients with metastatic disease are not eligible; MRI of spine with and without contrast must be performed if metastatic disease is suspected by the treating physician.
STEP 1: Patients with gliomatosis cerebri type 1 or 2 are not eligible, with the exception of H3 K27M-mutant bithalamic tumors.
STEP 1: Patients who are not able to receive protocol specified radiation therapy.
STEP 1:
Female patients who are pregnant are ineligible since there is yet no available information regarding human fetal or teratogenic toxicities.
Lactating females are not eligible unless they have agreed not to breastfeed their infants. It is not known whether selinexor is excreted in human milk.
Female patients of childbearing potential are not eligible unless a negative pregnancy test result has been obtained.
Sexually active patients of reproductive potential are not eligible unless they have agreed to use two effective methods of birth control (including a medically accepted barrier method of contraception, e.g., male or female condom) for the duration of their study participation and for 90 days after the last dose of selinexor. Abstinence is an acceptable method of birth control.
What this trial measures
- Maximum tolerated doseFrom day 1 of selinexor treatment until the start of maintenance therapy, assessed up to 10 weeks from treatment start date
Defined as the highest dose of selinexor in combination with standard of care radiation therapy that does not cause unacceptable side effects.
- Event free survival (EFS)From the date of enrollment until disease progression date, secondary malignant neoplasm occurrence date, death date of any cause, or last follow-up date, assessed up to 5 years
Will be calculated for diffuse midline glioma/ high grade glioma patients. EFS curve will be estimated by Kaplan Meier estimates.
- Overall Survival (OS)From the date of enrollment until death date of any cause or last follow-up date, assessed up to 5 years
Will be calculated for diffuse intrinsic pontine glioma patients. The OS curve will be estimated by Kaplan Meier estimates.
- Overall response rateUp to 5 years
Defined as the proportion of patients whose best response is partial response or complete response.