Selinexor (KPT-330) in Combination With Temozolomide and Radiation Therapy in Patients With Newly Diagnosed Glioblastoma

* INCLUSION CRITERIA:

  1. Histological diagnosis

     * Pathologically confirmed glioblastoma or gliosarcoma (including astrocytoma, grade IV)
  2. Patients must be eligible for definitive external beam radiotherapy and temozolomide.
  3. Age \>18 years. Because no dosing or adverse event data are currently available on the use of Selinexor in combination with Temodar in patients \<18 years of age, children are excluded from this study.
  4. Patients should have a Karnofsky performance scale (KPS) greater than or equal to 70
  5. Absolute neutrophil count (ANC) \>1.5x10\^9/L; platelet count \>100x10\^9/L; and hemoglobin (Hb) \>9.0 g/dL. Note: the use of transfusion or other intervention prior to cycle 1 day 1 to achieve Hb \>9.0 g/dL is acceptable.
  6. Ability of subject or Legally Authorized Representative (LAR) to understand and the willingness to sign a written informed consent document.
  7. The effects of Selinexor on the developing human fetus are unknown. For this reason and because Selinexor agents as well as other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study treatment and for one month after treatment. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.
  8. Patients must have had surgery and/or biopsy not greater than 8 weeks prior to initial evaluation to be eligible for this study.

     EXCLUSION CRITERIA:

  <!-- -->

  1. Patients who are receiving any other investigational agents and have had prior therapy including:

     * Patients who have previously received radiation therapy (RT) to the brain.
     * Patients who received chemotherapy for the treatment of their glioma
     * Patients who are being treated with implanted Gliadel wafers
     * Patients who are being treated with tumor treating fields.
  2. History of allergic reactions attributed to compounds of similar chemical or biologic composition to selinexor or temozolomide used in study.

  3 Patients with coagulation problems and medically significant bleeding in the month prior to start of treatment (peptic ulcers, epistaxis, spontaneous bleeding). Prior history of deep vein thrombosis (DVT) or pulmonary embolism (PE) is not exclusionary.

  4\. Patients with active uncontrolled or suspected infections

  5\. Patients with severe liver dysfunction defined as:
  * Total bilirubin \> 1.5 x upper limit of normal (ULN) Note: Subjects with Gilberts syndrome should not be excluded as long as total bilirubin is \< 3.0 x ULN and documentation to support diagnosis is available.
  * Serum glutamate pyruvate transaminase (SGPT) or called as Alanine aminotransferase (ALT) greater than or equal to 3 x ULN = 135 U/L; for the purpose of this study, the ULN for SGPT is 45 U/L
  * Serum glutamic oxaloacetic transaminase (SGOT) or called as Aspartate aminotransferase (AST) greater than or equal to 3 x ULN = 150 U/L; for the purpose of this study, the ULN for SGOT is 50 U/L
  * Serum albumin greater than or equal to 2 x ULN

    6\. Known active hepatitis A, B, or C infection

    7\. Human immunodeficiency virus (HIV) patients are not eligible because of their immunocompromised status and overlap of side effects between highly active antiretroviral therapy (HAART) and radiation therapy.

    8 Patients must not have significantly diseased or obstructed gastrointestinal tract malabsorption, uncontrolled vomiting or diarrhea, or inability to swallow oral medication.

    9\. Pregnant women are excluded from this study because Selinexor could have the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with Selinexor, breastfeeding should be discontinued if the mother is treated with Selinexor. These potential risks may also apply to temozolomide used in this study.

    10\. Patients with pre-existing known or suspected radiation sensitivity syndromes will be excluded due to potential confounding effect on outcome.