A Clinical Study on the Efficacy and Safety of Methotrexate (MTX) or Thiotepa (for MTX Intolerance) or Temozolomide (TMZ) Combined With Orelabrutinib and Selinexor in Relapsed/Refractory Primary or Secondary Central Nervous System Lymphoma（SELINA）

Recruiting now · Not applicable

Conditions studied: Lymphoma Cns

In brief

Clinical Study on the Efficacy and Safety of Methotrexate (MTX) or Thiotepa (for MTX intolerance) or Temozolomide (TMZ) Combined with Orelabrutinib and Selinexor in the Treatment of Relapsed/Refractory Primary or Secondary Central Nervous System Lymphoma This study adopts an open-label, prospective, single-arm, single-center design aimed at evaluating the efficacy and safety of methotrexate (MTX) or thiotepa (for MTX intolerance) or temozolomide (TMZ) combined with orelabrutinib and selinexor in the treatment of relapsed/refractory primary or secondary central nervous system lymphoma (r/r CNSL). Primary Objective To evaluate the efficacy and safety of methotrexate (MTX) or thiotepa (for MTX intolerance) or temozolomide (TMZ) combined with orelabrutinib and selinexor in the treatment of relapsed/refractory primary or secondary central nervous system lymphoma (r/r CNSL). Secondary Objective To assess the benefit-risk balance of methotrexate (MTX) or thiotepa (for MTX intolerance) or temozolomide (TMZ) combined with orelabrutinib and selinexor in combination with chemotherapy in the clinical management of relapsed/refractory primary or secondary central nervous system lymphoma (r/r CNSL). Patients with relapsed/refractory primary or secondary CNSL (PCNSL/SCNSL) who meet the inclusion criteria will be enrolled. Previous study data indicate that the combination of orelabrutinib with methotrexate or temozolomide in the treatment of relapsed/refractory central nervous system lymphoma can achieve an ORR of 60%. It is anticipated that the addition of selinexor will increase the ORR to 75%. The treatment effect in r/r CNSL patients is expected to be superior to that of chemotherapy-based combination regimens (one-sided test). With a one-sided alpha = 0.025, beta = 0.1, and an expected enrollment completion within 12 months, along with a follow-up period of 24 months, the planned sample size is 23 patients. Accounting for a 10% dropout rate, the corrected sample size for this study is 25 patients. Patients who meet the inclusion/exclusion criteria and provide signed informed consent will be enrolled in the experimental group. Each treatment cycle lasts 3 weeks. After 6 cycles of induction therapy, patients who do not achieve a PR or experience disease progression at any time will withdraw from the study and receive salvage therapy. Patients who achieve CR or PR will undergo autologous transplantation if they are young and eligible for transplantation. For patients with TP53 mutations, selinexor will be incorporated into the transplant conditioning regimen. Patients who are ineligible for transplantation will receive consolidative radiotherapy. After consolidative therapy, maintenance treatment with orelabrutinib may be administered based on treatment response and patient tolerance. For patients with TP53 mutations, selinexor will be added to orelabrutinib maintenance therapy. For patients with SD/PD, subsequent treatment will be determined by the investigator, followed by observation and follow-up for up to 3 years. Experimental Group Regimen: Induction Therapy: Orelabrutinib 150 mg once daily, selinexor 40 mg weekly, methotrexate 3.5 g/m² (for patients intolerant or resistant to methotrexate: temozolomide 150 mg/m² or thiotepa 30-40 mg/m² may be used as alternatives). Each cycle lasts 3 weeks, for a total of 6 cycles. Maintenance Therapy: Non-TP53mut patients without transplantation: After consolidative radiotherapy, maintenance therapy with orelabrutinib 150 mg once daily may be administered. TP53mut patients without transplantation: After consolidative radiotherapy, maintenance therapy with orelabrutinib 150 mg once daily combined with selinexor 40 mg weekly may be administered.

Key facts

Study ID: NCT07191431
Run by: Ruijin Hospital
People needed: 25
Starts: 2025-09-22
Expected to finish: 2029-09-02
Last updated by the study team: 2025-09-24

Who can join

Age: 14 and older, up to 80. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Patients must meet all of the following criteria to be enrolled in this study:
Fully understand this study and voluntarily sign the informed consent form;
Age: 14-80 years;
Life expectancy judged by the investigator to exceed 3 months;
B-cell origin central nervous system lymphoma (CNSL) confirmed by pathology or flow cytometry (histology or cytology);
Relapsed or refractory PCNSL or SCNSL: Must have received at least one prior systemic therapy for CNS lesions; number of relapses is not restricted;
Any non-hematological toxicity related to prior treatment should have recovered to Grade 1 or normal (according to NCI CTCAE version 5.0, except alopecia).
Bone marrow and organ function meeting the following criteria (no transfusion, no G-CSF use, no medication for correction within 14 days before screening):
Bone marrow function: Absolute neutrophil count ≥1.0x10⁹/L, platelets ≥50x10⁹/L, hemoglobin ≥60g/L;Liver function: Serum total bilirubin ≤1.5xULN (≤3.0xULN if liver metastases present); AST and ALT ≤ 2.5xULN (≤5.0xULN if liver metastases present);Coagulation function: International Normalized Ratio (INR) and activated partial thromboplastin time ≤1.5xULN;Renal function: Serum creatinine ≤1.5xULN or estimated creatinine clearance ≥30 mL/min (Male: Cr (mL/min) = (140 - age) x weight (kg) / (72 x serum creatinine (mg/dL)); Female: Cr (mL/min) = (140 - age) x weight (kg) / (85 x serum creatinine (mg/dL))).
Female subjects of childbearing potential and male subjects with reproductive ability, who have no pregnancy plan with their partners during the study period and for 3 months after treatment interruption, must use one of the following effective contraceptive methods throughout the study and for 3 months after treatment interruption: abstinence, physical contraception (e.g., ligation, condoms, etc.), hormonal contraceptive drugs started at least 3 months before the first dose in the study. Male subjects are prohibited from sperm donation from the start of treatment until 3 months after treatment cessation. The patient or their legal guardian voluntarily signs the informed consent form.
Good compliance, willing to adhere to the visit schedule, dosing plan, laboratory tests, and other trial procedures.

You may not qualify if…

Patients who meet any of the following criteria will not be allowed to enter this study:
Contraindication to any drug in the treatment regimen;
Subject has a history of active liver disease, including viral or other hepatitis or cirrhosis (Hepatitis B defined as HBV-DNA above the upper limit of normal; active Hepatitis C defined as seropositive for HCV antibody, but those with negative HCV-RNA can be enrolled);
Human Immunodeficiency Virus (HIV) infection;
Congestive heart failure (New York Heart Association Class >2); history of acute myocardial infarction, unstable angina, stroke, or transient ischemic attack within the past six months;
Hereditary long QT syndrome or QTc >480ms (Note: QTc interval must be calculated using Fridericia's formula, QTcF = QT/(RR)\^0.33);
Pregnant and lactating women, or those planning to become pregnant during the study period;
Clear history of neurological or psychiatric disorders, or history of psychotropic drug abuse or drug addiction;
Clinically significant active infection.

Where it is running

Ruijin Hospital, Shanghai Jiao Tong University School of Medicine — Shanghai, Shanghai Municipality, China (enrolling)

Full record on ClinicalTrials.gov

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