Dr. Vij on the Integration of Selinexor in Relapsed/Refractory Multiple Myeloma

Ravi Vij, MD, MBA, professor, Department of Medicine, Oncology Division, Section of Bone Marrow Transplantation and Leukemia, Washington University School of Medicine, medical director, Siteman Cancer Center, Barnes West County Hospital, Barnes St. Peter’s Hospital, South County Satellite, discusses the integration of selinexor (Xpovio) into the relapsed/refractory multiple myeloma armamentarium.

Selinexor, an XPO1 inhibitor, has demonstrated utility in patients with triple-class refractory multiple myeloma, says Vij. The agent was first approved in June 2019 for use in combination with dexamethasone in patients with relapsed/refractory disease who have received 4 or more prior therapies and whose disease is refractory to 2 or more proteasome inhibitors, 2 or more immunomodulatory agents, and a CD38-directed monoclonal antibody.

However, findings from the phase 3 BOSTON trial led to the December 2020 FDA approval of selinexor in combination with bortezomib (Velcade) and dexamethasone for patients with multiple myeloma who have received at least 1 prior therapy. Notably, this once-weekly regimen appears to confer greater efficacy and less neuropathy vs twice-weekly bortezomib and dexamethasone alone, says Vij.

Additionally, since the integration of the agent into the multiple myeloma armamentarium, the field has become more comfortable with managing selinexor-related toxicities, says Vij. Patients receiving selinexor may require antiemetic agents, appetite stimulants, and antidiarrheal agents to manage toxicities, says Vij. Dose monitoring, intravenous fluids, and growth factor support may be required in heavily pretreated patients, concludes Vij.