Dr. Dimopoulos on the Evolution of Selinexor in Multiple Myeloma

Meletios A. Dimopoulos, MD, professor and chairman of the Department of Clinical Therapeutics at the University Athens School of Medicine, Athens, Greece, discusses the evolution of selinexor in multiple myeloma.

Selinexor is an oral, selective inhibitor of nuclear export that blocks exportin 1, that leads to the nuclear accumulation and reactivation of tumor suppressor proteins. The drug had shown activity when used in combination with low-dose dexamethasone in the phase 2 STORM trial. In July 2019, the FDA granted an accelerated approval to selinexor for use in combination with dexamethasone for the treatment of adult patients with relapsed/refractory multiple myeloma who have received at least 4 prior therapies and whose disease is refractory to at least 2 proteasome inhibitors, at least 2 immunomodulatory agents, and a CD38-targeted monoclonal antibody.

The next logical step was to evaluate the drug in combination with other active agents in earlier lines of therapy, says Dimopoulos. To that end, the phase 3 BOSTON trial was launched and patients who had received between 1 and 3 prior lines of therapy were randomized to receive the combination of selinexor plus bortezomib (Velcade) and dexamethasone or bortezomib and dexamethasone alone. The results of the trial were presented during the 2020 ASCO Virtual Scientific Program.