Selinexor–Bortezomib–Dexamethasone: A Review in Previously Treated Multiple Myeloma

Selinexor [Nexpovio® (EU); Xpovio® (USA)] is a first-in-class, selective exportin-1 inhibitor. Oral selinexor once weekly in combination with subcutaneous bortezomib once weekly and oral dexamethasone twice weekly (selinexor-bortezomib-dexamethasone) is approved in the EU and USA for the treatment of adult patients with multiple myeloma who have received at least one prior therapy. In the open-label, randomized, phase 3 BOSTON trial, this regimen significantly prolonged progression-free survival (PFS) compared with the standard bortezomib-dexamethasone regimen in patients with previously treated multiple myeloma. Selinexor-bortezomib-dexamethasone had a generally manageable tolerability profile and an acceptable safety profile in BOSTON, with a lower incidence of peripheral neuropathy (a bortezomib-induced toxicity) compared with bortezomib-dexamethasone. The triplet regimen uses less bortezomib and dexamethasone during the first 24 weeks of treatment. The efficacy and safety profiles of selinexor-bortezomib-dexamethasone, combined with its once-weekly administration of selinexor and bortezomib, make it a useful additional triplet therapy option for previously treated multiple myeloma.Despite the availability of several drug classes, relapse and refractoriness is common in multiple myeloma. Selinexor [Nexpovio® (EU); Xpovio® (USA)] is an oral drug that selectively inhibits exportin-1, a nuclear exporter protein overexpressed in many cancer cells. Selinexor-bortezomib-dexamethasone is approved in the EU and USA for the treatment of adult patients with multiple myeloma who have received at least one prior therapy. In the pivotal BOSTON trial, the triplet regimen significantly prolonged PFS compared with standard bortezomib-dexamethasone regimen in patients with previously treated multiple myeloma, with a generally manageable tolerability profile and an acceptable safety profile. Selinexor-bortezomib-dexamethasone uses less bortezomib and dexamethasone versus standard bortezomib-dexamethasone regimen. Therefore, selinexor-bortezomib-dexamethasone is a useful additional triple treatment option for previously treated multiple myeloma.