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

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Abstract

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.

Plain Language Summary

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.

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Acknowledgements

During the peer review process, the manufacturer of selinexor was also offered an opportunity to review this article. Changes resulting from comments received were made on the basis of scientific and editorial merit.

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    Yahiya Y. Syed

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Yahiya Y. Syed is a salaried employee of Adis International Ltd/Springer Nature and declares no relevant conflicts of interest. All authors contributed to the review and are responsible for the article content.

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Additional information

The manuscript was reviewed by: M. Delforge, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium; S. Knop, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany; P. L. McCarthy, Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA; J. Richter, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

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Syed, Y.Y. Selinexor–Bortezomib–Dexamethasone: A Review in Previously Treated Multiple Myeloma. Targ Oncol 18, 303–310 (2023). https://doi.org/10.1007/s11523-022-00945-3

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