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COMy 2025 | Selinexor dose reduction in patients with len-refractory myeloma: BOSTON trial subgroup analysis
Sosana Delimpasi, MD, General Hospital Evangelismos, Athens, Greece, presents the findings of a subgroup analysis of the BOSTON trial (NCT03110562), which assessed the feasibility of selinexor dose reduction in patients with lenalidomide (len)-refractory multiple myeloma (MM) receiving the SVD regimen (selinexor, bortezomib, dexamethasone). Dr Delimpasi highlights that a lower dose of selinexor may benefit patients, resulting in improved progression-free survival (PFS), overall response rate (ORR), and duration of response when compared to the standard dose. This interview took place at the 11th World Congress on Controversies in Multiple Myeloma (COMy) congress in Paris, France.
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Transcript
Actually, the sub-analysis of the Boston study SVD versus VD showed that 52 patients who were refractory to lenalidomide did exceptionally well with selinexor VD. And the meta-analysis of this cohort showed that patients who received a lower dose of selinexor, that was not in the recommended dose of 100 milligrams once weekly but in lower dosing, had better results in respect to progression-free survival, overall response rate and also duration of response...
Actually, the sub-analysis of the Boston study SVD versus VD showed that 52 patients who were refractory to lenalidomide did exceptionally well with selinexor VD. And the meta-analysis of this cohort showed that patients who received a lower dose of selinexor, that was not in the recommended dose of 100 milligrams once weekly but in lower dosing, had better results in respect to progression-free survival, overall response rate and also duration of response. Actually in this cohort of 52 patients, 35 patients had dose adjustments and 18 patients had followed the full regimen and actually patients that had dose adjustments had the progression-free survival of 13.1 months against four months which was an incredible result. And also the adverse events were less. So we propose that these dose adjustments are very meaningful for this regimen.
Also the main reason that patients don’t use selinexor is the adverse events like not hematological adverse events but events of other systems and the usually gastrointestinal adverse events. So it has been shown that when from 100 milligrams the starting dose would be 60 or 80 milligrams once weekly, these adverse events may fade and then the patients can stay longer on treatment.
I believe that this regimen is a very good one especially in the patients that are triple class refractory even from the first line of treatment. Now that we use all three cluster regimens up front and every patient would be a perfect candidate for this treatment once the problem with the gastrointestinal adverse events is resolved.
Of course, there is also sometimes neutropenia and also there is thrombocytopenia, mainly due to Velcade, but these are some adverse events that can be easily managed from the hematologist’s side. And also Velcade is also once weekly, which is much better for the patients because they don’t experience so much peripheral neuropathy and also thrombocytopenia.
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Disclosures
Advisory: GSK, J&J; Speaker: J&J, AOP PHARMA,TAKEDA.
