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New survival data from the Phase 3 BOSTON study, a multi-center, randomised study that evaluated 402 adult patients with relapsed or refractory multiple myeloma who had received one to three prior lines of therapy, was recently presented at the European Hematology Association (EHA) Congress 2023.
It showed a significant 71% reduction in risk of disease progression or death in the elinexor, bortezomib, and dexamethasone (SVd) arm versus bortezomib and dexamethasone (Vd) arm.
Further data showed a significant 47% reduction in risk of death with SVd versus Vd in multiple myeloma patients who are refractory to treatment with lenalidomide.
In patients with just one prior line of treatment, median progression-free survival (mPFS) was 21 months for those treated with SVd, versus 10.7 months for those treated with Vd alone (HR 0.62). In proteasome inhibitor (PI)-naïve patients, the mPFS was 29.5 months with SVd compared to 9.7 months with Vd alone (HR 0.29).
In patients who were refractory to lenalidomide, overall survival was 26.7 months for the SVd arm, compared to 18.6 months for the Vd arm (HR 0.53). These efficacy analyses were based on the final data cut from the BOSTON trial in February 2021, representing a one-year update of previously presented data from 2020.
Professor Maria-Victoria Mateos, MD, PhD, University Hospital Salamanca, Spain, said: “The data presented emphasise the synergy between selinexor and bortezomib, highlighting the importance of a double mode of action switch. These results are particularly relevant considering the increased use of the daratumumab lenalidomide dexamethasone combination in clinical practice.
“These findings further support the use of selinexor in combination with bortezomib in PI / bortezomib-naïve or lenalidomide-refractory RRMM patients, as well as for patients at first relapse.”
Multiple myeloma remains incurable
Multiple myeloma is an incurable cancer with significant morbidity and the second most common hematologic malignancy. According to the World Health Organization, in 2020, there were approximately 51,000 new cases and 32,000 deaths from multiple myeloma in Europe.
While the treatment of multiple myeloma has improved over the last 20 years, and overall survival has increased considerably, the disease remains incurable, and nearly all patients will eventually relapse and develop disease that is refractory to all approved anti-myeloma therapies. Therefore, there continues to be a high unmet medical need for new therapies, particularly those with novel mechanisms of action.
Selinexor (Nexpovio) is a first-in-class, oral exportin 1 (XPO1) inhibitor. It functions by selectively binding to and inhibiting the nuclear export protein exportin 1 (XPO1, also called CRM1).
