Expert Discusses the BOSTON Trial of Selinexor in Multiple Myeloma

Noopur S. Raje, MD, professor of medicine at Harvard Medical School and director of the Multiple Myeloma Program at Massachusetts General Hospital, discusses the results of the BOSTON trial (NCT03110562) of selinexor (Xpovio), bortezomib (Velcade), and dexamethasone in patients with multiple myeloma.

Selinexor, which is an oral selective inhibitor of nuclear export proteins that causes cell death in this disease, had been studied previously in the STORM trial and the STOMP trial, according to Raje. STORM (NCT02336815) served as the basis for the agent’s accelerated approval in 2019. The BOSTON trial is the confirmatory trial.

In the trial, patients were randomized to receive selinexor plus bortezomib and dexamethasone versus bortezomib and dexamethasone alone. A 4-month progression-free survival benefit was observed with the triplet in patients who had received up to 3 lines of treatment. Raje says selinexor is here to stay but feels the physicians in this field are struggling with the dosing and schedule of selinexor and need to better understand how to incorporate the agent with other combinations of therapy. She believes the agent will be used at a different schedule and in a different combination in the future.

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