Selinexor Combination Therapy for RRMM

Paul G. Richardson, MD: I think what’s very impressive, though, Cristina, is when you combine selinexor with other drugs, and especially when you dose once a week, the challenge of the tolerability becomes far less. What’s particularly interesting is how that informed us regarding the pivotal BOSTON study, which we just presented at ASCO [the American Society of Clinical Oncology annual meeting]. You were a key investigator in the STOMP study, and you had first experience with some of the combination strategies. Was that your experience, too? Basically, when you’re able to administer selinexor weekly and combine it with other drugs, do many of the adverse effect challenges that we dealt with in STORM get mitigated?

Cristina Gasparetto, MD: Absolutely. We were pleasantly surprised with all of the combinations in STOMP. As you know, there were 9 arms. But the idea was to have this new backbone, selinexor/dexamethasone, get combined with different agents. I was surprised, too, because I was afraid that I was not going to be able to support the patients on certain combinations. But the weekly administration was key. In this situation that we found ourselves in with the COVID-19 [coronavirus disease 2019] pandemic, I think having another oral combination is important for some patients. You know, less exposure to the clinic and exposure to other patients. It’s also another important factor to consider when we talk about this drug.

But I agree with you. The toxicity was a different situation.

Paul G. Richardson, MD: I agree.

Cristina Gasparetto, MD: Of course, we learned that we have to go out of the gate with antiemetics, IV [intravenous] fluid, and supportive care, but we were able to support patients. In fact, with some of the combinations, like with daratumumab, I have had patients stay on treatment for over 2 years, or close to 3 years, at a very low dose. It’s amazing.

Paul G. Richardson, MD: I agree. I think that was very much our experience, too. And my experience since the accelerated approval of selinexor last year has been that when we combine it with drugs informed by your study, Cristina, STOMP, specifically bortezomib and carfilzomib, as well as daratumumab, the results have been quite impressive. The results have not only been impressive in terms of the ability to engender response for very aggressive, highly resistant myeloma, but also in terms of the tolerability profile.

Transcript edited for clarity.