Dr. Borrello on Selinexor in Penta-Refractory Multiple Myeloma

Ivan M. Borrello, MD, associate professor of oncology, Johns Hopkins Medicine, discusses the use of selinexor (Xpovio) in the treatment of patients with penta-refractory multiple myeloma.

In July 2019, the FDA granted an accelerated approval to selinexor for use in combination with dexamethasone in the treatment of patients with relapsed/refractory multiple myeloma whose disease is refractory to ≥2 proteasome inhibitors, ≥2 immunomodulatory agents, and a CD38-targeted monoclonal antibody. The drug has a novel mechanism of action, says Borrello. As an oral selective inhibitor of nuclear export (SINE), evaluating the agent in triplet regimens will open a realm of new possibilities for patients, he adds.

Selinexor is a first-in class SINE inhibitor that can be prescribed overnight, says Borrello; this is in contrast to any cellular-based therapy. For example, with CAR T-cell therapy, patients have to go through leukapheresis to have their T cells collected, after which the cells are sent for manufacturing for a period of 2 to 4 weeks. Once the T cells are returned to the institution, patients have to undergo a period of lymphodepletion before they receive the transfusion of T cells.