What is Better for Patients with Multiple Myeloma?

Bortezomib, dexamethasone, and Selinexor once-per-week versus bortezomib and dexamethasone twice-per-week.

Cancer is a horrible, insidious disease, and multiple myeloma is no different. While treatments are available for individuals with this illness, the quest to develop more effective methods is a never-ending one. As such, doctors and researchers alike continue to test new strategies as they search for better multiple myeloma treatments.

The standard treatment for patients who have been previously treated for multiple myeloma is a twice-weekly administration of bortezomib and dexamethasone. However, the use of Selinexor with dexamethasone has shown promise in such patients, leading to the theory that adding Selinexor to the combination of bortezomib and dexamethasone may be an effective method of treatment.

With this potential improvement in mind, researchers conducted a trial to test it.

The Study

121 sites in 21 countries were included in this randomized, open-label trial. To be included, patients with multiple myeloma had to be 18-years old or older and be previously treated with qualifying treatment methods.

402 of the eligible patients were randomly allocated to two groups. The first would receive bortezomib, dexamethasone, and Selinexor, while the second would receive bortezomib and dexamethasone. These treatments began as early as June 2017, and the last initial dose was administered in February 2019. As of February 2020, 55 patients remain in the ongoing trial.

Findings

The most common adverse events of grade three or four that occurred were thrombocytopenia, fatigue, anemia, and pneumonia. In the bortezomib, dexamethasone, and Selinexor group, these events occurred at rates of 39%, 13%, 16%, and 11%, respectively. In the bortezomib and dexamethasone group, the rates were 17%, 1%, 10%, and 11%, respectively.

Mortality occurred at a 24% rate among patients in the three-medication group compared to 30% in the two-medication group.

What it Means

For patients who have received one to three previous lines of therapy for multiple myeloma, a treatment strategy of bortezomib, dexamethasone, and Selinexor is convenient and effective, as it only requires one-per-week usage.

While adverse events occurred more frequently in patients assigned to the three-medication group, mortality occurred less often. It should be noted that, as of February 2020, this study is ongoing. As such, more data may emerge regarding both adverse events and mortality.

As it currently stands, a regimen of bortezomib, dexamethasone, and Selinexor is a suitable, more convenient alternative to bortezomib and dexamethasone alone.