Effect of age and frailty on the efficacy and tolerability of once‐weekly selinexor, bortezomib, and dexamethasone in previously treated multiple myeloma
Year: 2021
Type: article
Abstract: Elderly and frail patients with multiple myeloma (MM) are more vulnerable to the toxicity of combination therapies, often resulting in treatment modifications and suboptimal outcomes. The phase 3 BOSTON study showed that once-weekly selinexor and bortezomib with low-dose dexamethasone (XVd) improved PFS and ORR compared with standard twice-weekly bortezomib and moderate-dose dexamethasone (Vd) in patients with previously treated MM. This is a retrospective subgroup analysis of the multicenter, prospective, randomized BOSTON trial. Post hoc analyses were performed to compare XVd versus Vd safety and efficacy according to age and frailty status (<65 and ≥65 years, nonfrail and frail). Patients ≥65 years with XVd had higher ORR (OR 1.77, p = .024), ≥VGPR (OR, 1.68, p = .027), PFS (HR 0.55, p = .002), and improved OS (HR 0.63, p = .030), compared with Vd. In frail patients, XVd was associated with a trend towards better PFS (HR 0.69, p = .08) and OS (HR 0.62, p = .062). Significant improvements were also observed in patients <65 (ORR and TTNT) and nonfrail patients (PFS, ORR, ≥VGPR, and TTNT). Patients treated with XVd had a lower incidence of grade ≥ 2 peripheral neuropathy in ≥65 year-old (22% vs. 37%; p = .0060) and frail patients (15% vs. 44%; p = .0002). Grade ≥3 TEAEs were not observed more often in older compared to younger patients, nor in frail compared to nonfrail patients. XVd is safe and effective in patients <65 and ≥65 and in nonfrail and frail patients with previously treated MM.
Source: American Journal of Hematology
DOI: 10.1002/ajh.26172
Authors: Holger W. Auner, Maria Gavriatopoulou, Sosana Delimpasi, Maryana Simonova, Ivan Spicka, Ludek Pour, Meletios A. Dimopoulos, Iryna Kriachok, Halyna Pylypenko, Xavier Leleu, Vadim Doronin, Ganna Usenko, Roman Hajek, Reuben Benjamin, Tuphan Kanti Dolai, Dinesh Kumar Sinha, Christopher P. Venner, Mamta Garg, Don Ambrose Stevens, Hang Quach, Sundar Jagannath, Phillipe Moreau, Moshe Levy, Ashraf Badros, Larry D. Anderson, Nizar J. Bahlis, Thierry Facon, Maria Victoria Mateos, Michele Cavo, Yi Chai, Melina Arazy, Jatin Shah, Sharon Shacham, Michael G. Kauffman, Paul G. Richardson, Sebastian Grosicki
Institutions: Imperial College London, National and Kapodistrian University of Athens, Alexandra Hospital, Evangelismos Hospital, Institute of Blood Pathology and Transfusion Medicine of the National Academy of Medical Sciences of Ukraine, National Academy of Medical Sciences of Ukraine, Charles University, University Hospital Brno, National Cancer Institute, Inserm, Centre Hospitalier Universitaire de Poitiers, City Clinical Hospital, Moscow Multidisciplinary Clinical Center "Kommunarka", University of Ostrava, University Hospital Ostrava, King's College Hospital NHS Foundation Trust, Nil Ratan Sircar Medical College and Hospital, Medical College and Hospital, Kolkata, Indira Gandhi Institute of Medical Sciences, University of Alberta, Cross Cancer Institute, University Hospitals of Leicester NHS Trust, Norton Healthcare, The University of Melbourne, St Vincent's Hospital Melbourne, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Centre Hospitalier Universitaire de Nantes, Baylor University Medical Center, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, University of Calgary, Centre Hospitalier Universitaire de Lille, Complejo Hospitalario de Salamanca, University of Bologna, Karyopharm Therapeutics (United States), Dana-Farber Cancer Institute, Medical University of Silesia
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,500
Funder: Karyopharm Therapeutics
OpenAlex ID: W3137319952