Dose Reduction of Xpovio Improves Safety and Optimizes Patient Outcomes in Myeloma

A dose reduction of Xpovio (selinexor), when given in combination with Velcade (bortezomib) and dexamethasone, led to promising outcomes in patients with multiple myeloma, highlighting the importance of decreasing doses (when appropriate) to optimize patient outcomes.

The findings came from the BOSTON trial, and will be presented at the 2021 American Society of Hematology Annual Meeting. In an interview with CURE®, Dr. Sundar Jagannath, Director of the Center of Excellence for Multiple Myeloma and a professor of medicine at The Tisch Cancer Institute in New York, explained why reducing the dose of a drug doesn’t mean patients are getting less benefit.

“Because you adjust the dose of the drug, the efficacy doesn't go down,” Jagannath said. “And because now it is tolerable, actually, the patients stay on the drug longer. And because they stay on the drug longer, they are able to control the disease much longer and more deeper responses are achieved, because they are able to stay on the drug longer. And therefore, the duration of response is better.”

Transcription:

What we were surprised to find (was) that the people who got dose reduced because of side effects, as well as the patients who didn't get dose reduced because they didn't experience side effects, there was not a big difference in terms of age, sex of the patient, or type of disease or something like that. So, they were comparable.

The next question that comes up, “OK, so at least they were comparable. So how did the patients who got dose reduced do as compared to patients who didn't have dose reduction?”

(The) most important thing is, was there a reduction in the efficacy as you reduce the dose? And to our surprise, we found out that the patients who had dose reduction actually had a higher response rate; they had a response rate of 81.7%, as compared to 62%.

And not only that, (but) the duration of the response was longer. So that outcome was better — the outcome measured in terms of progression-free survival, or overall survival. So it was actually the progression free survival improved to 17 months compared to nine months.

So this is very important, that means you are able to manage the patient with this new drug in the combination to benefit the patient. You can adjust the dose of the drug, and because you adjust the dose of the drug, the efficacy doesn't go down. And because now it is tolerable, actually, the patients stay on the drug longer. And because they stay on the drug longer, they are able to control the disease much longer and more deeper responses are achieved, because they are able to stay on the drug longer. And therefore, the duration of response is better.

So what we found (were) surprises — dose adjustment actually benefited the patient. So the message (that) is going to be put out in the American Society of Hematology Meeting, is for hematologist oncologists, and to let them know because they are all physicians that yes, you can use this drug safely, you can dose reduce without worrying about efficacy going down. So that was the importance of this particular abstract.

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