Rachid Baz, MD, associate member, head of the Myeloma Section at Moffitt Cancer Center, discusses the potential use of selinexor (KPT-330) in patients with multiple myeloma.

Physicians at Moffitt Cancer Center have had selinexor in the clinical trial setting for the past 4 to 5 years—since the first phase I trial in hematologic malignancies, says Baz. The agent has demonstrated activity in patients who have penta-refractory disease, though it may be worthwhile to study in combination, explains Baz.

If it was used in combination, it could be given on a once-weekly schedule. Investigational combinations include those with bortezomib (Velcade), carfilzomib (Kyprolis), and lenalidomide (Revlimid), all of which have demonstrated high response rates so far, states Baz. Teasing out where those combinations will fall will be important, explains Baz. It is unlikely that selinexor will be used in combination with dexamethasone.

In July 2018, Karyopharm Therapeutics, the manufacturer of the XPO1 inhibitor, submitted a new drug application to the FDA for the treatment of patients with penta-refractory multiple myeloma.

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Dr. Baz on Selinexor in Multiple Myeloma

Rachid Baz, MD, hematologist and medical oncologist, Moffitt Cancer Center, discusses how treatment approaches vary for patients with multiple myeloma.

Historically, physicians tried to avoid alkylating agents for patients who were eligible for transplant, Baz explains. Now, when considering treatments for elderly patients, the determinant outcome of these patients turns out to be based on fitness or frailty. For patients considered to be frail, a doublet regimen of lenalidomide (Revlimid)/dexamethasone that is dose-adjusted, or a subcutaneous injection of weekly bortezomib (Velcade) and dexamethasone could be choices.

For patients of intermediate fitness, a reasonable treatment would be bortezomib, lenalidomide, and dexamethasone. Emerging, ongoing clinical trials are challenging that data for the future.

Rachid Baz, MD

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Dr. Baz on Selinexor in Multiple Myeloma

Dr. Baz on Varying Treatment Approaches for Patients With Multiple Myeloma