Selective inhibition of nuclear export with oral selinexor for treatment of relapsed or refractory multiple myeloma

Dan T. Vogl, David Dingli, Robert Frank Cornell, Carol Ann Huff, Sundar Jagannath, Divaya Bhutani, Jeffrey Zonder, Rachid Baz, Ajay Nooka, Joshua Richter, Craig Cole, Ravi Vij, Andrzej Jakubowiak, Rafat Abonour, Gary Schiller, Terri L. Parker, Luciano J. Costa, David Kaminetzky, James E. Hoffman, Andrew J. YeeAjai Chari, David Siegel, Rafael Fonseca, Scott Van Wier, Gregory Ahmann, Ilsel Lopez, Michael Kauffman, Sharon Shacham, Jean Richard Saint-Martin, Carla D. Picklesimer, Cassandra Choe-Juliak, A. Keith Stewart

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Abstract

Purpose Selinexor, a first-in-class, oral, selective exportin 1 (XPO1) inhibitor, induces apoptosis in cancer cells through nuclear retention of tumor suppressor proteins and the glucocorticoid receptor, along with inhibition of translation of oncoprotein mRNAs. We studied selinexor in combination with low-dose dexamethasone in patients with multiple myeloma refractory to the most active available agents. Patients and Methods This phase II trial evaluated selinexor 80 mg and dexamethasone 20 mg, both orally and twice weekly, in patients with myeloma refractory to bortezomib, carfilzomib, lenalidomide, and pomalidomide (quad-refractory disease), with a subset also refractory to an anti-CD38 antibody (penta-refractory disease). The primary end point was overall response rate (ORR). Results Of 79 patients, 48 had quad-refractory and 31 had penta-refractory myeloma. Patients had received a median of seven prior regimens. The ORR was 21% and was similar for patients with quad-refractory (21%) and penta-refractory (20%) disease. Among patients with high-risk cytogenetics, including t(4;14), t(14;16), and del(17p), the ORR was 35% (six of 17 patients). The median duration of response was 5 months, and 65% of responding patients were alive at 12 months. The most common grade Ö 3 adverse events were thrombocytopenia (59%), anemia (28%), neutropenia (23%), hyponatremia (22%), leukopenia (15%), and fatigue (15%). Dose interruptions for adverse events occurred in 41 patients (52%), dose reductions occurred in 29 patients (37%), and treatment discontinuation occurred in 14 patients (18%). Conclusion The combination of selinexor and dexamethasone has an ORR of 21% in patients with heavily pretreated, refractory myeloma with limited therapeutic options.

Original languageEnglish (US)
Pages (from-to)859-866
Number of pages8
JournalJournal of Clinical Oncology
Volume36
Issue number9
DOIs
StatePublished - Jan 1 2018

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Vogl, D. T., Dingli, D., Cornell, R. F., Huff, C. A., Jagannath, S., Bhutani, D., Zonder, J., Baz, R., Nooka, A., Richter, J., Cole, C., Vij, R., Jakubowiak, A., Abonour, R., Schiller, G., Parker, T. L., Costa, L. J., Kaminetzky, D., Hoffman, J. E., ... Keith Stewart, A. (2018). Selective inhibition of nuclear export with oral selinexor for treatment of relapsed or refractory multiple myeloma. Journal of Clinical Oncology, 36(9), 859-866. https://doi.org/10.1200/JCO.2017.75.5207