Can Xpovio be used with dexamethasone alone for heavily pretreated relapsed Multiple Myeloma?
For patients with heavily pretreated relapsed or refractory multiple myeloma (RRMM), treatment options become limited. Xpovio (selinexor) is a targeted therapy that works by blocking exportin-1, a protein that helps cancer cells survive. The FDA has approved selinexor in combination with dexamethasone specifically for patients who have received at least four prior therapies and whose disease is resistant to multiple drug classes, including proteasome inhibitors, immunomodulatory agents, and an anti-CD38 antibody. This approval was based on the STORM trial, which showed that this two-drug combination can produce meaningful responses in this difficult-to-treat population.
What the research says
The FDA label for Xpovio (selinexor) explicitly states that it is indicated, in combination with dexamethasone, for adult patients with relapsed or refractory multiple myeloma who have received at least four prior therapies and whose disease is refractory to at least two proteasome inhibitors, at least two immunomodulatory agents, and an anti-CD38 monoclonal antibody 1. This approval was supported by the phase 2 STORM trial, which demonstrated that the selinexor-dexamethasone (Sd) combination achieved an overall response rate of about 26% in heavily pretreated patients, with a median duration of response of 4.4 months 10. A systematic review of selinexor-based regimens confirmed that selinexor in combination with dexamethasone is a viable option for heavily pretreated triple-class refractory RRMM 9. The review also noted that selinexor combination therapy is both safe and effective for pretreated RRMM patients 9. While triplet combinations (e.g., selinexor plus bortezomib and dexamethasone) have shown improved outcomes in some settings, the Sd doublet remains an important option for patients who cannot tolerate or have exhausted other agents 910. Common side effects include nausea, fatigue, and low blood counts, which are manageable with supportive care 10.
What to ask your doctor
- Given my treatment history, am I eligible for selinexor plus dexamethasone based on the FDA criteria?
- What are the expected benefits and side effects of the selinexor-dexamethasone combination for my situation?
- How does this regimen compare to other options I might have, such as clinical trials or triplet therapies?
- What supportive care measures (e.g., anti-nausea medications, growth factors) would I need to manage potential side effects?
- How will we monitor my response to treatment and decide if it is working?
This question is drawn from common patient questions about Hematology and answered using cited medical research. We do not provide individualized advice.