BOSTON Trial: Survival Outcomes With Selinexor in Elderly Patients With Multiple Myeloma
Posted: Wednesday, August 11, 2021
During the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, Thierry Facon, MD, PhD, of the University of Lille, CHU Lille, Service des Maladies du Sang, France, and colleagues presented post hoc analyses from the phase III BOSTON study, which evaluated survival outcomes by age with the small-molecule selinexor, bortezomib, and dexamethasone (Abstract 8019). Their findings demonstrated improved progression-free survival and overall response, with reduced peripheral neuropathy, in older patients (≥ 65) with a poor prognosis.
This phase III trial enrolled 402 patients with multiple myeloma who received one to three prior lines of treatment. Participants were randomly assigned to receive either bortezomib and dexamethasone twice weekly or selinexor, bortezomib, and dexamethasone once weekly.
Among the patients in the selinexor combination group, 109 were 65 years of age or older, compared with 86 patients in the bortezomib/dexamethasone group. The median progression-free survival increased in patients given selinexor compared with those who were not in both age groups. In patients aged 65 and older, the triplet correlated with a higher overall response rate (76.1%) when compared with the doublet (64.4%); a similar pattern was observed in those younger than 65 (76.7% vs. 58.7%).
The median overall survival was not reached in the overall population or in patients older than 65 who were given selinexor, but it was 28.6 months for those who did not receive the small molecule; there was no observed difference for participants younger than 65. Additionally, patients 65 and older had a lower incidence of mortality with the triplet than with the doublet, but treatment-emergent adverse events appeared to affect both age groups similarly. Of note, cases of peripheral neuropathy of any grade were significantly lower with selinexor than without it among participants in both age groups.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.