Selinexor-Based Triplet in Myeloma: Impact of Age and Frailty in BOSTON Trial
Posted: Tuesday, May 25, 2021
In the multicenter phase III BOSTON trial, patients with previously treated multiple myeloma seemed to benefit from treatment with once‐weekly selinexor plus bortezomib and low‐dose dexamethasone compared with standard twice‐weekly bortezomib and moderate‐dose dexamethasone. Holger W. Auner, MD, PhD, of the Imperial College London, United Kingdom, and colleagues conducted a retrospective subgroup analysis to compare the safety and efficacy of these treatments based on age and frailty status. Their findings were published in the American Journal of Hematology.
“Elderly and frail patients with multiple myeloma are more vulnerable to the toxicity of combination therapies,” the investigators commented. “The use of [the once-weekly regimen] in older and frail patient populations is effective, safe, tolerated, and manageable.”
In this trial, a total of 402 patients were randomly assigned to receive the once- or twice-weekly regimen. Patients older than 65 who received the once‐weekly regimen seemed to have significantly higher very good partial response and objective response rates than those who received the twice-weekly regimen; they also appeared to derive a significant progression-free and overall survival benefit. In frail patients, treatment with the once‐weekly regimen seemed to be associated with a trend toward improved survival outcomes. The objective response rate and the time to next treatment seemed to significantly improve in patients younger than 65. In nonfrail patients, the investigators reported significant improvements in progression-free survival, objective response rate, very good partial response rate, and time to next treatment.
Peripheral neuropathy of grade 2 or higher was observed significantly less frequently in frail patients and in those older than age 65 who were treated with the once‐weekly regimen. The rates of treatment-related adverse events of grade 3 or higher did not appear to differ based on age or frailty status.
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