The following is a summary of “Optimal timing and drug combination of selinexor in multiple myeloma: a systematic review and meta-analysis,” published in the March 2023 issue of Hematology by Gu, et al.

Despite improvements in available therapies, multiple myeloma (MM) was an untreatable illness. Therefore, for a systematic review and meta-analysis, researchers sought to assess the efficacy of selinexor in treating relapsed/refractory multiple myeloma (RRMM) and to determine the optimal timing and drug combination for selinexor treatment.

The study included clinical trials and real-world studies that involved patients with multiple myeloma treated with selinexor. The pooled risk ratio (RR) was calculated to compare the rates with a 95% CI and p-value assessment. A random-effects model was used for a conservative evaluation.

A total of 16 studies, comprising 817 patients, were included. Selinexor usage as fifth-line or prior therapy had a higher objective response rate (ORR) (65.9% versus 23.4%, P < 0.01). In addition, it longer pooled progression-free survival (PFS) (median: 12.5 months versus 2.9 months, P < 0.01) than post-fifth-line usage. When compared to post-fifth-line usage, early usage produced a consistent trend of pooled overall survival (median: 22.7 months versus 8.9 months, P = 0.26). In comparison to the Xd-only regimen for RRMM, selinexor and dexamethasone (Xd) plus protease inhibitors (PIs) or immunomodulatory drugs (IMiDs) both produced better ORRs of 56.1%, 52.5%, and 24.6%, respectively (P< 0.01).

Selinexor has shown promising efficacy for RRMM treatment. Using selinexor as the fifth-line or prior therapy is more effective than post-fifth-line usage. The combination of selinexor and dexamethasone with PIs or IMiDs is recommended for treating RRMM.