Exercise no. 312 Selinexor (NEXPOVIO°) in relapsed or refractory multiple myeloma

The drugs used in multiple myeloma mainly belong to four classes: corticosteroids (usually dexamethasone), "immunomodulators" (lenalidomide, pomalidomide or thalidomide), proteasome inhibitors (bortezomib, carfilzomib or ixazomib), and anti-CD38 monoclonal antibodies (daratumumab or isatuximab). Other drugs are sometimes added, in particular cytotoxic drugs such as cyclophosphamide or melphalan. When multiple myeloma is symptomatic, various drug combinations are used, but there is no consensus over which combination to choose. The choice is based on many factors, including: whether or not the conditions are met for an autologous haematopoietic stem cell transplant; the "aggressiveness" of the disease; the patient's age, physical condition and comorbidities; and the treatments already received. The various protocols typically include two to four drugs. For patients with relapsed or refractory multiple myeloma, clinical trials have shown that various combinations of antineoplastic drugs extend survival, e.g. carfilzomib + dexamethasone, daratumumab + bortezomib + dexamethasone, and daratumumab + lenalidomide + dexamethasone. As of mid-2024, the combination of bortezomib + dexamethasone is an option that is sometimes offered.