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XPOVIO + Vd within 4 different treatment journeys

If you see patients like these in your practice, consider whether introducing a different class could be their next step.

Primary endpoint: mPFS in the ITT population1

mPFS: 13.9 months with XPOVIO + Vd (n=195) vs 9.5 months with Vd alone (n=207); HR, 0.70 (95% CI, 0.53-0.93; P=.0075)

After 13 months, Michelle relapsed

Could XPOVIO + Vd be right for her?

For triple-class exposed patients like Michelle who may benefit from introducing a different class at second relapse, consider XPOVIO + Vd.

Relapsed following 2L therapy

Characteristics:

  • 5-month history of fatigue
  • New-onset hip pain
  • Tenderness upon palpation at the hips and lower back

1L treatment history:

  • RVd (lenalidomide + bortezomib + dexamethasone): 8 cycles
  • Stem cell transplant
  • Maintenance lenalidomide (8 months)

2L treatment history:

  • DPd (daratumumab + pomalidomide + dexamethasone)
  • Continuous therapy with DPd until disease progression

After 30 months, Jon relapsed

Could XPOVIO + Vd be right for him?

Consider a class switch to XPOVIO + Vd for patients at first relapse, including those like Jon, who are over 65 years of age and have not had prior PI exposure.

Sixty-five years or older, with MM that progressed following 1L therapy with an anti-CD38 mAb and has no prior exposure to a proteasome inhibitor

Characteristics:

  • Loss of appetite for 8 weeks
  • Bone pain near chest
  • Muscle weakness upon examination
  • Ineligible for stem cell transplant

1L treatment history:

  • DRd (daratumumab + lenalidomide + dexamethasone): 8 cycles
  • Continuous therapy with DRd until progression

Limitations of subgroup analyses: These subgroup analyses were exploratory in nature, not included in the study objectives, and do not control for type 1 error. These subgroup analyses were not powered or adjusted for multiplicity to assess PFS/ORR across these subgroups.

*These subgroup data are derived from an updated efficacy analysis of the BOSTON trial.

After 28 months, Emily relapsed

Could XPOVIO + Vd be right for her?

For patients like Emily who have renal insufficiency and had prior exposure to daratumumab, consider introducing a different class with XPOVIO + Vd.

Chronic kidney disease and progressed following her 2L therapy with an anti-CD38 mAb

Characteristics:

  • Chronic fatigue
  • New-onset back pain
  • Tenderness upon palpation at the hips and lower back

1L treatment history:

  • RVd (lenalidomide + bortezomib + dexamethasone): 8 cycles
  • Stem cell transplant
  • Maintenance lenalidomide (8 months)

2L treatment history:

  • DKd (daratumumab + carfilzomib + dexamethasone)
  • Continuous therapy with DKd until disease progression

Limitations of subgroup analyses: These subgroup analyses were exploratory in nature, not included in the study objectives, and do not control for type 1 error. These subgroup analyses were not powered or adjusted for multiplicity to assess PFS/ORR across these subgroups.

After 24 months on maintenance, Joseph relapsed

Could XPOVIO + Vd be right for him?

Consider XPOVIO + Vd for patients like Joseph who have high-risk cytogenetics and progressed after an anti-CD38 mAb.

High-risk cytogenetics and progressed following his 1L quadruplet therapy with an anti-CD38 mAb

Characteristics:

  • 3-month history of fatigue
  • High-risk cytogenetics: del[17p]

1L treatment history:

  • DVTd (daratumumab + bortezomib + thalidomide + dexamethasone): 8 cycles
  • Stem cell transplant
  • Maintenance daratumumab

Limitations of subgroup analyses: These subgroup analyses were exploratory in nature, not included in the study objectives, and do not control for type 1 error. These subgroup analyses were not powered or adjusted for multiplicity to assess PFS/ORR across these subgroups.

Next steps
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XVd Trial Results

View the results of the XVd trial, including efficacy observed in certain subgroups.

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Starting XPOVIO

Learn how to start patients on XPOVIO + Vd and how to adjust their dose for ARs, if necessary.

Image portraying Nurse Case Manager and patient living with multiple myeloma. Image portraying Nurse Case Manager and patient living with multiple myeloma.

Patient support starts here

Eligible patients prescribed XPOVIO can enroll in KaryForward®, a patient support program by Karyopharm Therapeutics® Inc.

KaryForward® provides help with insurance information, financial assistance, and guidance from Nurse Case Managers.

Learn More

Abbreviations: 1L, first line; 2L, second line; AR, adverse reaction; CI, confidence interval; CLCR, creatinine clearance; HR, hazard ratio; ITT, intent-to-treat; mAb, monoclonal antibody; MM, multiple myeloma; mPFS, median progression-free survival; NR, not reached; ORR, overall response rate; PFS, progression-free survival; PI, proteasome inhibitor; R-ISS, Revised International Staging System; Vd, bortezomib and dexamethasone; XVd, selinexor, bortezomib, and dexamethasone.

Reference: 1. XPOVIO (selinexor) [prescribing information]. Newton, MA. Karyopharm Therapeutics, Inc.

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INDICATION

XPOVIO® (selinexor) is a prescription medicine approved in combination with bortezomib and dexamethasone (XVd) to treat adult patients with multiple myeloma who have received at least one prior therapy.

IMPORTANT SAFETY INFORMATION

Thrombocytopenia: XPOVIO can cause life-threatening thrombocytopenia, potentially leading to hemorrhage. Thrombocytopenia was reported in patients with multiple myeloma.

Thrombocytopenia is the leading cause of dosage modifications. Monitor platelet counts at baseline and throughout treatment. Monitor more frequently during the first 3 months of treatment. Monitor patients for signs and symptoms of bleeding. Interrupt, reduce dose, or permanently discontinue based on severity of adverse reaction.

Neutropenia: XPOVIO can cause life-threatening neutropenia, potentially increasing the risk of infection.

Monitor more frequently during the first 3 months of treatment. Consider supportive measures, including antimicrobials and growth factors (e.g., G-CSF). Interrupt, reduce dose, or permanently discontinue based on severity of adverse reaction.

Gastrointestinal Toxicity: XPOVIO can cause severe gastrointestinal toxicities in patients.

Nausea/Vomiting/Diarrhea: Provide prophylactic antiemetics or treatment as needed.

Anorexia/Weight Loss: Monitor weight, nutritional status, and volume status at baseline and throughout treatment and provide nutritional support, fluids, and electrolyte repletion as clinically indicated.

Hyponatremia: XPOVIO can cause severe or life-threatening hyponatremia.

Monitor sodium level at baseline and throughout treatment.

Serious Infection: XPOVIO can cause serious and fatal infections. Atypical infections reported after taking XPOVIO include, but are not limited to, fungal pneumonia and herpesvirus infection.

Neurological Toxicity: XPOVIO can cause life-threatening neurological toxicities.

Coadministration of XPOVIO with other products that cause dizziness or mental status changes may increase the risk of neurological toxicity.

Advise patients to refrain from driving and engaging in hazardous occupations or activities, until the neurological toxicity fully resolves. Institute fall precautions as appropriate.

Embryo-Fetal Toxicity: XPOVIO can cause fetal harm when administered to a pregnant woman.

Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential and males with a female partner of reproductive potential to use effective contraception during treatment with XPOVIO and for 1 week after the last dose.

Cataracts: New onset or exacerbation of cataract has occurred during treatment with XPOVIO. The incidence of new onset or worsening cataract requiring clinical intervention was reported.

ADVERSE REACTIONS

The most common adverse reactions (ARs) (≥20%) in patients with multiple myeloma who received XVd were fatigue, nausea, decreased appetite, diarrhea, peripheral neuropathy, upper respiratory tract infection, decreased weight, cataract, and vomiting.

Grade 3-4 laboratory abnormalities (≥10%) were thrombocytopenia, lymphopenia, hypophosphatemia, anemia, hyponatremia and neutropenia.

Fatal ARs occurred in 6% of patients within 30 days of last treatment. Serious ARs occurred in 52% of patients. Treatment discontinuation rate due to ARs was 19%. The most frequent ARs requiring permanent discontinuation in >2% of patients included fatigue, nausea, thrombocytopenia, decreased appetite, peripheral neuropathy and vomiting. Adverse reactions led to XPOVIO dose interruption in 83% of patients and dose reduction in 64% of patients.

USE IN SPECIFIC POPULATIONS

No overall difference in effectiveness of XPOVIO was observed in patients >65 years old when compared with younger patients. Patients ≥65 years old had a higher incidence of discontinuation due to an adverse reaction (AR) and a higher incidence of serious ARs than younger patients.

The effect of end-stage renal disease (CLCR <15 mL/min) or hemodialysis on XPOVIO pharmacokinetics is unknown.

Please see full Prescribing Information.

To report SUSPECTED ADVERSE REACTIONS, contact Karyopharm Therapeutics Inc. at 1-888-209-9326 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

© 2023 Karyopharm Therapeutics Inc.

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