The HemOnc Pulse XPO1 Inhibition Across the Myeloma Journey
Dec 26, 2025
Dr. Paul G. Richardson, a leading expert in multiple myeloma from Dana-Farber, shares his insights on innovative treatment strategies involving XPO1 inhibition. He dives into the evolution of selinexor, discussing its flexible use in relapsed multiple myeloma cases, particularly how it can serve as a bridge to CAR T therapies. Dr. Richardson highlights real-world patient scenarios and emphasizes the importance of personalized treatment plans to optimize outcomes. He also reveals promising data on selinexor in combination with emerging therapies, showcasing its potential for rapid responses.
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Why XPO1 Is A High-Value Target
- XPO1 inhibition blocks nuclear export to restore tumor suppressor function and disrupt cancer growth signaling.
- This pathway enables myeloma resistance, especially in 17p-deleted disease, making it a high-value target.
Selinexor's Clinical Strengths
- Selinexor is orally bioavailable and shifted from twice-weekly to a weekly schedule to improve tolerability.
- Combining selinexor with agents like bortezomib or carfilzomib yields strong activity and manageable toxicity.
Proactively Manage Selinexor Side Effects
- Be proactive with antiemetics, hydration, sodium monitoring, and use olanzapine (Zyprexa) to prevent falling behind on selinexor tolerability.
- Start at 40–80 mg weekly, aiming for a 60–80 mg sweet spot but individualize dose based on tolerance.