All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit the Lymphoma Coalition.
Introducing
Now you can personalise
your Lymphoma Hub experience!
Bookmark content to read later
Select your specific areas of interest
View content recommended for you
Find out moreThe Lymphoma Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the Lymphoma Hub cannot guarantee the accuracy of translated content. The Lymphoma Hub and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.
The Lymphoma & CLL Hub is an independent medical education platform, sponsored by Beigene and Roche, and supported through educational grants from Bristol Myers Squibb, Ipsen Biopharmaceuticals, Lilly, Pfizer, and Pharmacyclics LLC, an AbbVie Company and Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC View funders.
Bookmark this article
On June 22, 2020, the U.S. Food and Drug Administration granted approval to selinexor for the treatment of adult patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL), not otherwise specified, including DLBCL arising from follicular lymphoma, after ≥ 2 prior lines of systemic therapy.1
The accelerated approval of this first-in-class, oral, selective inhibitor of nuclear export (SINE) compound was based on results from the phase IIb SADAL study (NCT02227251). The FDA’s Accelerated Approval program granted approval based on response rates, and continued approval for the R/R DLBCL indication may depend on verification and description of clinical benefit in confirmatory trials.
The SADAL trial evaluated 134 patients with R/R DLBCL who had a median of two prior lines of systemic therapies (range, 1–5). Selinexor was administered orally at a fixed dose of 60 mg, twice weekly, for a 4-week cycle. The primary endpoint of overall response rate was met: the overall response rate was 29%, including a complete response rate of 13% and partial response rate of 16%. A key secondary endpoint was the median duration of response; 56% of patients maintained a response at 3 months, 38% at 6 months, and 15% at 12 months.
All 134 patients were included in the safety analyses. The most common treatment-related adverse events were cytopenias, gastrointestinal symptoms, and constitutional symptoms. These were managed with dose alterations and/or standard supportive care. The most common non-hematologic adverse events were mostly Grade 1 and 2 events, and included fatigue (63%), nausea (57%), decreased appetite (37%), and diarrhea (37%). Laboratory abnormalities of Grade 3 and 4 that occurred in ≥ 15% of patients were thrombocytopenia, lymphopenia, neutropenia, anemia, and hyponatremia. Laboratory abnormalities of Grade 4 that occurred in ≥ 5% of patients included thrombocytopenia (18%), lymphopenia (5%), and neutropenia (9%).
As part of the FDA Accelerated Approval process, an additional trial—the XPORT-DLBCL-030 trial (NCT04442022)—could be used as the confirmatory study for evaluating selinexor in DLBCL. This study aims to assess the efficacy of selinexor vs placebo combined with the standard backbone immunochemotherapy of rituximab–gemcitabine–dexamethasone–platinum (R-GDP) in patients with R/R DLBCL. This study is anticipated to begin by the end of 2020.
Earlier on in the year, the FDA accepted the supplemental new drug application filing for selinexor as a treatment for R/R DLBCL; click here to read about it. Selinexor has also previously received both orphan drug and Fast Track designations from the FDA for the treatment of patients with relapsed or refractory DLBCL.
Understanding your specialty helps us to deliver the most relevant and engaging content.
Please spare a moment to share yours.
Please select or type your specialty
Your opinion matters
Subscribe to get the best content related to lymphoma & CLL delivered to your inbox