Common brand names

• Xpovio

How it is administered

Selinexor is taken by mouth (orally) as a tablet. It is available in several strengths: 10 mg, 20 mg, 40 mg, 50 mg, and 60 mg. The tablets should be swallowed whole with water and should not be broken, chewed, crushed, or divided. The dosing schedule depends on the specific blood cancer being treated and whether selinexor is used alone or in combination with other medications.

How it works

Selinexor is a nuclear export inhibitor. It works by blocking a protein called exportin 1 (XPO1), which is responsible for transporting certain proteins, including tumor suppressor proteins, out of the cell nucleus. By inhibiting XPO1, selinexor causes these tumor suppressor proteins to accumulate in the nucleus, where they can help control cell growth and trigger the death of cancer cells.

This mechanism leads to cell cycle arrest and apoptosis (programmed cell death) of cancer cells. Selinexor has shown pro-apoptotic activity in multiple myeloma cells and anti-tumor activity in animal models of multiple myeloma and diffuse large B-cell lymphoma (DLBCL). It may also reduce levels of certain oncoproteins, such as c-myc and cyclin D1, which are involved in cancer cell growth.

Who should take it

Selinexor is used to treat adults with certain types of blood cancers:

• In combination with bortezomib and dexamethasone for adults with multiple myeloma who have received at least one prior therapy.
• In combination with dexamethasone for adults with relapsed or refractory multiple myeloma who have received at least four prior therapies and whose disease is resistant to at least two proteasome inhibitors, two immunomodulatory agents, and an anti-CD38 monoclonal antibody.
• As a single agent for adults with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), including DLBCL arising from follicular lymphoma, after at least two lines of systemic therapy.

Selinexor is generally prescribed when other treatments have not worked or when the disease has come back after previous treatments.

Who should not take it

There are no absolute contraindications listed for selinexor. However, it should not be used in patients who are allergic to selinexor or any of its ingredients.

Caution is advised in patients who are pregnant, as selinexor can cause fetal harm. Women of reproductive potential and men with partners of reproductive potential should use effective contraception during treatment and for one week after the last dose. The safety and effectiveness of selinexor in children have not been established. Patients with severe side effects or those who cannot tolerate the medication may need to stop treatment.

Commonly used with

Selinexor is commonly used in combination with other medications for blood cancers:

• With bortezomib (a proteasome inhibitor) and dexamethasone (a corticosteroid) for multiple myeloma.
• With dexamethasone alone for multiple myeloma in patients who have received several prior therapies.

Supportive medications, such as anti-nausea drugs (5-HT3 receptor antagonists), are often recommended to help manage side effects.

Commonly tested with

In clinical studies, selinexor has been tested:

• In combination with bortezomib and dexamethasone for multiple myeloma.
• In combination with dexamethasone for multiple myeloma.
• As a single agent for diffuse large B-cell lymphoma (DLBCL).

Other supportive medications, such as antiemetics and growth factors, are often used alongside selinexor in clinical trials to help manage side effects.