What Is Xpovio (Selinexor)?
XPOVIO® (selinexor) is a “nuclear export inhibitor,” the first medication in this drug class to treat myeloma. Nuclear export inhibitors prevent cancer cells from expelling tumor suppressor proteins that help protect the cell from cancer.
How Is Xpovio Used and Who Is a Candidate to Receive It?
Xpovio is used in multiple myeloma in both early relapse and late relapse settings.
In 2019, supported by the results of the phase IIb STORM clinical trial, the U.S. Food and Drug Administration (FDA) approved Xpovio in combination with the steroid dexamethasone (Xd) for the treatment of adult patients with relapsed or refractory multiple myeloma who have received at least four prior therapies and are refractory to at least two proteasome inhibitors, at least two immunomodulatory agents, and an anti-CD38 monoclonal antibody.
In 2020, supported by the results of the BOSTON phase III clinical trial, the FDA approved Xpovio in combination with Velcade® (bortezomib) and dexamethasone (XVd) for multiple myeloma patients who have received at least one prior therapy.
Xpovio is a nuclear export inhibitor indicated:
- In combination with bortezomib and dexamethasone for the treatment of adult patients with multiple myeloma who have received at least one prior therapy.
- In combination with dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma who have received at least four prior therapies and whose disease is refractory to at least two proteasome inhibitors, at least two immunomodulatory agents, and an anti-CD38 monoclonal antibody.
How Is Xpovio Taken?
Xpovio is an oral (taken by mouth) medication in tablet form. Each tablet should be swallowed whole with water. Do not break, chew, crush, or divide the tablets. The recommended dose is 100 mg taken once weekly in combination with bortezomib and dexamethasone OR 80 mg taken orally on Days 1 and 3 of each week in combination with dexamethasone.
Your doctor will monitor your complete blood count (CBC), standard blood chemistry panel, and body weight before you start Xpovio and as needed during treatment.
Prior to and during treatment with Xpovio, you will receive treatment to prevent nausea and vomiting. Be sure to take your anti-nausea medication as a preventive prior to treatment with Xpovio, even if you’re not experiencing nausea.
It is very important to maintain good intake of food and fluids throughout your treatment with Xpovio.
Warnings and Precautions When Taking Xpovio
Thrombocytopenia: Monitor platelet counts throughout treatment. Manage with dose interruption and/or reduction and supportive care.
Neutropenia: Monitor neutrophil counts throughout treatment. Manage with dose interruption and/or reduction and granulocyte colony-stimulating factors.
Gastrointestinal Toxicity: Nausea, vomiting, diarrhea, anorexia, and weight loss may occur. Provide antiemetic prophylaxis. Manage with dose interruption and/or reduction, antiemetics, and supportive care.
Hyponatremia: Monitor serum sodium levels throughout treatment. Correct for concurrent hyperglycemia and high serum paraprotein levels. Manage with dose interruption, reduction, or discontinuation, and supportive care.
Serious Infection: Monitor for infection and treat promptly.
Neurological Toxicity: Advise patients to refrain from driving and engaging in hazardous occupations or activities until neurological toxicity resolves. Optimize hydration status and concomitant medications to avoid dizziness or mental status changes.
Embryo-Fetal Toxicity: Can cause fetal harm. Advise females of reproductive potential and males with a female partner of reproductive potential, of the potential risk to a fetus and use of effective contraception.
Cataract: Cataracts may develop or progress. Treatment of cataracts usually requires surgical removal of the cataract
Possible Side Effects of Xpovio
Side effects of Xpovio can be prevented or managed well with dose reductions, dose interruptions, or other supportive care. Common side effects include:
- thrombocytopenia (low level of platelets)
- anemia (low level of red blood cells)
- decreased appetite
- hyponatremia (low level of sodium in the blood)
- neutropenia (low level of neutrophils, a type of white blood cell)
- lymphopenia (low level of lymphocytes, a type of white blood cell)
- peripheral neuropathy
- hypophosphatemia (low level of phosphorus in the blood)
- decreased weight
- dyspnea (shortness of breath)
- upper respiratory tract infection
Please visit Karyforward.com or call KayForward Patient Support by Karyopharm at 1-877-KARY4WD.
The International Myeloma Foundation medical and editorial content team
Comprised of leading medical researchers, hematologists, oncologists, oncology-certified nurses, medical editors, and medical journalists, our team has extensive knowledge of the multiple myeloma treatment and care landscape. Additionally, Dr. Brian G.M. Durie reviews and approves all medical content on this website.
Last Medical Review: August 1, 2019