Drug updated on 4/18/2024
| Dosage Form | Tablet (oral: 20 mg 40 mg, 50 mg, 60 mg) |
| Drug Class | Nuclear export inhibitors |
| Ongoing and Completed Studies | ClinicalTrials.gov |
Indication
- Indicated in combination with bortezomib and dexamethasone for the treatment of adult patients with multiple myeloma who have received at least one prior therapy.
- Indicated in combination with dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma (RRMM) 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.
- Indicated for the treatment of adult patients with relapsed or refractory diffuse large B‐cell lymphoma (DLBCL), not otherwise specified, including DLBC arising from follicular lymphoma, after at least 2 lines of systemic therapy.
Summary
- Selinexor (Xpovio) is indicated for use in combination with bortezomib and dexamethasone to treat adult patients with multiple myeloma who have received at least one prior therapy. Additionally, it is approved for use with dexamethasone for adult patients with relapsed or refractory multiple myeloma who have received at least four prior therapies and for the treatment of adults with relapsed or refractory diffuse large B-cell lymphoma after a minimum of two lines of systemic therapy.
- Six studies were reviewed, providing detailed information on Xpovio's role in treating various malignancies, its safety profile, effectiveness, and comparison to other pharmacological treatments.
- In terms of health-related quality outcomes in relapsed or refractory large B-cell lymphoma, CAR T cell therapy showed notably improved results compared to others, while novel therapies including selinexor demonstrated mixed results, indicating variability in their impact on patient quality of life and survival metrics.
- For the treatment of Multiple Myeloma characterized by +1q21 cytogenetic abnormality often associated with worse outcomes, selinexor was highlighted alongside lenalidomide and isatuximab due to its ability to improve progression-free survival rates among this challenging patient subset.
- A network meta-analysis suggested that despite being categorized under novel-drug-based regimens, Xpovio ranked lower than daratumumab-, isatuximab-, and carfilzomib-based treatments concerning objective response rates, implying that other therapies might offer more considerable immediate benefit, especially within relapsed or refractory multiple myeloma settings based on response quality.
- Selinexor has been noted as both a safe and effective option, particularly when combined with agents such as carfilzomib, immunomodulatory drugs (IMiDs), and CD38 monoclonal antibodies, offering better depth of response without excessive toxicity, making it a suitable choice for heavily pretreated patients with relapsed or refractory multiple myeloma.
Product Monograph / Prescribing Information
| Document Title | Year | Source |
|---|---|---|
| Xpovio (selinexor) Prescribing Information. | 2022 | Karyopharm Therapeutics Inc., Newton, MA |
Systematic Reviews / Meta-Analyses
Clinical Practice Guidelines
| Document Title | Year | Source |
|---|---|---|
| Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. | 2021 | Annals of Oncology |