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Selinexor

(Xpovio®)

Xpovio®

Drug updated on 10/29/2024

Dosage FormTablet (oral: 20 mg 40 mg, 50 mg, 60 mg)
Drug ClassNuclear 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 Bcell lymphoma (DLBCL), not otherwise specified, including DLBC arising from follicular lymphoma, after at least 2 lines of systemic therapy.

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Summary
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  • This summary is based on the review of seven systematic review(s)/meta-analysis(es). [1-7]
  • Selinexor demonstrated an overall clinical benefit rate of 56.21% in relapsed/refractory multiple myeloma (RRMM) patients, with an overall response rate (ORR) of 46.91%, complete response rate of 4.89%, very good partial response rate of 23.41%, partial response rate of 24.68%, and stable disease rate of 28.06%.
  • The effectiveness of selinexor was significantly higher when used as a fifth-line therapy or earlier, yielding an ORR of 65.9% and a median progression-free survival (PFS) of 12.5 months compared to post-fifth-line usage, which had an ORR of 23.4% and median PFS of 2.9 months (p<0.01).
  • Selinexor showed enhanced efficacy when combined with dexamethasone and proteasome inhibitors or immunomodulatory drugs, leading to better ORRs (56.1% and 52.5%) compared to the selinexor-only regimen (24.6%, p<0.01), while also demonstrating effectiveness in the high-risk cytogenetic subgroup (+1q) without performance degradation in patients with advanced disease.
  • Selinexor was associated with a significant discontinuation rate of 16.80% due to safety concerns, indicating potential tolerability issues in patients receiving this treatment.
  • While selinexor demonstrated a durable response and tolerable safety profile when combined with carfilzomib and dexamethasone in both carfilzomib-naive and carfilzomib-refractory RRMM patients, it showed worse outcomes compared to CAR T-cell therapy and several other recently developed agents in the context of relapsed/refractory diffuse large B-cell lymphoma.