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XPO1 (Exportin-1) Inhibitor

Selinexor

Brand names: Nexpovio

Selinexor is an oral selective inhibitor of nuclear export (SINE) used in combination regimens for relapsed or refractory multiple myeloma.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It blocks exportin-1 (XPO1), trapping tumour-suppressor proteins in the nucleus and reducing oncoprotein translation, thereby promoting apoptosis of malignant plasma cells.

Prescribing in practice

  • Causes frequent and sometimes severe gastrointestinal toxicity and hyponatraemia, so prophylactic antiemetics, attention to hydration, and sodium monitoring are essential from the outset.
  • Marked thrombocytopenia and neutropenia are common and require regular blood counts with dose modification or interruption.
  • Monitor for fatigue, anorexia, weight loss, and neurological effects, providing supportive care to maintain treatment tolerability.

Monitoring

Monitor full blood count, serum sodium, body weight, and hydration status throughout treatment.

Counselling the patient

  • Take antiemetics as prescribed and maintain fluid intake to reduce nausea and dehydration.
  • Report persistent vomiting, confusion, or significant weight loss promptly.
  • Regular blood tests are needed to monitor platelets and sodium.

Evidence & guidelines

Selinexor combination therapy in relapsed/refractory myeloma is supported by the BOSTON trial and licensed for this indication.

Reference: BOSTON trial (Grosicki et al. NEJM 2020); NICE TA680; MHRA SPC Nexpovio; STORM trial (Chari et al. NEJM 2019 — penta-refractory); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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