Nexpovio (Selinexor)

• Nexpovio is a selective inhibitor of nuclear export used in hematologic malignancies.
• Relapsed or refractory multiple myeloma: improves disease control and extends progression‑free survival in patients who have received prior therapies.
• Diffuse large B‑cell lymphoma: provides an additional therapeutic option for adults with disease that is refractory to standard chemo‑immunotherapy.
• Adult patients with high‑risk disease: may be considered when other approved regimens are unsuitable.

• Selinexor binds to exportin 1 (XPO1), blocking the nuclear export of tumor suppressor proteins, growth regulators, and oncogenic mRNA. This retention within the nucleus reactivates tumor‑suppressive pathways and triggers apoptotic signaling, leading to selective death of malignant cells while sparing most normal tissues.

Common Side Effects

• Nausea: frequent gastrointestinal upset that may require anti‑emetic support.
• Fatigue: persistent tiredness affecting daily activities.
• Anorexia: reduced appetite leading to weight loss.
• Thrombocytopenia: lowered platelet counts increasing bleeding risk.
• Neutropenia: decreased neutrophils raising infection susceptibility.
• Vomiting: occasional episodes, often concurrent with nausea.

Serious or Rare Side Effects

• Severe neutropenia with fever: may require hospitalization and antibiotics.
• Grade 3–4 thrombocytopenia: can lead to serious bleeding events.
• Hepatic toxicity: elevated liver enzymes or bilirubin requiring monitoring.
• Cardiac arrhythmias: QT‑interval prolongation in susceptible patients.
• Dehydration and electrolyte imbalance: may necessitate intravenous fluids.
• Tumor lysis syndrome: rapid tumor breakdown causing metabolic disturbances.

• Before initiating therapy, clinicians should evaluate baseline laboratory values and patient comorbidities.
• Monitor blood counts: perform regular CBC to detect cytopenias.
• Assess liver function: check transaminases and bilirubin prior to each cycle.
• Evaluate cardiac risk: obtain ECG if patient has known QT‑prolonging factors.
• Avoid use in pregnancy: teratogenic potential is unknown; contraception is recommended.
• Adjust dose in renal impairment: consider reduced dosing for severe renal dysfunction.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Selinexor may interact with several concomitant medications.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin): may markedly reduce selinexor exposure.
• QT‑prolonging agents (e.g., macrolide antibiotics): increase risk of cardiac arrhythmia.
• Potent P‑gp inhibitors (e.g., elacridar): may elevate systemic concentrations.

Moderate Interactions (Monitor Closely)

• CYP3A4 inhibitors (e.g., ketoconazole): can raise selinexor levels, requiring dose adjustment.
• Anticoagulants (e.g., warfarin): altered platelet counts may affect bleeding risk.
• Live vaccines: immunosuppression may reduce vaccine efficacy; avoid during treatment.