Nexpovio (Selinexor)

Nexpovio (selinexor) is indicated for hematologic malignancies that are refractory to standard therapies.

• Relapsed/refractory multiple myeloma: improves disease control and extends progression‑free survival in patients who have received at least two prior lines of therapy.
• Relapsed/refractory diffuse large B‑cell lymphoma: provides an additional therapeutic option for patients whose disease has progressed after standard chemoimmunotherapy.

• Selinexor selectively inhibits exportin 1 (XPO1), the key nuclear export protein that transports tumor‑suppressor proteins and growth‑regulatory molecules from the nucleus to the cytoplasm. By blocking XPO1, selinexor forces retention of these proteins within the nucleus, reactivating tumor‑suppressor pathways and inducing apoptosis of malignant cells.

Common Side Effects

• Fatigue: persistent tiredness affecting daily activities.
• Nausea and vomiting: gastrointestinal upset often managed with antiemetics.
• Anorexia: reduced appetite leading to weight loss.
• Diarrhea: loose stools that may require hydration.
• Thrombocytopenia: lowered platelet count increasing bleeding risk.

Serious or Rare Side Effects

• Severe neutropenia: markedly reduced neutrophils predisposing to infection.
• Hyponatremia: low blood sodium that can cause neurological symptoms.
• Severe thrombocytopenia: heightened risk of serious bleeding events.
• Infections: opportunistic or serious bacterial, viral, or fungal infections.

Before initiating therapy, clinicians should evaluate baseline laboratory values and monitor patients regularly.

• Monitor blood counts: perform complete blood count with differential at baseline and periodically.
• Assess electrolytes: check serum sodium and correct abnormalities promptly.
• Evaluate hepatic function: adjust use in patients with moderate hepatic impairment.
• Provide antiemetic prophylaxis: consider routine anti‑nausea medication to improve tolerability.
• Store at below 25°C: keep tablets in the original container, protect from moisture and direct sunlight.

Selinexor may interact with other medicines that affect its metabolism or increase toxicity.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin): may reduce selinexor exposure and efficacy.
• Strong CYP3A4 inhibitors (e.g., ketoconazole): may increase selinexor levels and risk of adverse events.

Moderate Interactions (Monitor Closely)

• Anticoagulants (e.g., warfarin): monitor INR and adjust dose as needed.
• CYP3A4 substrate drugs (e.g., midazolam): may require dose adjustment.
• P‑gp inhibitors or inducers: could alter selinexor absorption; observe therapeutic response.