Selinexor Worth Prescribing, with Proper Supportive Care

Careful dosing and monitoring are keys to safe use

• Selinexor (brand name: Xpovio) was initially prescribed twice a week, but many oncologists have lowered the dose to once-weekly because of poor tolerability
• The FDA approved selinexor in combination with bortezomib (brand name: Velcade), but many oncologists now partner it with carfilzomib (brand name: Kyprolis)
• Patients need to be carefully monitored and given adequate nausea control while on this treatment

In late 2020, the FDA approved selinexor (brand name: Xpovio) for the treatment of adult patients with multiple myeloma who have received at least one prior therapy. However, prescribing the right dose and navigating side effects have proved challenging. Initially, the recommended dose was twice weekly, but side effects necessitated a shift to a once-weekly dose.

“I think over time I think we’ve all become more familiar with how to give it,” Dr. Thomas Martin, hematologist-oncologist at UCSF Medical Center, said during a virtual SurvivorNet Connect panel discussion. “It actually has to be given once weekly, with dexamethasone, and with adequate nausea control and frequent checks of (the patient’s) chemistry panel.” In his practice, patients on selinexor receive antiemetics, salt tabs and IV saline as needed, as well as blood count support.

Though selinexor is approved for use in combination with bortezomib (brand name: Velcade) and dexamethasone, Dr. Martin instead prescribes it with carfilzomib (brand name: Kyprolis). Dr. Ravi Vij, professor of medicine at Washington University School of Medicine in St. Louis, follows the same approach.

He often uses selinexor as a bridge in patients he wants to get to CAR T-cell therapy. “I have had responses in patients who’ve progressed after CAR T, so the drug is active,” he says. “You do need to develop some familiarity with the drug, but it does have a role in myeloma.”

“I think with adequate supportive care, you can see some responses in patients, and patients can continue on that therapy, but you really have to watch them closely,” Dr. Martin says.