Xpovio (Selinexor) is a nuclear export inhibitor used in combination with dexamethasone to treat 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 PIs, at least two immunomodulatory agents, and an anti‐CD38 monoclonal antibody.
Dosage: The recommended starting dosage of selinexor is 80 mg (four 20 mg tablets) taken orally on Days 1 and 3 of each week until the disease is progressive or unacceptable toxicity occurs. The recommended starting dosage of dexamethasone is 20 mg taken orally with each dose of selinexor on Days 1 and 3 of each week. Each selinexor dose should be taken at around the same time of day, and each tablet should be swallowed whole with water. Do not break, chew, crush, or divide the pills. In case a dose of selinexor is missed or delayed, instruct patients to take their next dose at the next regularly scheduled time. If a patient vomits a dose of selinexor, do not repeat the dose and the patient should take the next dose on the next regularly scheduled day.
Side Effects: The most commonly reported xpovio side effects include:
- Decreased appetite
- Decreased weight
- Upper respiratory tract infection
Warnings and Precautions:
- Monitor patients with xpovio tablets for signs/symptoms of concomitant infection and evaluate promptly.
- Monitor patients for complete blood count, standard blood chemistry, and body weight at baseline and during therapy. Monitor more frequently during the initial 2 months of therapy.
- Patients are advised to maintain the adequate fluid and caloric intake throughout the therapy with selinexor tablets. Intravenous hydration can be considered for patients at the risk of dehydration.
- Provide the prophylactic concomitant treatment with a 5‐HT3 antagonist or other anti‐nausea agents prior to and while on treatment with selinexor.
- Verify the pregnancy status of females of reproductive age before initiating selinexor 20 mg. As it can cause fetal harm if administered to a pregnant woman.
- Because of the risk for serious adverse events in a breastfed child, women are advised to not breastfeed while on the xpovio dose and for 1 week after the last dose.