selinexor

Selinexor is a drug that functions as a selective inhibitor of nuclear export (SINE), targeting exportin 1 (XPO1, also known as CRM1). By inhibiting XPO1, selinexor prevents the export of certain proteins from the cell nucleus to the cytoplasm, leading to the accumulation of tumor suppressor proteins in the nucleus and promoting cancer cell cycle arrest and apoptosis. It is administered orally and has been studied in various hematologic and solid tumors.

In the United States, selinexor has been approved by the Food and Drug Administration for adults with relapsed or refractory multiple myeloma in combination with dexamethasone, after the patient has received at least four prior therapies. This approval recognizes its use as part of a targeted approach for difficult-to-treat multiple myeloma. Regulatory status and indications may differ in other regions, and ongoing research continues to evaluate broader applications of the drug.

Clinical use of selinexor involves combining it with dexamethasone on established dosing regimens. The treatment is associated with several adverse effects, most notably hematologic toxicities such as thrombocytopenia, neutropenia, and anemia, as well as fatigue, nausea, decreased appetite, hyponatremia, and an increased risk of infection. Patients require regular monitoring of blood counts and electrolytes, and dose adjustments may be necessary based on tolerability and safety. Selinexor is metabolized by CYP3A and can interact with strong CYP3A inhibitors or inducers, which can necessitate dose modifications.