selinexor: clinical use

Prescribing considerations

• Use only under specialist multiple-myeloma supervision and assess the safety requirements of all combination medicines.
• Provide appropriate anti-nausea prophylaxis and address hydration and nutritional intake.
• Consider frailty and tolerability carefully; older trial participants experienced more serious adverse reactions and discontinuations.
• Review severe hepatic impairment before treatment. Evidence is unavailable to support use in end-stage renal disease or haemodialysis.

Contraindications and cautions

• Hypersensitivity to selinexor or any product excipient.
• Use caution with baseline cytopenias, active infection, dehydration, electrolyte disturbance, significant cognitive symptoms or ocular disease.

Monitoring

• Full blood count at baseline and throughout treatment, with closer monitoring early in therapy.
• Bleeding, infection and febrile neutropenia.
• Fluid status, oral intake, weight, sodium and other clinically relevant electrolytes.
• Gastrointestinal toxicity and need for supportive treatment.
• Neurological or cognitive symptoms, dizziness and falls risk.
• Vision changes or cataract; arrange ophthalmic assessment when clinically indicated.
• Renal and hepatic function and tumour lysis risk where relevant.

Clinical pharmacology

Selinexor is a reversible covalent selective inhibitor of nuclear export that blocks XPO1. It is metabolised through CYP3A4, UDP-glucuronosyltransferases and glutathione S-transferases; peak plasma concentration is reached within several hours and plasma-protein binding is high.

Formulation and product differences

• The selected product is a blue, round, film-coated oral tablet marked “K20”.
• Tablets must remain intact because contact with the active substance may irritate skin.
• No special storage conditions are required; packs use child-resistant inner cartons.