• Relapsed or refractory multiple myeloma in patients who have received at 4 previous therapies and whose disease is refractory to at 2 proteasome inhibitors, 2 immunomodulatory agents, and an anti-CD38 monoclonal antibody (in combination with dexamethasone).

Contraindicated in:

• OB: Pregnancy (may cause fetal harm)
• Lactation: Lactation.

Use Cautiously in:

• Women of reproductive potential and men with female partners of reproductive potential
• Pedi: Safety and effectiveness not established
• Geri: ↑risk of adverse reactions.

EENT: blurred vision, epistaxis.

Endo: hyperglycemia.

F and E: dehydration, hypokalemia, hyponatremia.

GI: constipation, diarrhea, nausea, vomiting.

GU: ↑serum creatinine, ↓ fertility.

Hemat: anemia, lymphopenia, neutropenia, thrombocytopenia, BLEEDING.

Metab: ↓appetite, ↓weight.

Neuro: altered consciousness, dizziness, dysgeusia, fatigue, headache, insomnia, mental status changes, syncope.

Resp: cough, dyspnea.
Misc: fever, infection.

Drug-Drug:

• None reported.

• Tablets: 20 mg;

• PO (Adults): 80 mg on Days 1 and 3 of each week; continue until disease progression or unacceptable toxicity.

Xpovio

• Inhibits exportin 1 which inhibits nuclear export of tumor suppression proteins, growth regulators, and mRNAs of oncogenic proteins. This action leads to accumulation of tumor suppression proteins in the nucleus of the tumor cell, reduction in oncogenic proteins and tumor cell apoptosis.

• Decreased progression of multiple myeloma.

Therapeutic Classification: antineoplastics

Pharmacologic Classification:

Absorption: Unknown.

Distribution: Extensively distributed to tissues.

Protein Binding: 95%.

Metabolism/Excretion: Metabolized by the CYP3A4 isoenzyme, UDP-glucuronosyltransferases (UGTs), and glutathione S-transferases. Excretion pathway unknown.

Half-life: 6–8 hr.

(plasma concentrations)

• Instruct patient to take selinexor as directed. If a dose is missed or patient vomits, omit dose and take dose at next regularly scheduled time.
• Advise patients to maintain adequate fluid and caloric intake during therapy.
• May cause confusion and dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
• Instruct patient to notify health care professional if signs of bleeding, fatigue, shortness of breath, nausea, vomiting, diarrhea, decreased appetite, weight loss, or infection (chills, fever) occurs.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken, to avoid alcohol, and to consult health care professional before taking any new medications.
• May cause fetal harm. Advise females of reproductive potential and males with a female partner of reproductive potential to use effective contraception during and for 1 wk after last dose of therapy. Advise females to avoid breastfeeding and for 1 wk after last dose of therapy. May impair male and female fertility.

SEL-i-NEX-or