Ask the Nurse: Selinexor

We are often asked about available treatments and clinical trials for new drugs in the UK.

A drug called selinexor (Nexpovio^®) is one of the latest treatments to be approved and it is now available through the NHS across the UK.

In this blog, we tell you more about selinexor and how it works.

What is selinexor?

Selinexor is a drug called a selective inhibitor of nuclear export (SINE). It has been investigated in several combinations for the treatment of myeloma. Selinexor works in an entirely different way from other anti-myeloma drugs and therefore provides a new kind of treatment option for patients who have relapsed multiple times or do not respond (are refractory) to currently available anti-myeloma treatments. Selinexor is an oral tablet that can be taken at home.

How does it work?

Selinexor stops a protein called Exportin 1 (XPO1) from working properly. XPO1 is a protein responsible for moving other proteins between different parts of the cell. Myeloma cells exploit XPO1 to get rid of proteins, called tumour suppressor proteins, which would stop them growing and multiplying. By blocking XPO1, the tumour suppressor proteins build up within the myeloma cells and kills them. This is shown in Figure 1 and 2.

Why was selinexor approved for use?

Several clinical trials evaluated the safety and effectiveness of different selinexor combination treatments.

SVD is available to patients at second and third-line treatment and combines three drugs – selinexor, bortezomib (Velcade^®), and dexamethasone. Data from the BOSTON clinical trial showed that 76% of patients responded well to SVD and had an average remission of over 13 months. This was around four months longer than patients receiving bortezomib and dexamethasone alone.

SD combines selinexor and dexamethasone, and has been approved for patients at fifth line and beyond. Data from the STORM clinical trial showed that over a quarter of patients responded well to treatment and had an average remission of nearly three months.

You can read more about development of new treatments in our Clinical trials and how treatments are developed Infoguide.

 Is selinexor available in the UK?

In 2024, selinexor was approved for use in two different treatment combinations (SD and SVD) by both NICE and the SMC. This means the drug is now routinely available for myeloma patients in the UK. Treatment access depends on which treatments a patient has previously received.

SD is aimed at patients who have received at least four prior treatments and whose myeloma is refractory to:

• At least two proteasome inhibitors – e.g. bortezomib, carfilzomib (Kyprolis^®) and ixazomib
• Two immunomodulatory drugs such as lenalidomide (Revlimid^®), thalidomide or pomalidomide (Imnovid^®)
• An anti-CD38 monoclonal antibody like daratumumab (Darzalex^®) or isatuximab (Sarclisa^®)

SVD is aimed at patients who have received at least one prior treatment and whose myeloma has become resistant to lenalidomide and if an anti-CD38 monoclonal antibody such as daratumumab is not a viable option.

You can find out more information by downloading the Selinexor Treatment Guide. It is always best to discuss treatment options with your healthcare team as they can offer specific advice based on your circumstances.

Whilst selinexor is now routinely available in the UK, other new treatments are only available through clinical trials. If you’d like to find out more about clinical trials that are currently recruiting, you can check our Myeloma Trial Finder. You can also find out more about anti-myeloma drugs on our Myeloma Drug Tracker.

If you have any further questions or need support, contact us through the Myeloma UK Infoline at 0800 980 3332 (UK) or 1800 937 773 (Ireland) or use our Ask the Nurse email service.