Selinexor
Selinexor is a first-in-class pill that traps tumour-suppressor proteins inside the nucleus; approved in myeloma, it failed its endometrial cancer test in 2026.
Approved 2019 (penta-refractory myeloma with dexamethasone), 2020 (DLBCL; with bortezomib in myeloma, BOSTON). In endometrial cancer, SIENDO (2022) missed its primary endpoint but a TP53-wild-type subgroup showed a large PFS difference; the confirmatory XPORT-EC-042 missed its primary endpoint in July 2026. Nausea, fatigue, weight loss, and thrombocytopenia limit tolerability.
1.Binds XPO1 in the nuclear pore complex
- Route
- Oral
- Schedule
- 80 mg weekly with dexamethasone (myeloma); 60 mg weekly (endometrial trials)
- Monitoring
- Weekly CBC, sodium, weight; antiemetic prophylaxis
- Medicare
- Part D (self-administered)
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026).
- Commercial insurance
- covered with prior authorisation
Covered for FDA-labelled and NCCN-listed uses, but almost always behind prior authorisation confirming diagnosis, biomarker and line of therapy; dispensed through a specialty pharmacy.
- Assistance programmes
- KaryForward
- PAN Foundation — Disease-specific co-pay and premium funds; open and closed funds change monthly.
- HealthWell Foundation
- CancerCare Co-Payment Assistance Foundation
- Patient Advocate Foundation Co-Pay Relief
- Leukemia & Lymphoma Society financial support
Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
- Notes
- Licensed 2021; NICE appraisal for myeloma not verified. Check NICE.
Sources: NICE search: selinexor. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
- 30 Jul 2026Filing / dealUS
XPORT-EC-042 misses primary endpoint; endometrial development deprioritised source
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 2019 | Relapsed/refractory multiple myeloma (≥4 lines) with dexamethasone |
| US | 2020 | Relapsed/refractory DLBCL; myeloma with bortezomib after ≥1 line |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Nausea | 84% | 10% |
| Thrombocytopenia | 43% | 9% |
| Fatigue | 49% | 9% |
SIENDO selinexor arm. Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
Trials
topRecruiting now (live from ClinicalTrials.gov)
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Landmark trials in OnCo
Latest papers
topQuery for this drug: (TITLE:"Selinexor" OR ABSTRACT:"Selinexor" OR TITLE:"Xpovio" OR ABSTRACT:"Xpovio" OR TITLE:"KPT-330" OR ABSTRACT:"KPT-330") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Selinexor, not a curated reading list.