Selinexor in multiple myeloma.

INTRODUCTION: Selinexor, an XPO1 inhibitor, has emerged as a promising therapeutic option in the challenging landscape of relapsed/refractory multiple myeloma (RRMM).

AREAS COVERED: This article provides a review of selinexor, with a focus on available clinical studies involving MM patients and its safety profile. Clinical trials, such as STORM and BOSTON, have demonstrated its efficacy, particularly in combination regimens, showcasing notable overall response rates (ORR) and prolonged median progression-free survival (mPFS). Selinexor's versatility is evident across various combinations, including carfilzomib-dexamethasone (XKd), lenalidomide-dexamethasone (XRd), and pomalidomide-dexamethasone (XPd), with efficacy observed even in triple-class refractory and high-risk patient populations. However, challenges, including resistance mechanisms and adverse events, necessitate careful management. Real-world evidence also underscores selinexor's effectiveness in RRMM, though dose adjustments and supportive measures remain crucial. Ongoing trials are exploring selinexor in diverse combinations and settings, including pomalidomide-naïve patients and post-autologous stem cell transplant (ASCT) maintenance.

EXPERT OPINION: The evolving landscape of selinexor's role in the sequencing of treatment for RRMM, its potential in high-risk patients, including those with extramedullary disease, as revealed in the most recent international meetings, and ongoing investigations signal a dynamic era in myeloma therapeutics. Selinexor emerges as a pivotal component in multidrug strategies and innovative combinations.