Objective: To review the pharmacology, pharmacokinetics, efficacy, and safety of 
selinexor for management of relapsed multiple myeloma (MM). Data Sources: A 
literature search was performed of PubMed and MEDLINE databases (January 1, 
2000, to November 14, 2019), abstracts from the American Society of Hematology 
and the American Society of Clinical Oncology, and ongoing studies from US 
National Institutes of Health ClinicalTrials.gov. Queries were performed using 
key words selinexor, SINE, XPO1, and Xpovio.Study Selection/Data Extraction: 
Human and animal studies related to the pharmacology, pharmacokinetics, 
efficacy, and safety of selinexor were identified. Data Synthesis: Although 
numerous advances have been made in MM management, there remains an unmet need 
for treatment of heavily relapsed/refractory disease. Selinexor is a 
first-in-class selective inhibitor of nuclear export, which, through inhibition 
of exportin-1, causes accumulation of tumor suppressor proteins, reduction in 
oncoproteins, and apoptosis of plasma cells. Selinexor exhibited an overall 
response in 26% of patients with multiply relapsed MM. Median progression-free 
survival was 3.7 months, and overall survival was 8.6 months. Common adverse 
effects include thrombocytopenia, neutropenia, fatigue, and nausea. Ongoing 
studies are investigating combination therapies utilizing selinexor. Relevance 
to Patient Care and Clinical Practice: This review describes the efficacy, 
safety, and clinical applicability of selinexor, a novel agent with potential to 
meet an unmet need in refractory MM. Conclusion: Selinexor has demonstrated 
activity in a heavily refractory patient population. Given the adverse effect 
profile and associated costs, additional studies are needed to further elucidate 
the appropriate clinical scenario and combinations for selinexor use.