Selinexor, as a novel nuclear export inhibitor, is mainly effective in the treatment of recurrent/refractory hematological tumors, demonstrating anti-tumor activity through its unique mechanism of action. The following provides a detailed explanation of the mechanism of action, clinical data, and factors affecting therapeutic efficacy.

1. Core mechanism of action

(1) Selective inhibition of XPO1: Inducing cancer cell apoptosis by blocking the nuclear output of tumor suppressor proteins and growth regulatory proteins.

(2) Synergistic sensitization effect: It can restore the sensitivity of traditional drugs and enhance the anti myeloma effect when combined with dexamethasone.

2 Key Clinical Research Data

(1) Multiple myeloma: In the STORM study, the overall response rate of the combination therapy was 26.2%, with a median response duration of 4.4 months.

(2) Diffuse large B-cell lymphoma: SADAL study shows an overall response rate of 28%, with 7% achieving complete response.

3 factors affecting therapeutic efficacy

(1) Number of treatment lines: Patients who have received ≤ 3-line treatment in the past have a significantly higher remission rate than those who have received multi line treatment (34% vs 21%).

(2) Adverse reaction management: Timely treatment of side effects such as thrombocytopenia can ensure the continuity of treatment.

4 Response characteristics of special populations

(1) Elderly patients: Close monitoring of toxicity is necessary for those aged 75 and above, and there is no significant difference in efficacy compared to younger patients.

(2) Renal insufficiency: Mild damage does not require dose adjustment, moderate to severe damage requires careful evaluation.