Xpovio (selinexor) vs Xalkori (crizotinib)

Xpovio (selinexor) is a nuclear export inhibitor approved for the treatment of multiple myeloma and certain types of diffuse large B-cell lymphoma, targeting the exportin 1 (XPO1) protein to induce cancer cell death. Xalkori (crizotinib), on the other hand, is an ALK and ROS1 inhibitor used primarily for non-small cell lung cancer (NSCLC) with specific genetic alterations, functioning by blocking the activity of the ALK or ROS1 proteins to inhibit tumor growth. When deciding between the two, it is essential to consider the type of cancer being treated, as each medication is tailored to target different mechanisms and is approved for distinct cancer profiles; therefore, a healthcare provider's guidance based on the patient's specific diagnosis and molecular testing results is crucial.

Difference between Xpovio and Xalkori

Metric	Xpovio (selinexor)	Xalkori (crizotinib)
Generic name	Selinexor	Crizotinib
Indications	Multiple myeloma, diffuse large B-cell lymphoma	Non-small cell lung cancer, anaplastic large cell lymphoma
Mechanism of action	Selective inhibitor of nuclear export	ALK and ROS1 tyrosine kinase inhibitor
Brand names	Xpovio	Xalkori
Administrative route	Oral	Oral
Side effects	Nausea, vomiting, fatigue, anorexia, weight loss	Visual disturbances, GI disturbances, edema, elevated transaminases
Contraindications	Thrombocytopenia, neutropenia, pregnancy	Hepatic impairment, QT prolongation, bradycardia
Drug class	Antineoplastic agent	Antineoplastic agent
Manufacturer	Karyopharm Therapeutics	Pfizer

Efficacy

Efficacy of Xpovio (Selinexor) in Lymphoma

Selinexor, marketed under the brand name Xpovio, is a selective inhibitor of nuclear export (SINE) that has shown efficacy in the treatment of certain types of lymphoma. It functions by inhibiting the nuclear export protein XPO1, leading to the accumulation of tumor suppressor proteins in the cell nucleus and inducing cancer cell death. The U.S. Food and Drug Administration (FDA) has approved selinexor for use in combination with dexamethasone for the treatment of adults with relapsed or refractory multiple myeloma, which is a cancer of plasma cells, a type of white blood cell that can be considered a form of lymphoma.

Although not initially approved for the treatment of lymphoma, selinexor has been studied in clinical trials for its potential in treating various subtypes of this disease, including diffuse large B-cell lymphoma (DLBCL). In these studies, selinexor has demonstrated a certain level of efficacy as a single agent or in combination with other therapies. However, it is important to note that the efficacy can vary based on the specific type of lymphoma and the patient's individual disease characteristics.

Efficacy of Xalkori (Crizotinib) in Lymphoma

Crizotinib, sold under the brand name Xalkori, is an oral small-molecule inhibitor of the anaplastic lymphoma kinase (ALK) and is primarily used in the treatment of non-small cell lung cancer (NSCLC). The efficacy of crizotinib in lymphoma is specifically associated with ALK-positive anaplastic large cell lymphoma (ALCL), a rare type of non-Hodgkin lymphoma. In ALK-positive ALCL, the ALK protein is abnormally expressed due to a chromosomal translocation, and crizotinib targets this aberrant protein.

Clinical trials have shown that crizotinib is effective in inducing responses in patients with relapsed or refractory ALK-positive ALCL. The response rates in these studies suggest that crizotinib can be a valuable treatment option for patients with this specific subtype of lymphoma. However, the use of crizotinib in lymphoma is considered off-label, and its efficacy and safety for this indication have not been fully established in large-scale, randomized clinical trials. Therefore, its use in lymphoma is generally reserved for cases where other treatment options have been exhausted or are not suitable.

Regulatory Agency Approvals

Xpovio

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

Xalkori

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Pharmaceuticals and Medical Devices Agency (PMDA), Japan
Therapeutic Goods Administration (TGA), Australia

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