Selinexor monotherapy (JAKi-refractory/intolerant myelofibrosis)

Current understanding

Single-agent selinexor (XPO1 inhibitor) is being evaluated in a phase II single-arm trial as salvage therapy for primary or secondary myelofibrosis patients who are refractory or intolerant to ruxolitinib and/or other JAK1/2 inhibitors. This represents a distinct clinical context from the JAKi-naïve monotherapy program and the ruxolitinib- or pacritinib-combination programs, targeting an underserved post-JAKi population. Evidence remains early (trial-early, prospective phase II).

Evidence log

• 2026-07-02 — A Study to Evaluate Single Agent Selinexor Versus Physician’s Choice in Participants With Previously Treated Myelofibrosis: Trial-early: Phase 2 randomized open-label trial evaluating single-agent selinexor vs physician’s choice in myelofibrosis patients with ≥6 months prior JAK1/2 inhibitor exposure — first head-to-head RCT design for XPO1 inhibition in the JAKi-pretreated setting, upgrading the evidence base beyond prior single-arm data. (novelty: 3)
• 2026-06-08 — Selinexor in Myelofibrosis Refractory or Intolerant to JAK1/2 Inhibitors: cross-connection with selinexor-monotherapy-mf: Both evaluate single-agent selinexor in MF but in opposite clinical contexts — JAKi-naïve (with moderate thrombocytopenia) vs JAKi-refractory/intolerant — together delineating the monotherapy positioning of XPO1 inhibition across the MF treatment course. (novelty: 3)

Open questions

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