Cancer drugs A to Z list
SVd is a cancer drug combination. You have:
S - selinexor (pronounced seh-lih-nek-sor)
V - bortezomib (bor-teh-zoh-mib) also known as Velcade
d - dexamethasone (deks-ah-meth-uh-zone)
It is a treatment for myeloma.
You might have SVd if you are not able to have a and either:
you have had at least 1 other treatment that contains the medicines daratumumab and lenalidomide, but this has stopped working
you have had at least 2 other treatments and lenalidomide doesn’t control your cancer
You might have these medicines as part of a .
Selinexor and bortezomib are .
Selinexor is a type of targeted cancer drug called a selective inhibitor of nuclear export (SINE). It works by blocking the action of a within myeloma cells. The protein is called exportin 1 (XPO1). By blocking this protein it stops the myeloma cells growing and dividing, causing them to die.
Bortezomib is a type of targeted cancer drug called a proteasome inhibitor. Proteasomes are found in cells. They help to break down proteins that the cell doesn't need. Bortezomib blocks the proteasomes so the proteins build up inside the cell. The cell then dies.
Dexamethasone is a steroid. It works by helping to reduce inflammation and kill myeloma cells .
Find out more about targeted cancer drugs
Selinexor and dexamethasone are tablets.
You have bortezomib as an injection under your skin (subcutaneous injection).
You usually have injections under the skin into the tummy (abdomen) or thigh.
You might have stinging or a dull ache for a short time after this type of injection. The skin in the area may go red and itchy for a while.
You have this injection in a different area of skin each time, to avoid irritation.
You take selinexor with a glass of water. You need to swallow the tablets whole. Don’t break, crush or chew them. They can cause skin irritation when broken. You should take them at the same time every day. You can take selinexor with or without food.
You take dexamethasone after food or with milk as they can irritate your stomach. Taking them in the morning might help to stop difficulty in sleeping (insomnia).
Speak to your pharmacist if you have problems swallowing the tablets.
Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, no more or less.
Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.
You have SVd as of treatment. Each cycle of treatment lasts 35 days (5 weeks).
You continue taking SVd for as long as it is working and you are not experiencing too many side effects.
You usually have SVd in the following way:
You take selinexor once a day in the morning.
You have bortezomib as an injection under the skin.
You take dexamethasone in the morning after breakfast.
You take dexamethasone in the morning after breakfast.
You have no treatment.
You take selinexor once a day in the morning.
You have bortezomib as an injection under the skin.
You take dexamethasone in the morning after breakfast.
You take dexamethasone in the morning after breakfast.
You have no treatment.
You take selinexor once a day in the morning.
You have bortezomib as an injection under the skin.
You take dexamethasone in the morning after breakfast.
You take dexamethasone in the morning after breakfast.
You have no treatment
You take selinexor once a day in the morning.
You have bortezomib as an injection under the skin.
You take dexamethasone in the morning after breakfast.
You take dexamethasone in the morning after breakfast.
You have no treatment.
You take selinexor once a day in the morning.
You take dexamethasone in the morning after breakfast.
You take dexamethasone in the morning after breakfast.
You have no treatment.
You then start the next cycle of treatment.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV. This is called a viral screen.
It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your and can cause the virus to become active again (reactivation).
Before each cycle of treatment you have a blood or urine test to check your levels.
Find out more about paraproteins for myeloma
Side effects can vary from person to person. They also depend on what other treatment you are having.
Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
you have severe side effects
your side effects aren’t getting any better
your side effects are getting worse
the side effects are affecting your daily life
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.
Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
You might also develop a cough or breathing problems. This could be due to an infection, such as pneumonia. The cough could be dry, or you might have phlegm. You might also sweat, feel shivery, and have a fast heartbeat.
Rarely you might have fluid in or around your lungs causing difficulty breathing. Or lower oxygen levels in your body causing shortness of breath even when you are not exercising. Your breathing may become shallow, or you might have wheezing.
This treatment can cause bleeding from anywhere in your body. This is usually mild but there is a risk of a serious bleed. This might happen due to a drop in the number of platelets in your blood. Or your blood might not be able to form blood clots properly, but this is rare.
Signs of bleeding include bruising, blood in your urine or poo, black poo, vomiting or coughing up blood, nosebleeds, bleeding gums, bleeding from your or you might have small red or purple spots on the skin.
Other symptoms can include headaches, dizziness, feeling weak, shortness of breath or looking pale.
You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.
You might feel very tired and as though you lack energy.
Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.
This treatment can cause nerve damage. Your skin might be sensitive or have a burning sensation.
You might have numbness or tingling in your fingers or toes. This is often temporary and can improve after you finish treatment. You might also have weakness in your arms and legs.
Less commonly you might have nerve pain in different parts of the body. Or the nerves that control movement might be affected. This can cause weakness, falls, tremors, twitching, loss of balance or the loss of ability to move (paralysis).
Rarely this treatment can affect the nerves to your senses that affect how you hear, smell, touch or taste. You might have changes to the way you speak, or you might have uncontrolled movements to different parts of your body.
is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.
Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.
Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain . But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables.
Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.
Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.
You might feel some pain in your muscles and joints.
Less commonly, you might notice you have less strength in your muscles, or you have muscle spasms.
Rarely, this treatment might cause inflammation and stiffness of your joints (arthritis).
Speak to your doctor or nurse if you have any of these symptoms. They can tell you about what painkillers you can take to help with this.
Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.
You might have eye problems such as blurred vision or a clouding of the lens of the eye (cataracts).
Less commonly, you might have swollen eyes, or your vision may change. You may develop sore, red, itchy, and dry eyes (conjunctivitis).
Rarer eye problems include infections, small red spots on the whites of the eyes, double vision, pain, dry eyes, watery eyes, inflammation, a lump in your eyelid (chalazion) or discharge.
Let your healthcare team know straight away if you have any problems with your eyes.
If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help.
You might feel dizzy. This treatment can also make you feel as though the room is spinning. This is called vertigo and happens less often.
Let your doctor or nurse know if this happens. Don’t drive or operate machinery if you have this.
You might lose weight while having this treatment. Let your doctor or nurse know and they can recommend ways of maintaining your weight. Or they can refer you to a dietitian.
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering. Contact your advice line straight away if you have any of these symptoms
changes in levels of , salts, and a chemical called in your body. You will have regular blood tests to check for this
changes to blood sugar levels. Symptoms may include feeling very thirsty, tired, blurred vision, losing weight without trying, feeling hungry, dizzy, or shaking. If you have you may need to check your blood sugar levels more often than usual
dehydration
mood changes such as feeling confused or anxious. Rarely, you may see or hear things that are not real (hallucinations) and believe things are true when they are not (delusional)
fainting
cognitive changes such as problems with your memory
taste changes including loss of taste
heart problems, such as a faster heartbeat. Rarely this treatment can change your heart rhythm and how well your heart pumps blood around the body. You might get chest pain, have a , get fluid or inflammation around the heart and problems with the heart muscle that may cause heart failure
high or low blood pressure including a drop in blood pressure when you stand up. Symptoms of blood pressure changes include feeling faint, lightheaded, dizzy, blurred vision, nosebleeds, headaches, shortness of breath and chest pain
pain in different parts of the body including your mouth, throat, abdomen, arms, legs, injection site, or chest. Dial 999 if you have chest pain
swollen tummy
indigestion, symptoms include heartburn, bloating and burping
dry mouth
wind (also known as flatulence and farting)
hair loss
night sweats
skin problems such as a rash, itchiness, dry skin, redness or lumps on the skin. Rarely, areas of skin might go lighter or darker, you might have rashes similar to acne. Or you might develop a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish, and your eyes may be more sensitive to light. This is serious and could be life threatening
kidney changes that are usually mild and don’t cause any symptoms. More rarely your kidneys may not work as well. Symptoms include not peeing enough or going very often, pain, feeling tired and weak, and feeling sick. You might have swelling in your legs, ankles and feet. You will have regular blood tests to check your kidneys
liver changes that are usually picked up on blood tests. Rarely this treatment can damage or cause inflammation of the liver. Symptoms can include fatigue, loss of appetite, abdominal pain, feeling or being sick, itchy skin, yellowing of the skin and whites of the eyes
feeling generally unwell
reactivation of a virus that you’ve had it in the past such as shingles. More rarely this can happen with hepatitis
mouth sores and ulcers
a build up of fluid causing swelling in your face, arms, legs or other parts of your body
feeling shivery (chills)
shingles - this might be all around the body and can also affect your eyes
These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:
a blood disorder where your red blood cells get destroyed faster than they can be made (haemolytic anaemia)
an allergic reaction - this may happen during treatment, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Tell your nurse or doctor immediately if at any time you feel unwell
changes to the levels of hormones in your blood
too much cortisol in your body (Cushing’s syndrome) – you may gain weight and notice your skin bruises easily
changes to the levels of chemicals in the blood due to breakdown of cancer cells (tumour lysis syndrome)
developing
posterior reversible encephalopathy syndrome (PRES) - a rare disorder of the nerves causing headache, fits, confusion and changes in vision - contact your health team straight away. This condition is reversible
fits (seizure)
hearing problems including ringing in the ears (tinnitus), ear pain or deafness
blood clots that can be life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
inflammation of your blood vessels. Symptoms can vary depending on which blood vessels are affected. General symptoms include feeling very tired, loss of appetite, weight loss, a high temperature, and aches and pains (vasculitis)
hiccups
inflammation of the and a blockage in the
a runny nose
a hoarse voice
a blockage in your bowel, symptoms can include severe abdominal pain, bloating, feeling or being sick, unable to have a poo or fart
difficulty getting an
weight gain
feeling thirsty
a second cancer
There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:
high levels of a fatty substance called cholesterol in your blood
thinner and weaker bones that are fragile and more likely to break (osteoporosis)
thinning of the skin
slower wound healing
You might have other side effects that are not listed on this page. You can look at the individual drug pages:
Selinexor is a new drug in cancer treatment. So there is limited information available at the moment about possible rare and longer term effects that it may cause. Tell your doctor if you notice anything that is not normal for you.
We have more information about side effects and tips on how to cope with them.
Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.
Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.
This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 3 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant.
You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
It is not known whether selinexor and bortezomib come through into the breast milk. Doctors usually advise that you don’t breastfeed for 1 week after your last treatment.
If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having.
Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever.
You can usually have:
other vaccines, but they might not give you as much protection as usual
the flu vaccine (as an injection)
the coronavirus (COVID-19) vaccine
Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.
You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your is weakened.
Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.
For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug on this website.
You can report any side effect you have to the Medicines and Healthcare Regulatory Agency (MHRA) as part of their Yellow Card Scheme.
Last reviewed: 14 Oct 2025
Next review due: 14 Oct 2028
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