Dr. Sborov on Supportive Care Approaches to Selinexor-Associated Toxicities in Multiple Myeloma

Douglas W. Sborov, MD, MS, assistant professor, Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah School of Medicine; director, Multiple Myeloma Program and Division of Hematology Biorepository; member, Huntsman Cancer Institute (HCI) Experimental Therapeutics Program; physician leader, Multiple Myeloma/Bone Marrow Transplant arm, HCI Clinical Trials Office; and member, HCI Protocol Review and Monitoring Committee, Huntsman Translational Scholar, University of Utah Health, discusses supportive care approaches for selinexor (Xpovio)-associated toxicities in multiple myeloma.

Based on available clinical trial data, the XPO1 inhibitor selinexor is an appropriate treatment option for some patients with relapsed/refractory multiple myeloma; however, it is critical to monitor patients for selinexor-associated toxicities, Sborov says. Common adverse effects observed with the agent include cytopenias, hyponatremia, and gastrointestinal events, such as anorexia, nausea, and diarrhea.

Prophylactic treatment during the initial cycles of selinexor administration could include ondansetron (Zofran) on up to day 2 after dosing, olanzapine (Zyprexa) dosed at night, and NK-1 receptor antagonists, Sborov explains. Additionally, encouraging patients to maintain adequate hydration is important, but weekly monitoring for intravenous fluid intervention is also critical.

Finally, G-CSF or TPO receptor agonists can be considered in patients with significant cytopenias to maintain adequate counts that allow for continued treatment with selinexor, Sborov concludes.