Dr. Wong on Mitigating Toxicities of Selinexor in R/R Multiple Myeloma

Sandy Wong, MD, assistant professor, University of California, San Francisco (UCSF) School of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, discusses ways to mitigate the toxicities of selinexor (Xpovio) in patients with relapsed/refractory multiple myeloma.

In July 2019, the FDA approved selinexor in combination with dexamethasone for the treatment of adult patients with relapsed/refractory multiple myeloma who have received ≥4 prior therapies and whose disease is refractory to ≥2 proteasome inhibitors, ≥2 immunomodulatory agents, and a CD38-targeted monoclonal antibody.

Supportive care can help mitigate some of the toxicities associated with selinexor, says Wong. Patients who experience fatigue are often prescribed methylphenidate (Ritalin), and olanzapine (Zyprexa) can be used to alleviate nausea. Additionally, patients who develop hyponatremia can be treated with salt tablets and intravenous fluids.

Despite toxicity concerns, selinexor has demonstrated response rates around 20% to 30% in heavily pretreated patients, says Wong