Integrated safety profile of selinexor in multiple myeloma: experience from 437 patients enrolled in clinical trials.
Published
Journal Article
Selinexor is an oral, small molecule inhibitor of the nuclear export protein exportin 1 with demonstrated activity in hematologic and solid malignancies. Side effects associated with selinexor include nausea, vomiting, fatigue, diarrhea, decreased appetite, weight loss, thrombocytopenia, neutropenia, and hyponatremia. We reviewed 437 patients with multiple myeloma treated with selinexor and assessed the kinetics of adverse events and impact of supportive care measures. Selinexor reduced both platelets and neutrophils over the first cycle of treatment and reached a nadir between 28 and 42 days. Platelet transfusions and thrombopoietin receptor agonists were effective at treating thrombocytopenia, and granulocyte colony stimulating factors were effective at resolving neutropenia. The onset of gastrointestinal side effects (nausea, vomiting, and diarrhea) was most common during the first 1-2 weeks of treatment. Nausea could be mitigated with 5-HT3 antagonists and either neurokinin 1 receptor antagonists, olanzapine, or cannbainoids. Loperamide and bismuth subsalicylate ameliorated diarrhea. The primary constitutional side effects of fatigue and decreased appetite could be managed with methylphenidate, megestrol, cannabinoids or olanzapine, respectively. Hyponatremia was highly responsive to sodium replacement. Selinexor has well-established adverse effects that mainly occur within the first 8 weeks of treatment, are reversible, and respond to supportive care.
Full Text
Duke Authors
Cited Authors
- Gavriatopoulou, M; Chari, A; Chen, C; Bahlis, N; Vogl, DT; Jakubowiak, A; Dingli, D; Cornell, RF; Hofmeister, CC; Siegel, D; Berdeja, JG; Reece, D; White, D; Lentzsch, S; Gasparetto, C; Huff, CA; Jagannath, S; Baz, R; Nooka, AK; Richter, J; Abonour, R; Parker, TL; Yee, AJ; Moreau, P; Lonial, S; Tuchman, S; Weisel, KC; Mohty, M; Choquet, S; Unger, TJ; Li, K; Chai, Y; Li, L; Shah, J; Shacham, S; Kauffman, MG; Dimopoulos, MA
Published Date
- September 2020
Published In
Volume / Issue
- 34 / 9
Start / End Page
- 2430 - 2440
PubMed ID
- 32094461
Pubmed Central ID
- 32094461
Electronic International Standard Serial Number (EISSN)
- 1476-5551
Digital Object Identifier (DOI)
- 10.1038/s41375-020-0756-6
Language
- eng
Conference Location
- England