Integrated safety profile of selinexor in multiple myeloma: experience from 437 patients enrolled in clinical trials

Maria Gavriatopoulou, Ajai Chari, Christine Chen, Nizar Bahlis, Dan T. Vogl, Andrzej Jakubowiak, David Dingli, Robert F. Cornell, Craig C. Hofmeister, David Siegel, Jesus G. Berdeja, Donna Reece, Darrell White, Suzanne Lentzsch, Cristina Gasparetto, Carol Ann Huff, Sundar Jagannath, Rachid Baz, Ajay K. Nooka, Joshua RichterRafat Abonour, Terri L. Parker, Andrew J. Yee, Philippe Moreau, Sagar Lonial, Sascha Tuchman, Katja C. Weisel, Mohamad Mohty, Sylvain Choquet, T. J. Unger, Kai Li, Yi Chai, Lingling Li, Jatin Shah, Sharon Shacham, Michael G. Kauffman, Meletios Athanasios Dimopoulos

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2430-2440
Number of pages11
JournalLeukemia
Volume34
Issue number9
DOIs
StatePublished - Sep 1 2020

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Gavriatopoulou, M., Chari, A., Chen, C., Bahlis, N., Vogl, D. T., Jakubowiak, A., Dingli, D., Cornell, R. F., Hofmeister, C. C., Siegel, D., Berdeja, J. G., Reece, D., White, D., Lentzsch, S., Gasparetto, C., Huff, C. A., Jagannath, S., Baz, R., Nooka, A. K., ... Dimopoulos, M. A. (2020). Integrated safety profile of selinexor in multiple myeloma: experience from 437 patients enrolled in clinical trials. Leukemia, 34(9), 2430-2440. https://doi.org/10.1038/s41375-020-0756-6