Dr. Hari on Mitigating Selinexor-Related Toxicities in Multiple Myeloma

Parameswaran Hari, MD, MRCP, the Armand J. Quick/William F. Stapp Professor of Hematology, and the chief of the Division of Hematology/Oncology, Department of Medicine, at the Medical College of Wisconsin, discusses mitigating selinexor (Xpovio)-related toxicities in relapsed/refractory multiple myeloma.

Selinexor plus dexamethasone is approved for twice-weekly administration for patients with heavily pretreated multiple myeloma. However, because of the significant gastrointestinal (GI) toxicities associated with selinexor, the agent’s second indication is typically preferred. As such, patients with multiple myeloma who have received at least 1 prior therapy can receive up to 100 mg of oral selinexor in combination with bortezomib (Velcade) once weekly.

Appropriate use of prophylactic agents, such as dexamethasone, 5-hydroxytryptamine receptor antagonists, and aprepitant (Emend), can be given to prevent GI toxicities with selinexor, Hari says. Moreover, with adequate prophylactic treatment, plus potential dose escalation and olanzapine (Zyprexa), selinexor has been shown to be tolerable and highly efficacious for patients with relapsed/refractory multiple myeloma who have limited or no treatment options, concludes Hari.