Table 4.

Monitoring and management of significant adverse events associated with selumetinib therapy [56]

Adverse event	Incidence in SPRINT	Recommended monitoring	Recommended management
Rash	91%	Monitor for rash at each encounter	Withhold treatment, reduce dose, or discontinue selumetinib
Diarrhea	77%	Monitor for diarrhea at each encounter	Loperamide Increase fluid intake Withhold treatment, reduce dose, or discontinue selumetinib
Increased CPK	76%	Measure CPK at baseline	Evaluate patients for rhabdomyolysis if CPK is increased Withhold treatment, reduce dose, or discontinue selumetinib
LVEF ≥ 10% below baseline (and below institutional lower limit)	23%	Echocardiogram at baseline, q3 months during the first year, and q6 months thereafter	Perform echocardiogram Withhold treatment, reduce dose, or discontinue selumetinib
Ocular toxicity (blurred vision, photophobia, cataracts, and ocular hypertension)	15%	Ophthalmic exam at baseline, and at regular intervals thereafter Optical coherence tomography q3 weeks until resolution in patients with RPED	Perform ophthalmic exam Withhold treatment, reduce dose, or discontinue selumetinib depending on severity Withhold selumetinib in patients with RPED, resume once resolved Discontinue selumetinib in patients with RVO

CPK Creatine phosphokinase, LVEF Left ventricular ejection fraction, q3 every 3, q6 every 6, RPED Retinal pigment epithelial detachment, RVO Retinal vein occlusion