Table 4.

Summary of recommended supportive care guidelines and patient management with selinexor treatment.

Patient management	Weekly monitoring of blood counts, serum sodium, and body weight for the first 8 weeks and as needed thereafter.
Prophylaxis for Nausea and/or Vomitinga	All patients should receive a 5-HT3 receptor antagonist (e.g., ondansetron, 8 mg, PO, 30 min prior to first dose of selinexor, with subsequent 8 mg dose 8 h after the first dose of selinexor; then administered 8 mg twice-daily (every 12 h with coverage for 24 h after the last dose of selinexor); continued use should be evaluated after the first 8 weeks. Patients at high-risk for nausea and/or vomiting, or decreased appetite should receive an additional agent such as olanzapine (5–10 mg, PO, once-daily in the evening) or NK1 receptor antagonist (e.g., rolapitant per label). If using aprepritant or fosapreptiant the dose of dexamethasone may need to be reduced. Olanzapine or NK1 receptor antagonists may be reduced or stopped after the first 8 weeks if the patient is tolerating selinexor treatment.
Diarrhea	Loperamide (4 mg for the first dose, and 2 mg thereafter, PO, as needed) until diarrhea resolves.
Hyponatremia	Hydration status and serum sodium should be monitored, and saline/salt tablets employed as needed.
Thrombocytopeniab	TPO receptor agonist for platelet counts below 25,000/mm3 (romiplostim, 5–10 mcg/kg, IV, once-weekly; or eltrombopag, 50 mg, PO, daily, until platelet counts recover to ≥50,000/mm3).
Neutropeniac	G-CSF for ANC below 500/mm3 (filgrastim, SC or IV, 5 mcg/kg), daily until neutrophil count resolves to >1000/mm3; or pegfilgrastim, SC, 6 mg, weekly until neutrophil count resolves to >1000/mm3).
Fatigued	Establish causative relationship between treatment regimen and fatigue (consider onset, pattern, duration, change over time, as well as the patient’s disease status and self-assessment of causes of fatigue). For grade 2 or 3 fatigue, methylphenidate (10 mg, PO, daily) as needed.

^aFollow NCCN and/or European Society for Medical Oncology (ESMO) guidelines for moderate emetogenic chemotherapies (MECs) and treat for both acute and delayed emesis.

^bRecommendation is off-label use of romiplostim and eltrombopag.

^cFollow 2019 NCCN guidelines: hematopoietic growth factors.

^dConsider 2019 NCCN guidelines for the treatment of cancer related fatigue.