Table 5.
Management of Toxicities of Selinexor and Belamaf
| Drug | Type of Toxicity | Nature of Toxicity | Management |
|---|---|---|---|
| Selinexor | Non-hematological | Infection/pneumonia | Antibiotics Hospitalization for supportive care |
| Fatiguea | Physical therapy | ||
| Diarrheaa | Loperamide Diphenoxylate/atropine Octreotide (severe or refractory) |
||
| Hyponatremiaa | Sodium replacement (normal saline or salt tablets) | ||
| Elevation of livera and pancreatic enzymes | Watchful monitoring (transient only) | ||
| Dehydration | Fluid resuscitation (infusion center vs inpatient) | ||
| Nauseaa/Vomiting | Antiemetics (Ondansetron, prochlorperazine, granisetron, aprepitant) | ||
| Anorexia/Weight lossa | Combine with dexamethasone Dronabinol Megestrol acetate Metoclopramide |
||
| Dysgeusia | Supportive | ||
| Confusion | Correct underlying cause like hyponatremia | ||
| Cataract | Surgical extraction | ||
| Hematological | Thrombocytopenia | Dose reduction or interruptions Treatment holidays Platelet transfusion Thrombopoietin receptor agonists |
|
| Anemiaa | Packed RBC Transfusion | ||
| Neutropeniaa | Granulocyte Colony Stimulating Factor | ||
| Belantamab mafodotin (Belamaf) | Non-hematological | Keratopathy | Avoid use of ophthalmic steroid drops (risk of steroid-induced glaucoma, cataract, and infection) |
| Blurred Vision | Serial ophthalmic evaluations | ||
| Visual acuity decline | Use of keratopathy and visual acuity scale (KVA) to decide future treatments of belamaf. | ||
| Photophobia | Management of Ocular toxicity: see Table 3 | ||
| Dry Eyes | Preservative free artificial tears | ||
| Pyrexia/headache/arthralgia | Acetaminophen/Ibuprofen | ||
| Constipation | Laxatives | ||
| Epistaxis | Correct underlying thrombocytopenia if severe Symptomatic management |
||
| Acute kidney injury | Fluid resuscitation can be inpatient or infusion center | ||
| Hypokalemia | Replace potassium orally (outpatient) or intravenous (inpatient) | ||
| Upper respiratory infection | Antibiotics | ||
| Cough | Dextromethorphan | ||
| Hypercalcemia | Ca <12 mg/dl: No treatment Ca 12–14 mg/dl: Normal saline and bisphosphonates Ca >14 mg/dl: Calcitonin or zoledronic acid in addition to normal saline |
||
| Infusion-related reactionsb | Premedication helpful. Supportive care for symptoms |
||
| Hematological | Thrombocytopenia | Platelet 25,000/mm3 to <50,0000/mm3: Withhold and/or reduce the dose Platelet <25,000/mm3: Withhold drug |
Notes: aAdverse Events of belantamab as well. Management same as selinexor. bInfusion-related reactions include a myriad of symptoms related to infusion such as pyrexia, chills, diarrhea, nausea, asthenia, hypertension, lethargy, tachycardia, vomiting, cough, and hypotension occurring within 24 hours of infusion.
Abbreviations: G, grade; RBC, red blood cell; Ca, calcium.