Nursing Considerations for Using Selinexor in Multiple Myeloma

Patients with relapsed/refractory multiple myeloma who received reduced doses of the triplet combination of selinexor (Xpovio), bortezomib (XVd), and dexamethasone (Velcade) achieved higher response rates and longer duration of responses, according to Sundar Jagannath,MBBS, professor of medicine and director of the Center of Excellence at Tisch Cancer Institute, Mount Sinai in New York, New York.

Specifically, in a post-hoc analysis of the phase 3 BOSTON Study (NCT03110562), which was recently presented at the 63rd American Society of Hematology Annual Meeting & Exposition, lower doses of selinexor (60 mg and 40 mg) were found to be more effective and tolerable compared with standard (100-mg) doses for this patient population.

Jagannath, who presented the data during the meeting, recently spoke with Oncology Nursing News® about nursing considerations and important patient education regarding selinexor. He highlighted the importance of medication adherence, nausea management, and proper hydration among patients about to receive this agent.

“This is an oral drug,” Jagannath said. “[Nurses] want to tell the patient to maintain a calendar—it is given only once a week [and] you have to ensure that they are taking the pill only once a week, [that] they are not by mistake, like a blood pressure medication, taking it every day... So, that's number 1.”

“We have to tell them, especially when [they are] starting on the medication, [that they are] going to take nausea medication, and dexamethasone because that alleviates the potential for nausea, [and] vomiting. Usually, we use ondansetron (Zofran)—it's available as an orderly dissolvable tablet. [It is important to] take it around the clock for 48 hours, not just 1 time before taking the pill; even if you don't feel sick, just take it for the first time around for 48 hours. If you tolerate it later on, after a month or so, [when] you are comfortable with the pill and [and] the side effect, you can always cut it down by not taking the nausea medication.’”

“You need to keep yourself well hydrated, especially in myeloma,” he continued. “If you're not able to keep yourself well hydrated because of the nausea, you [have] to give a call to the doctor's office, or go to the doctor to get some IV fluid and [receive] some nausea medication IV so that the nausea is medicated.”

He also advised that patients split their dose of dexamethasone across 2 days. “You can split and take it 2 days because dexamethasone with Zofran works synergistically in preventing the nausea. Even though you took all of this medication of selinexor in 1 day, taking the nausea medication with dexamethasone over 2 days also helps,” he said.

Selinexor is an oral selective inhibitor of XPO1-mediated nuclear export compound (SINE) which functions by enforcing nuclear retention, activating tumor suppress proteins, and inhibiting the translation of oncoproteins.

Reference

1. Clinical outcomes in patients (pts) with dose reduction of selinexor in combination with bortezomib, and dexamethasone (xvd) in previously treated multiple myeloma from the BOSTON study. Presented at: 2021 ASH Annual Meeting and Exposition; December 11-14, 2021; Atlanta, GA. Abstract 3793.