Profile and Management of Toxicity of Selinexor and Belantamab Mafodotin for the Treatment of Triple Class Refractory Multiple Myeloma

Abstract

Karun Neupane,1 Ahsan Wahab,2 Adeel Masood,3 Tehniat Faraz,4 Saman Bahram,5 Hamid Ehsan,6 Abdul Hannan,7 Faiz Anwer8 1Department of Internal Medicine, Manipal College of Medical Sciences, Pokhara, Gandaki, Nepal; 2Department of Internal Medicine, Baptist Medical Center South/University of Alabama at Birmingham, Montgomery, AL, USA; 3Department of Internal Medicine, Tidal Health Peninsula Regional, Salisbury, MD, USA; 4Department of Biochemistry, Dow University of Health Sciences, Karachi, Sindh, Pakistan; 5Department of Internal Medicine, Dow University of Health Sciences, Karachi, Sindh, Pakistan; 6Department of Biomedic Sciences/Biohazardous Threat Agents & Emerging Infectious Diseases, Georgetown University, Washington, DC, USA; 7Department of Hematology/Oncology, Simmons Cancer Institute at Southern Illinois University School of Medicine, Springfield, IL, USA; 8Department of Hematology/Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USACorrespondence: Karun NeupaneDepartment of Internal Medicine, Manipal College of Medical Sciences, Phulbari, Pokhara, Gandaki, 33700, NepalEmail [email protected]: Treatment options are limited for multiple myeloma patients who have developed four/five drug-refractory disease. Selinexor (Sel) and belantamab mafodotin (belamaf) were recently approved by the US FDA for treatment of RRMM. The toxicity profile of these drugs is a concern since these agents are used in patients who have already undergone multiple lines of treatment. In this review, we discuss the toxicity profile and strategies for the management of toxicities of Sel and belamaf for the treatment of RRMM. We conducted a comprehensive literature search on PubMed, Embase, Cochrane, and Clinicaltrials.gov using the terms “selinexor”, “belantamab”, “belamaf”, and “multiple myeloma” without applying any limitations based on the date of the study, language, or country of origin. The most common hematological toxicity associated with these two drugs is thrombocytopenia. Cytopenias, constitutional symptoms, gastrointestinal effects, and hyponatremia are the major toxicities of Sel. Keratopathy and anemia are the major toxicities of belamaf. Treatment modifications and dose interruption are usually needed when side effects are more than grade II. As these are newer drugs with limited data, continuous surveillance and monitoring are warranted during the treatment course with early mitigation strategies.Keywords: hematological malignancy, treatment, safety, ocular toxicity, relapsed and refractory multiple myeloma

Keywords

• hematological malignancy
• treatment
• safety
• ocular toxicity
• relapsed and refractory multiple myeloma