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Barroso A, Estevinho F, Hespanhol V, Teixeira E, Ramalho-Carvalho J, Araújo A. Management of infusion-related reactions in cancer therapy: strategies and challenges. ESMO Open 2024; 9:102922. [PMID: 38452439 PMCID: PMC10937241 DOI: 10.1016/j.esmoop.2024.102922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Several anticancer therapies have the potential to cause infusion-related reactions (IRRs) in the form of adverse events that typically occur within minutes to hours after drug infusion. IRRs can range in severity from mild to severe anaphylaxis-like reactions. Careful monitoring at infusion initiation, prompt recognition, and appropriate clinical assessment of the IRR and its severity, followed by immediate management, are required to ensure patient safety and optimal outcomes. Lack of standardization in the prevention, management, and reporting of IRRs across cancer-treating institutions represents not only a quality and safety gap but also a disparity in cancer care. The present article, supported by recently published data, was developed to standardize these procedures across institutions and provide a useful tool for health care providers in clinical practice to recognize early signs and symptoms of an IRR and promptly and appropriately manage the event.
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Affiliation(s)
- A Barroso
- Multidisciplinary Unit of Thoracic Tumours, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - F Estevinho
- Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - V Hespanhol
- Departamento de Medicina Faculty of Medicine, University of Porto, Porto, Portugal; Department of Pulmonology, Centro Hospitalar de São João, Porto, Portugal
| | - E Teixeira
- Lung Cancer Unit, CUF Descobertas, Lisboa, Portugal
| | | | - A Araújo
- Medical Oncology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Oncology Research Unit, UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal.
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2
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Ma Y, Xiao XB, Chen XL, Yuan SZ, Lu Y, Zhao SH, Chen JL, Shi GN, Wang YQ, Cheng NN, Feng P, Ding MS, Huang WR. [Daratumumab maintenance after autologous hematopoietic stem cell transplantation for newly diagnosed multiple myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:1016-1021. [PMID: 38503525 PMCID: PMC10834870 DOI: 10.3760/cma.j.issn.0253-2727.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Indexed: 03/21/2024]
Abstract
Objective: This study aimed to evaluate the efficacy and safety of daratumumab as a maintenance treatment after autologous hematopoietic stem cell transplantation (auto-HSCT) in patients with newly diagnosed multiple myeloma (NDMM) . Methods: The clinical data, hematological and renal response, and safety of 15 post-transplant patients with NDMM who had received daratumumab maintenance between May 1, 2022 and June 30, 2023 were retrospectively analyzed. Results: Fifteen patients (11 males and 4 females) with a median age of 58 (41-72) years were included. Thirteen patients did not receive daratumumab during induction therapy and auto-HSCT, 6 patients had renal impairment, and nine patients had high-risk cytogenetics. The median infusion of daratumumab was 12 (6-17) times, and the median duration of maintenance was 6 (1.5-12) months. The treatment efficacy was evaluated in all 15 patients, and daratumumab maintenance therapy increased the rate of stringent complete response from 40% to 60%. The renal response rate and median estimated glomerular filtration rate of six patients with RI-NDMM were also improved. During daratumumab maintenance therapy, the most common hematological grade 3 adverse event (AE) was lymphopenia [4 of 15 patients (26.67%) ], whereas the most common nonhematologic AEs were infusion-related reactions [7 of 15 patients (46.67%) ] and grade 3 pneumonia [5 of 15 patients (33.33%) ]. The five patients with pneumonia were daratumumab naive [5 of 13 patients (38.46%) ], with a median of 8 (6-10) infusions. Among them, the chest computed tomography of three patients showed interstitial infiltrates, and treatment with methylprednisolone was effective. With a median follow-up of 12 months, the 1-year overall survival rate was 93.33%, and only one patient died (which was not related to daratumumab treatment) . Conclusions: Daratumumab was safe and effective as a maintenance agent for post-auto-HSCT patients with NDMM, and AEs were controllable. The most common nonhematologic AE was grade 3 pneumonia, and a less dose-intense maintenance regimen for the first 8 weeks could reduce the incidence of pneumonia.
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Affiliation(s)
- Y Ma
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - X B Xiao
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - X L Chen
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - S Z Yuan
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - Y Lu
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - S H Zhao
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - J L Chen
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - G N Shi
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - Y Q Wang
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - N N Cheng
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - P Feng
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - M S Ding
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
| | - W R Huang
- Department of Lymphoma & Plasma Cell Disease, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital, Beijing 100071, China
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De Novellis D, Fontana R, Palmieri S, Della Pepa R, Di Perna M, Cetani G, Esposito D, Amendola A, Delle Cave G, Serio B, Morini D, Rizzo M, Mettivier L, Trastulli F, Rocco S, Pagano A, Barbato S, Leone A, La Magna M, Bianco R, Rascato G, Carobene A, Cuffa B, Iannalfo M, Giudice V, Svanera G, Annunziata M, Pizzuti M, Frigeri F, Califano C, Ferrara F, Pane F, Selleri C. Safety of Subcutaneous Daratumumab in Anti-CD38 Monoclonal Antibody-Naïve Patients with Plasma Cell Disorders: A Multicenter Real-Life Experience. Target Oncol 2023; 18:885-892. [PMID: 37747623 PMCID: PMC10663178 DOI: 10.1007/s11523-023-01001-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Daratumumab, an anti-CD38 monoclonal antibody, is used for treatment of multiple myeloma (MM) and light chain amyloidosis at an intravenous dosage of 16 mg/kg or at a subcutaneous fixed dose of 1800 mg. However, the subcutaneous formulation has only recently been approved in Europe, and real-life data on its safety are still few. OBJECTIVE In this multicenter retrospective real-life experience, we provided evidence for the safety of subcutaneous daratumumab in plasma cell disorders. PATIENTS AND METHODS A total of 189 patients diagnosed with MM or light chain amyloidosis were included in this retrospective study, and all subjects were daratumumab-naïve. Primary endpoint was safety of subcutaneous daratumumab, especially for infusion-related reaction (IRR) incidence and severity. All patients received premedication with dexamethasone, paracetamol, and antihistamine, with montelukast usage in 85% of cases. RESULTS Eight patients (4%) experienced IRRs, mainly of grade I-II, and other frequent toxicities were: hematological (thrombocytopenia, 4%; neutropenia, 5%; lymphopenia, 6%) and non-hematological (pneumonia, 4%; diarrhea, 2%; and cytomegalovirus reactivation, 0.5%). In our multicenter retrospective real-life experience, subcutaneous daratumumab was well-tolerated with an excellent safety profile with a very low (4%) IRR incidence, even in frailer MM patients with severe renal impairment or increased body weight. CONCLUSIONS Subcutaneous daratumumab was safe in a real-life setting including patients with severe renal failure and advanced disease. However, further studies on larger and prospective cohorts are required to confirm our real-life observations.
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Affiliation(s)
- Danilo De Novellis
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081, Baronissi, Italy
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Raffaele Fontana
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081, Baronissi, Italy
| | | | - Roberta Della Pepa
- Hematology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Giusy Cetani
- Hematology, Hospital "Sant'Anna e San Sebastiano", Caserta, Italy
| | | | - Angela Amendola
- Hematology and Transplant Center "San Carlo" Hospital, Potenza, Italy
| | | | - Bianca Serio
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081, Baronissi, Italy
| | - Denise Morini
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081, Baronissi, Italy
| | - Michela Rizzo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081, Baronissi, Italy
| | - Laura Mettivier
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081, Baronissi, Italy
| | | | - Stefano Rocco
- Hematology, Hospital "Antonio Cardarelli", Naples, Italy
| | | | - Serafina Barbato
- Hematology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Aldo Leone
- Hematology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Martina La Magna
- Hematology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Rosario Bianco
- Hematology, Hospital "Sant'Anna e San Sebastiano", Caserta, Italy
| | | | - Angela Carobene
- Hematology and Transplant Center "San Carlo" Hospital, Potenza, Italy
| | - Bianca Cuffa
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081, Baronissi, Italy
| | | | - Valentina Giudice
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081, Baronissi, Italy.
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
| | - Gino Svanera
- Hematology, Hospital "San Giuliano", Giugliano, Italy
| | | | - Michele Pizzuti
- Hematology and Transplant Center "San Carlo" Hospital, Potenza, Italy
| | | | | | | | - Fabrizio Pane
- Hematology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Carmine Selleri
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081, Baronissi, Italy.
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
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Candelaria PV, Nava M, Daniels-Wells TR, Penichet ML. A Fully Human IgE Specific for CD38 as a Potential Therapy for Multiple Myeloma. Cancers (Basel) 2023; 15:4533. [PMID: 37760502 PMCID: PMC10526502 DOI: 10.3390/cancers15184533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Multiple myeloma (MM) is an incurable malignancy of plasma cells and the second most common hematologic malignancy in the United States. Although antibodies in clinical cancer therapy are generally of the IgG class, antibodies of the IgE class have attractive properties as cancer therapeutics, such as their high affinity for Fc receptors (FcεRs), the low serum levels of endogenous IgE allowing for less competition for FcR occupancy, and the lack of inhibitory FcRs. Importantly, the FcεRs are expressed on immune cells that elicit antibody-dependent cell-mediated cytotoxicity (ADCC), antibody-dependent cell-mediated phagocytosis (ADCP), and/or antigen presentation such as mast cells, eosinophils, macrophages, and dendritic cells. We now report the development of a fully human IgE targeting human CD38 as a potential MM therapy. We targeted CD38 given its high and uniform expression on MM cells. The novel anti-CD38 IgE, expressed in mammalian cells, is properly assembled and secreted, exhibits the correct molecular weight, binds antigen and the high affinity FcεRI, and induces degranulation of FcεRI expressing cells in vitro and also in vivo in transgenic BALB/c mice expressing human FcεRIα. Moreover, the anti-CD38 IgE induces ADCC and ADCP mediated by monocytes/macrophages against human MM cells (MM.1S). Importantly, the anti-CD38 IgE also prolongs survival in a preclinical disseminated xenograft mouse model using SCID-Beige mice and human MM.1S cells when administered with human peripheral blood mononuclear cells (PBMCs) as a source of monocyte effector cells. Our results suggest that anti-CD38 IgE may be effective in humans bearing MM and other malignancies expressing CD38.
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Affiliation(s)
- Pierre V. Candelaria
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Miguel Nava
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Tracy R. Daniels-Wells
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Manuel L. Penichet
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
- UCLA AIDS Institute, Los Angeles, CA 90095, USA
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA
- The Molecular Biology Institute, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
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5
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Stakiw J, Kodad S, LeBlanc R, Sebag M, Hay AE, Kukreti V, Côté J, Camacho F, Fu M, Gul E, Reece D. A Phase II, Open-Label Study of an Accelerated Infusion Rate of Daratumumab in Patients With Relapsed and Refractory Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023:S2152-2650(23)00092-7. [PMID: 37127473 DOI: 10.1016/j.clml.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION/BACKGROUND Daratumumab is an anti-CD38 monoclonal antibody initially approved as a single agent for the treatment of relapsed and refractory multiple myeloma. The infusion-related reactions (IRRs) commonly seen with intravenous daratumumab have been managed by prolonging the first infusion, temporarily stopping/slowing the rate if reactions occur and using adequate pre- and post-infusion medications. Several retrospective studies have evaluated shorter infusions after ≥ 2 prior doses administered at the standard rates. Although the shorter infusions were well-tolerated, patients in these reports were given heterogeneous daratumumab regimens and had often already received multiple doses at the longer standard rates. PATIENTS AND METHODS CMRG-009 is a prospective study designed to demonstrate the safety of accelerated daratumumab infusions commencing with the second dose. After an initial dose on Cycle 1 Day consisting of 8 mg/kg over 4 hours, all subsequent doses were given over 90 minutes. RESULTS No grade 3 IRRs were observed with the 90-minutes infusions. Both the safety profile and anti-myeloma effects were otherwise similar to those observed with other single agent daratumumab studies using longer infusion times. CONCLUSION This is the first formal prospective trial using infusion times shorter than the standard schedule directly after an initial 4-hours dose. This rapid infusion protocol has resulted in more efficient resource utilization and has become the standard protocol for the use in all intravenous daratumumab regimens in Canada. This approach has been particularly helpful in shortening chair time during the COVID-19 pandemic and providing a useful alternative in jurisdictions without access to subcutaneous daratumumab.
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Affiliation(s)
- Julie Stakiw
- Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shruthi Kodad
- Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Richard LeBlanc
- Maisonneuve-Rosemont Hospital Research Centre, University of Montréal, Montréal, Quebec, Canada
| | - Michael Sebag
- Department of Oncology, Division of Hematology, McGill University, Montréal, Quebec, Canada
| | - Annette E Hay
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Vishal Kukreti
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Julie Côté
- Hôpital de l'Enfant-Jésus, CHU de Québec, Université Laval, Québec, Quebec, Canada
| | - Fernando Camacho
- CMRG is an independent non-profit CRO (clinical research organization), Canadian Myeloma Research Group, Vaughan, Ontario, Canada
| | - Molei Fu
- CMRG is an independent non-profit CRO (clinical research organization), Canadian Myeloma Research Group, Vaughan, Ontario, Canada
| | - Engin Gul
- CMRG is an independent non-profit CRO (clinical research organization), Canadian Myeloma Research Group, Vaughan, Ontario, Canada
| | - Donna Reece
- CMRG is an independent non-profit CRO (clinical research organization), Canadian Myeloma Research Group, Vaughan, Ontario, Canada.
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Coffman K, Carstens C, Fajardo S. Daratumumab infusion reaction rates pre- and post-addition of montelukast to pre-medications. J Oncol Pharm Pract 2023; 29:333-337. [PMID: 35018845 DOI: 10.1177/10781552211072876] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Daratumumab, a CD38-directed monoclonal antibody indicated for multiple myeloma treatment in adult patients, is associated with a high incidence of infusion-related reactions (IRRs). Due to CD38 receptor presence in the lungs, many reactions present similarly to asthma or allergic rhinitis. Montelukast, a leukotriene receptor antagonist, has been hypothesized to reduce daratumumab IRRs due to its efficacy in treating allergic rhinitis and asthma and the presence of leukotriene receptors in the lungs. Recently published data reported daratumumab can be safely administered via rapid rate protocol that reduces infusion time from 195 min to 90 min after completion of two doses. This retrospective, observational cohort study examined 73 patients who received daratumumab in the outpatient setting between December 2015 and April 2020. Patients were included if they were 18 years or older, had an International Classification of Disease (ICD)-10 diagnosis code for multiple myeloma, and received daratumumab intravenously. The primary outcome was a comparison of IRRs between those who did and did not receive montelukast. Secondary outcomes included IRR symptoms, rescue medications utilized for IRRs, and rapid rate administration outcomes. Montelukast use was associated with a lower rate of IRRs (44.4% vs. 65.2%, p = 0.044). Pulmonary IRR symptoms were more common in those who did not receive montelukast. Rapid rate administration of daratumumab did not lead to any IRRs. Adding montelukast as a pre-medication for daratumumab infusions led to a reduction in IRRs, and rapid rate administration was found to be safe after completion of two full doses of daratumumab.
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Affiliation(s)
- Kelsey Coffman
- 21782The University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Coby Carstens
- 21782The University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Susan Fajardo
- 21782The University of Iowa Hospitals and Clinics, Iowa City, USA
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7
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Shah B, Gray J, Abraham I, Chang M. Pharmacy considerations: Use of anti-CD38 monoclonal antibodies in relapsed and/or refractory multiple myeloma. J Oncol Pharm Pract 2023; 29:170-182. [PMID: 35726199 DOI: 10.1177/10781552221107850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This article reviews current evidence for the approved anti-CD38 monoclonal antibodies, isatuximab and daratumumab, for the treatment of patients with relapsed and/or refractory multiple myeloma (RRMM) and the implications for pharmacists. DATA SOURCES We conducted a literature search on PubMed/Medline and other sources using the drug names and the terms CD38, multiple myeloma, and pharmacists. DATA SUMMARY Monoclonal antibodies targeting the CD38 transmembrane glycoprotein offer a promising treatment approach for patients with RRMM. Isatuximab and daratumumab bind to different epitopes on CD38. In this review, we describe the similarities and differences in their mechanism of action, regulatory labeling, and the current guidelines for isatuximab and daratumumab use in RRMM. We review the current evidence for the efficacy and safety of these agents in combination with pomalidomide or carfilzomib and dexamethasone from the landmark phase 3 clinical trials that led to their approval. We discuss key differences in the eligibility criteria between the clinical trials, and differences in dosing, administration, available formulations, and pre- and post-infusion medications for the two agents. We outline recent data from pharmacoeconomic analyses comparing the cost-effectiveness of isatuximab-based regimens with that of daratumumab-based regimens. A brief overview of other anti-CD38 agents in the pipeline for the treatment of patients with RRMM is presented. CONCLUSIONS Given that pharmacists play an integral role in driving cost-effective use of drugs without compromising efficacy and safety for the end user, educating pharmacists on the key differences between isatuximab and daratumumab can guide the selection of the appropriate anti-CD38 antibody.
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Affiliation(s)
- Bhavesh Shah
- 1836Boston Medical Center, One Boston Medical Center Place, Boston, MA, USA
| | - Joy Gray
- Tennessee Cancer Specialists, Knoxville, TN, USA
| | - Ivo Abraham
- University of Arizona Cancer Center and Center for Health Outcomes and PharmacoEconomic Research, Tucson, AZ, USA
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8
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Cook G, Ashcroft J, Fernandez M, Henshaw S, Khalaf Z, Pratt G, Tailor A, Rabin N. Benefits of switching from intravenous to subcutaneous daratumumab: Perspectives from UK healthcare providers. Front Oncol 2023; 13:1063144. [PMID: 36910662 PMCID: PMC9996301 DOI: 10.3389/fonc.2023.1063144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Daratumumab is a CD38-directed monoclonal antibody indicated to treat multiple myeloma (MM). Daratumumab was initially administered intravenously (IV), subsequently a subcutaneous (SC) formulation was developed to increase convenience of administration. The UK was an early adopter of SC daratumumab and, as such, this report provides consensus recommendations from a group of UK MM experts, with the aim of facilitating the transition from IV to SC daratumumab for other European healthcare providers. The switch from IV to SC daratumumab has been beneficial to patients and healthcare providers, as it simplifies treatment, reduces pressure on hospitals and can improve patients' quality of life.
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Affiliation(s)
- Gordon Cook
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - John Ashcroft
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom.,Department of Haematology, Pinderfields General Hospital, Wakefield, United Kingdom
| | | | - Sarah Henshaw
- Department of Haematology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Zeyad Khalaf
- Janssen Europe, the Middle East and Africa (EMEA), Beerse, Belgium
| | - Guy Pratt
- Department of Haematology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Anish Tailor
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - Neil Rabin
- Department of Haematology, University College London Hospitals, London, United Kingdom
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9
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Tam T, Smith E, Lozoya E, Heers H, Andrew Allred P. Roadmap for new practitioners to navigate the multiple myeloma landscape. Heliyon 2022; 8:e10586. [PMID: 36164513 PMCID: PMC9508512 DOI: 10.1016/j.heliyon.2022.e10586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 10/25/2022] Open
Abstract
Multiple myeloma (MM) is a blood cancer in which monoclonal plasma cells cause end organ damage resulting in hypercalcemia, renal failure, anemia, and bone lesions. MM is considered incurable, however, recent advances in treatment have improved survival. Historically, MM has been treated with immunomodulatory drugs (IMiDs), proteosome inhibitors (PIs), and corticosteroids. While newer therapeutic approaches such as monoclonal antibodies and cellular therapies have broadened the treatment horizon, the selection and sequencing of these therapies has become more complex. This review aims to help advanced practice providers navigate through the diagnosis, staging, treatment, and supportive care considerations in the MM space.
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Affiliation(s)
- Tiffany Tam
- Banner MD Anderson Cancer Center, 2946 E Banner Gateway Drive, Gilbert, AZ 85295, United States
| | - Eric Smith
- Banner MD Anderson Cancer Center, 2946 E Banner Gateway Drive, Gilbert, AZ 85295, United States
| | - Evelyn Lozoya
- Banner MD Anderson Cancer Center, 2946 E Banner Gateway Drive, Gilbert, AZ 85295, United States
| | - Hayley Heers
- Banner MD Anderson Cancer Center, 2946 E Banner Gateway Drive, Gilbert, AZ 85295, United States
| | - P Andrew Allred
- Banner MD Anderson Cancer Center, 2946 E Banner Gateway Drive, Gilbert, AZ 85295, United States
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10
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Steinbach M, Julian K, McClune B, Sborov DW. Toxicity management strategies for next-generation novel therapeutics in multiple myeloma. Ther Adv Hematol 2022; 13:20406207221100659. [PMID: 35860442 PMCID: PMC9289924 DOI: 10.1177/20406207221100659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/27/2022] [Indexed: 12/11/2022] Open
Abstract
The therapeutic options available for patients with multiple myeloma have greatly expanded over the past decade and incorporating these novel agents into routine clinical practice has significantly improved outcomes. The next generation of therapeutics is available for relapsed and refractory patients either as standard of care or in clinical trial, and these drugs represent a generational paradigm shift. Patients now have access to a multitude of novel immunotherapeutics, including monoclonal antibodies, an antibody-drug conjugate, chimeric antigen receptor T-cells (CAR-T), and bispecific T-cell redirecting antibodies, and novel oral therapies including selinexor (selective inhibitor of nuclear export) and venetoclax (bcl-2 inhibitor). While these drugs have the potential to be highly efficacious in certain subsets of patients when used as single agents or in combination regimens, they are each associated with unique toxicity profiles. It is imperative to understand these potential adverse events to ensure patient safety. Appropriate supportive care management is paramount to maximize drug exposure and therapeutic efficacy. The following review focuses its discussion on drugs and combination regimens that are currently FDA-approved and those that continue to be investigated in clinical trials, highlights the clinically relevant toxicity profiles for each of the different agents, and provides practical considerations for the treatment team.
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Affiliation(s)
- Mary Steinbach
- Department of Internal Medicine, Huntsman
Cancer Institute, The University of Utah, Salt Lake City, UT, USA
| | - Kelley Julian
- Department of Pharmacy, The University of Utah,
Salt Lake City, UT, USA
| | - Brian McClune
- Department of Internal Medicine, Huntsman
Cancer Institute, The University of Utah, Salt Lake City, UT, USA
| | - Douglas W. Sborov
- Department of Internal Medicine, Huntsman
Cancer Institute, The University of Utah, 2000 Circle of Hope Drive, Salt
Lake City, UT 84112, USA
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11
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Fucci L, Gensini L, Coppetelli U, La Barbera EO, Gentile M, Fiori L, Perrone S, Cimino G. Daratumumab triplet therapies in patients with relapsed or refractory Multiple Myeloma: a “real world” experience. Leuk Res Rep 2022; 17:100330. [PMID: 35694449 PMCID: PMC9184873 DOI: 10.1016/j.lrr.2022.100330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/18/2022] [Accepted: 05/28/2022] [Indexed: 11/24/2022] Open
Abstract
We report our retrospective analysis on 34 relapsed/refractory multiple myeloma (RRMM) patients treated with daratumumab based triplets. Twenty patients were females and 14 males. Median age was 73.2. Daratumumab was associated to lenalidomide in and dexamethasone (DRd) in 30 (88,3%) and to bortezomib and dexamethasone (DVd) in 4 cases (11,7%). The ORR was 88%. CR occurred in 12% of cases, VGPR in 44% and PR in 32%. The 12 months PFS and OS rates were 78% and 86,5%, respectively. Present data confirm those recently reported in the literature and further reinforce the early use of daratumumab-based triplets for RRMM patients.
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12
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Kim JH, Park SS, Yoon JH, Lee SE, Kim HJ, Min CK. Daratumumab monotherapy in relapsed and refractory multiple myeloma patients with severely compromised forced expiratory volume in one second. Blood Res 2022; 57:76-80. [PMID: 35342045 PMCID: PMC8958367 DOI: 10.5045/br.2022.2021183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/05/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jin-Hyo Kim
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Soo Park
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Ho Yoon
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Eun Lee
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee-Je Kim
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Moore DC, Oxencis CJ, Shank BR. New and emerging pharmacotherapies for management of multiple myeloma. Am J Health Syst Pharm 2022; 79:1137-1145. [PMID: 35333922 DOI: 10.1093/ajhp/zxac091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The pharmacology, efficacy, safety, and dosing/administration of new and emerging therapies for the treatment of multiple myeloma are summarized. SUMMARY There have been significant advancements in the treatment of multiple myeloma in recent years, with an expansion of available drug therapies. Newer therapies for multiple myeloma include the anti-CD38 monoclonal antibodies daratumumab and isatuximab, the exportin 1 inhibitor selinexor, the anti-B-cell maturation antigen (BCMA) antibody-drug conjugate belantamab mafodotin, and the chimeric antigen receptor (CAR) T-cell therapy idecabtagene vicleucel. These agents have unique toxicity profiles, specific monitoring parameters, and operational considerations that clinicians treating multiple myeloma should be aware of. There is likely to be continued rapid expansion of new agents for patients with multiple myeloma, as there are many novel investigational agents in the drug development pipeline, such as bispecific antibodies and additional CAR T-cell therapies. CONCLUSION Several therapeutic agents have been recently approved by the Food and Drug Administration for the treatment of multiple myeloma. There are many novel agents in the pipeline, including bispecific antibodies and CAR T-cell therapies that have the potential to continue to change the treatment landscape of multiple myeloma.
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Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Concord, NC, USA
| | | | - Brandon R Shank
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Arnall JR, Maples KT, Harvey RD, Moore DC. Daratumumab for the Treatment of Multiple Myeloma: A Review of Clinical Applicability and Operational Considerations. Ann Pharmacother 2021; 56:927-940. [PMID: 34963325 DOI: 10.1177/10600280211058754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To review the available data for the efficacy and safety of daratumumab in the treatment of multiple myeloma (MM), both in the newly diagnosed and relapsed/refractory settings, as well as provide additional guidance to clinicians on operational, safety, and supportive care considerations. DATA SOURCES A literature search of PubMed (1966 to October 2021) was conducted using the keywords daratumumab, Darzalex, and myeloma. Data were also obtained from prescribing information and unpublished abstracts from meetings. STUDY SELECTION AND DATA EXTRACTION All relevant published articles, prescribing information, and unpublished meeting abstracts on daratumumab for the treatment of MM were reviewed. DATA SYNTHESIS Daratumumab is an anti-CD38 monoclonal antibody indicated for the treatment of MM. The addition of daratumumab to proteasome inhibitor and immunomodulatory drug-based regimens has led to a consistent improvement in progression-free survival and response rates in relapsed/refractory MM as per the POLLUX, CASTOR, APOLLO, and CANDOR trials. The ALCYONE and MAIA phase III trials have demonstrated an overall survival benefit when adding daratumumab to frontline regimens for transplant-ineligible patients with newly diagnosed MM. In transplant-eligible patients, daratumumab-based quadruplet regimens have improved depth of response in the CASSIOPIEA and GRIFFIN trials. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Operational and safety considerations that clinicians need to account for do exist, including different administration and infusion strategies, infusion-related reactions, increased risk for infectious complications, and interference with blood transfusion management. CONCLUSIONS Daratumumab has led to a shift in the treatment paradigm of both newly diagnosed and relapsed/refractory MM, leading to improvements in outcomes such as response rates, depth of response, and progression-free survival.
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Affiliation(s)
- Justin R Arnall
- Specialty Pharmacy Service, Atrium Health, Charlotte, NC, USA
| | - Kathryn T Maples
- Department of Pharmaceutical Services, Winship Cancer Institute, Emory University Hospitals, Atlanta, GA, USA
| | - R Donald Harvey
- Winship Cancer Institute, School of Medicine, Emory University, Atlanta, GA, USA
| | - Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, Concord, NC, USA
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