Hematologic Oncology Update, Issue 1, 2016 (Video Program)Clinical experience with the newly FDA-approved monoclonal antibody daratumumab
2:40 minutes.
TRANSCRIPTION:
DR FONSECA: So actually we schedule our patients starting very early in the morning. We do it at the outpatient infusion center because we close late. We close until 9:00. So this is sometimes a challenge for our colleagues in private practice. And we partner with them sometimes to start the treatment at our center as well. The patients have to be started. And then if there is a reaction, which occurs in about 50% of patients, what you have to do is administer, of course, the reaction medications but stop and then restart the infusion at 50% of the rate when the reaction has subsided. In the clinical trials, actually, there were no patients who had to stop treatment because of these adverse reactions. And our clinical experience is the same. During the first month of usage, we used to get phone calls all the time from the nursing staff, many concerns. Now that has subsided. I think everyone is comfortable with its use. And most patients are able to complete during that first day. And, of course, for subsequent infusions it becomes easier. DR LOVE: So what’s the minimal amount of time it would take, in your experience, giving daratumumab for the first time? And how many people are not actually even able to get through the first dose? DR FONSECA: Most of our patients have been able to get through the first dose. We kind of made the decision, if the infusion can go on, instead of admitting the patient, just finish the day with whatever you were able to give and then go on to day number 2. The infusion cannot be held overnight. It’s supposed to be used within 15 hours. So you would have to mix medication again. So we just say, “Let’s go and get as much as we can.” And in every case the infusion has been completed, certainly in my personal experience. And then subsequent to that the infusions are shorter, in the range of 4 hours. But I would say that everyone should plan for a full day of work for the first day of infusional daratumumab. DR LOVE: So now kind of getting more into clinical usage, it is approved currently after 3 lines of therapy. Right now in your practice, how are you using it? And are you using it by itself as approved, or with other agents? DR FONSECA: For the most part, it’s being used by itself, although several of my colleagues have used it in combination with things like pomalidomide and dexamethasone. We have used it mostly in the setting of patients who have received extensive therapy before. And as we have learned to use it, there are different scenarios. There’s occasionally the patient who has very advanced disease, for which it’s hard to achieve much in the way of response. And then we’ve been quite gratified by some patients who appear to have pretty aggressive disease and have been well controlled with daratumumab. |