Current Clinical Algorithms and Recent Therapeutic Advances in the Management of Multiple Myeloma and Related Blood Disorders (Video Program)Activity of the anti-CD38 monoclonal antibody isatuximab (SAR650984) in relapsed/refractory MM
2:13 minutes.
TRANSCRIPTION:
DR RAJE: There is an ongoing trial where we’re using the other CD38 monoclonal antibody, which is isatuximab. The SAR compound — DR LOVE: That’s still out there, huh? DR RAJE: No, it’s doing actually very well. DR LOVE: Is that going to come to practice? DR RAJE: Absolutely. Hopefully, because it’s very similar to daratumumab. And the studies we’re doing with isatuximab are in combination with pomalidomide right now, so pom/dex/isa. And if you extend that to dara — because, in my mind, they’re quite similar — doing dara/pom/dex is a very, very, very potent combination. And I agree with Rafael completely. The toxicity of daratumumab is honestly just infusion related. It’s the first dose, or maybe dose 1 and dose 2. And after that, it’s very manageable. DR LOVE: Any comments about blood-banking issues with dara? DR FONSECA: Sure. One of the issues that has been reported with daratumumab — and it’s true with any of the antibodies that target CD38 — is the possibility of cross-reactivity and a positive Coombs test, difficulty doing typing for the blood. So our standard orders tell the nursing staff, if the patient’s going to get daratumumab, please contact the blood bank and send a sample so we can do the complete typification before we start the infusion. I think that’s an important one. In practicality now in the real world, it hasn’t been much of a problem, and patients seem to be doing well. The other one that I like to mention as we talk about toxicities — we talked about the infusional — one of the things that we have seen as well for isatuximab is that in combination with IMiDs, one has to be mindful of myelosuppression. Now, I don’t think we have a good explanation. I’ve thought that maybe, because CD38 may be expressed in stem cells, it puts some pressure with that. And you put pressure with IMiDs. So we’ve used quite a bit of daratumumab/pom/dex combination. We sometimes see pretty profound neutropenia, so we have to be careful with that. In the case of pomalidomide, I start at 2 mg and build from there, if at all possible. But that usually is more than enough. We get a pretty good response rate with that. |