Monoclonal Antibodies in Multiple Myeloma: Focus on Infusion-Related Reactions
Posted: Wednesday, September 5, 2018
Monoclonal antibodies have proved to be effective antimyeloma agents, but a common theme with their use has been infusion-related reactions, both respiratory and nonrespiratory. In a clinical review published in the Journal of Oncology Practice, Sagar Lonial, MD, of Emory University School of Medicine, Atlanta, and colleagues reviewed their institutional experience as well as clinical trial experience in managing such reactions to daratumumab and elotuzumab and offered practical strategies to reduce their occurrence.
“Most infusion-related reactions encountered with monoclonal antibodies were mild to moderate in severity, and grade 3 to 4 infusion-related reactions were rare; rates of discontinuations were seen in less than 1% of patients across all studies,” stated the review authors.
In several clinical trials, generally, adverse events related to elotuzumab were mild to moderate, with the most common effects being chills, fatigue, pyrexia, cough, headache, anemia, nausea, and back pain. “Appropriate pre- and postinfusion medications can help lower the rates of infusion-related reactions [with elotuzumab] and facilitate increase the infusion rates to enable shorter infusion times,” Dr. Lonial and colleagues reported.
As for treatment with daratumumab in 94 patients at the study authors’ institution, about half had an infusion-related reaction with their first infusion, with most (98%) being grade 1 or 2. “The all-grade infusion-related reactions with daratumumab are relatively higher than what is observed with elotuzumab but can be safely mitigated with an optimal pre- and postinfusion recipe (different for first infusion [incorporating montelukast] and subsequent infusions) and can minimize the much-dreaded respiratory infusion-related reactions,” the investigators concluded. Subcutaneous administration of daratumumab “seems a promise for the future,” they predicted.
