Using Monoclonal Antibody Therapy in Multiple Myeloma

Saad Z. Usmani, MD, FACP:As daratumumab moves into the frontline setting, it would be important to recognize the right kind of patients. Think about patients who are receiving a doublet regimen—where you want to add a third agent—which does not add a lot of adverse effects or competing adverse effects to that regimen. So utilizing a daratumumab-based frontline regimen for that kind of a patient, or for someone who has existing neuropathy, where you’re thinking that adding a proteasome inhibitor would aggravate the adverse effects of that issue with a given patient. Looking at the convenience factor as well, not every patient can come in for an infusion. It is important to think about the convenience factor for patients as well as deciding on the right treatment.

Infusion-related reactions to monoclonal antibodies tend to happen with daratumumab during the first cycle. That is the cycle you need to pay a little bit more attention to, specifically with the first one, but it does not happen in every patient. Three of 10 patients may experience some degree of infusion-related reactions during that first cycle. The other important thing to note as you manage these patients are pre-existing pulmonary conditions—to make sure that their COPD [chronic obstructive pulmonary disease] or asthma is well controlled. You would consider a monoclonal antibody for that kind of a patient. You would then talk to your patient about all these options and help them pick the best option for them.

We are in an exciting time for myeloma patients. The survival for myeloma patients has almost quadrupled in the past 2 decades. We are starting to incorporate monoclonal antibodies into the frontline setting. This makes our jobs as oncologists a little challenging on how best to sequence therapies, but that’s a good problem to have. With the growing number of regimens that we have for each setting, we are going to start seeing algorithms that are patient-specific. There was a time when we only had 1 or 2 options. Now we have several options, several different mechanisms of action—working together to get patients the best depth of response and survival outcomes. Overall, I am very hopeful for all myeloma patients.

Transcript edited for clarity.