Cancer Conference Update: A Multimedia Review of Key Presentations from the 2016 American Society of Hematology Annual MeetingAbstracts 1149, 1150: Daratumumab for relapsed/refractory MM (RRMM)
2:45 minutes.
TRANSCRIPTION:
DR MIKHAEL: I was fascinated by the subcutaneous daratumumab study for so many reasons, Neil. The first, the technology was quite remarkable. They’ve patented this really brilliant technology to be able to give the whole of the drug within 30 minutes. But, of course, there’s still a long time thereafter that it’s being released in the system. So I thought from a sheer technology standpoint, that was brilliant. DR LOVE: How do they actually do it? It’s a fairly big volume of fluid that they infuse into the belly, subQ belly? DR MIKHAEL: It’s not a huge amount of fluid, actually, or else it would be very inconvenient. In fact, I remember asking at the session itself about whether or not little pockets have been left afterwards. So it’s not a very large amount of fluid, but the molecule of the daratumumab is almost surrounded in these little tiny what appear to be beads that are slowly released into the system, which make it a much lower volume, of course. And the most brilliant part of it, of course, is that it was able to be delivered within 30 minutes. One of the greatest challenges we face in clinical practice is the length of the first infusion, in particular, of daratumumab, especially because 50% of patients have a reaction. I mean, we schedule at our clinic literally 9 to 10 hours for that first patient. And it can be inconvenient for them. It takes a lot of chair time. Some centers have gone to splitting it over 2 days if they can’t quite get it all into one. I can imagine a day where if patients came in for 30 minutes, it would be so much more convenient for them. And, thankfully, not only was it shorter, the rate of reaction systemically or local was much smaller than we saw with the IV administration, all the while seemingly preserving the efficacy of daratumumab. So obviously we’re not quite ready for prime time, but this could be a major shift in how we give daratumumab in a year or two to come, Neil. DR LOVE: Do we know what the pharmacokinetics are? Is there a lower peak level, or how does it compare to giving it IV? DR MIKHAEL: So they did show some data regarding that. Obviously their numbers were not massive thus far, so that needs to be confirmed. But because of this technology of how the drug is released subcutaneously, it seemed that it was actually quite similar to the kind of pharmacokinetics and dynamics that we saw with the IV and, hence, obviously hopefully still a same effect as we would see in the IV setting. Of course, these are longer-acting drugs than we see with some of our other chemotherapies. So it’s not that we necessarily need that big punch right up front and have it slow down thereafter, but that longer-term release of the drug into the system is still very effective because of its long half-life. |