Hematologic Oncology Update, Issue 3, 2016 (Video Program) - Video 1Obinutuzumab: Mechanism of action, activity and management of treatment-associated infusion reactions
2:53 minutes.
TRANSCRIPTION:
DR SEHN: I wouldn’t call it just another anti-CD20 monoclonal antibody. So there have been a variety of rituximab-like antibodies created. But obinutuzumab is quite novel. So it’s called a Type 2 monoclonal antibody based on how it attaches to the cell surface and the reaction it causes once it attaches to the cell surface. So its primary advantage is that it’s been shown to have a higher capacity to induce direct cell death than rituximab and also a higher capacity to enroll the immune system in terms of the antibody-dependent cellular cytotoxicity than rituximab. So there’s a lot of early preclinical data suggesting that it does have an advantage over rituximab. And now we’re seeing that pan out in a number of clinical trials. So it does have a very different mechanism of action from rituximab. And I think one thing we’re seeing is that it may not translate across — or its benefit may not translate across all non-Hodgkin lymphomas. Certainly we’ve seen a big advantage in the trial with chlorambucil in CLL. The GALLIUM trial is apparently positive as well, showing the benefit in follicular lymphoma. There will be another trial shown at ASH, the GOYA trial that looks at it in up-front diffuse large B-cell lymphoma. And the suggestion there is that it was not advantageous. So there might actually be a histology-specific benefit to this molecule, but I think we’ll learn more as the different clinical trial information emerges. DR LOVE: One of the things that we’ve started to hear about on obinutuzumab being used with CLL was the question of infusion reactions being worse. What’s your clinical experience been with the agent in that regard? DR SEHN: Mm-hmm. We know from the head-to-head clinical trials that the risk of an infusion-related reaction is higher with obinutuzumab. So the proportion of patients having Grade 3 or 4 reactions is slightly higher. That is predominantly similar to rituximab only in the first infusion. So after the patient’s received their first infusion, it becomes less of an issue. I have to say, my own clinical practice, it hasn’t been that notable. I mean, I think that our nurses are used to giving rituximab. They’re used to picking up the signs of the reaction. And the management, supportive management, is very similar to what you would do in administering rituximab. So I think being alert to that possibility that the infusion-related reactions might be a higher incidence and managing the reactions similar to what you would do with rituximab, we haven’t had any significant clinical issues. |