Options Following Recurrence in Multiple Myeloma



C. Ola Landgren, MD: When the protein came back, we had to restart therapy. You had been off therapy for a year. You chose to not be on maintenance, as we had discussed. We tried this oral regimen of ixazomib, lenalidomide, dexamethasone. You had toxicities with it—very profound fatigue and the nausea. It just didn’t work out for you. Then, we said, “Let’s see what other options there are.” I suggested that we use one of the new monoclonal antibodies. The daratumumab monoclonal antibody was one option. I told you that it could be given in combination with either an immunomodulatory drug, lenalidomide, or with pomalidomide, a related drug. Or it could be given with a proteasome inhibitor, bortezomib. The alternative would be to give it as a single drug—daratumumab, alone. We talked about this.

Aurora Torres: Yes.

C. Ola Landgren, MD: And I said to you, “If I look at the literature, the combinations are more powerful. There’s more efficacy there. Unfortunately, you also have to consider the risk of toxicity.” We talked about that. I asked you what you felt was the right thing for you, and you said you wanted to try the single drug.

Aurora Torres: Right. Being that I had such adverse effects with everything else that I’d taken, I decided to go with that.

C. Ola Landgren, MD: The discussion that you and I had was that if we picked a combination and it worked, that’s great, but if we picked a combination and you had toxicity, we would have to start peeling back drugs. On the flip side, we could also start with the single drug. If that works, that’s great. If it doesn’t, then we can add in drugs.

Aurora Torres: Right.

C. Ola Landgren, MD: You said that you wanted to do the single-drug regimen, and that’s what we did.

Aurora Torres: Right.

C. Ola Landgren, MD: We gave you the daratumumab by the FDA label. You got 8 weekly doses. Then, you got 8 doses, every other week. And now we’re into monthly infusions.

Now that you’re on the daratumumab infusions, what’s your experience been during and after the infusions? Have they changed over time?

Aurora Torres: Well, I noticed that the first infusion was very, very long. It was longer than what the other infusions have been. I was told that this was because of the side effects that you can get. They had to go very slowly in administering it. I started to feel redness or heat in my face. The nurse saw that I was red and she lowered the dose until I was alright again. Other than that, all of the other infusions had gone very well. I haven’t had any other symptoms, or negativities, or anything like that. The only drawback to that is the time. But, like I said, I prefer it over anything else at the moment, because it works for me.

C. Ola Landgren, MD: The reaction that you described happened to you with the first dose?

Aurora Torres: Only for the first dose. It never happened again.

C. Ola Landgren, MD: If I look at the literature, and if I look in my own practice, it’s the same. About 50% of all patients who receive daratumumab, at first dose, have some type of reaction to the drug—an infusion reaction. After that, it just does not seem to come back. Now, at our institution, we are about to change the infusion time. We are going to start doing 2-hour infusions from the third dose onward. So, that is how we are moving forward. This is in accord with new data from the ASH meeting of 2018, which is the biggest hematology meeting, every year, in the United States.

What’s your thinking? You are now on a regimen where you have to come in and get an infusion. It’s not just taking pills on your own.

Aurora Torres: Right.

C. Ola Landgren, MD: Is that an inconvenience for you?

Aurora Torres: No, not at all. It’s no inconvenience. I look forward to it, because I know that it’s helping me. I look at it in that light.

C. Ola Landgren, MD: So, if you have the option of taking an oral regimen, in your particular case, versus an infusion, the toxicities last for a short period of time and then it’s done. So, that’s what you would prefer?

Aurora Torres: Yes, exactly.

C. Ola Landgren, MD: Different people have different opinions. Some people like the freedom of taking tablets. Some people like that the toxicities are kind of short-lasting. And then, if they were there for a few days, they are over. So, I think it’s good that there are options. There are different options to choose between.

Aurora Torres: Oh, definitely.

C. Ola Landgren, MD: How are you feeling, overall, right now?

Aurora Torres: Well, I have days where I feel better than others. When I have my treatment, during the first 2 or 3 days, I’m good. And then, after that, I start to feel a little achy. My body starts to feel backaches. My legs ache. I feel that if I touch my body, I feel my nerves. But other than that, I’ve been great. I’ve been great with this treatment. I really can’t say that I’ve had too many negative things happen to me with this treatment. I’m functional. I’m not fatigued at all.

C. Ola Landgren, MD: You’re traveling and you’re very active?

Aurora Torres: Yes. I’m able to do a lot of things that I wasn’t able to do, previously, when I had the oral medications.

C. Ola Landgren, MD: You were in Florida, just recently?

Aurora Torres: I was in Florida.

C. Ola Landgren, MD: And I know that you’re going to California, soon?

Aurora Torres: Yes. I’m getting out there, because of this treatment.

C. Ola Landgren, MD: I’m very happy for you.

Aurora Torres: Thank you.

Transcript Edited for Clarity

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