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For a patient with MM progressing on a daratumumab-based regimen, is it preferable to entirely switch drug class or is another monoclonal antibody such as isatuximab an acceptable next step?

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What is your typical second line treatment approach for transplant ineligible MM after progression on a daratumumab-based regimen?

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5 Answers
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Medical Oncology · Memorial Sloan Kettering Cancer Center
Answered on

Class switch approach appears to give better disease control, isatuximab does not have activity in daratumumab refractory patients (Mikhael et al., PMID 33980831).

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Medical Oncology · University of Michigan
Answered on

I recommend switching drug classes after progression on daratumumab.

Isatuximab, like daratumumab, is a monoclonal antibody against CD38. It has been shown to be ineffective after progression on daratumumab. Mikhael et al, PMID 33980831. While elotuzumab is a monoclonal antibody with a different targ...

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Medical Oncology · University of Washington, Fred Hutchinson Cancer Research Center
Answered on

Agreed with the above two answers. In case the converse question ever comes up (daratumumab in isatuximab-exposed patients), it's also worth noting that a recent update from the ICARIA-MM trial at the 2021 ASCO meeting showed a 14% overall response rate (ORR) to daratumumab monotherapy and 31% ORR w...

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Medical Oncology · OhioHealth
Answered on

From personal experience, and also publication noted earlier, no benefit with Isatuximab after Daratumumab or possibly vice versa. May have some benefit if >6 mos since last exposure to either drug. Options here:

  • If on daratumumab alone and monthly, can actually change back to every 2 weeks and add...

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Medical Oncology · Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty
Answered on

Unfortunately, optimal treatment after daratumumab failure remains unknown, because most of the phase III trials including pomalidomide/dexamethasone or carfilzomib/dexamethasone backbones did not enroll patients refractory to anti-CD38 monoclonal antibodies. In patients not previously treated with ...

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