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?
Answer from: Medical Oncologist at Academic Institution
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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Answer from: Medical Oncologist at Academic Institution
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...
Answer from: Medical Oncologist at Academic Institution
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 Oncologist at Yale Cancer Center
While I generally agree with the above, a recent s...
While I generally agree with the above, a recent s...
Answer from: Medical Oncologist at Academic Institution
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 an...
Answer from: Medical Oncologist at Community Practice
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 ...