FDA Approved Multiple Myeloma Drugs
Daratumumab (Darzalex) is a recently FDA approved human CD38 directed monoclonal antibody. This monoclonal antibody has been effective in myeloma as a single agent in patients' refractory to other therapies.
Daratumumab is administered intravenously and the most common side effect is an infusion reaction, therefore all patients are pre-medicated with steroids, antihistamine and antipyretics. It is administered initially weekly then every four weeks. Daratumumab binds to myeloma cells CD38+ inhibiting the growth and leading to cytotoxicity or cell death. The response rate in patients' refractory to multiple previous treatments was 30%.
Elotuzumab (Empliciti) is another recently FDA approved monoclonal antibody for intravenous use in refractory myeloma patients. Elotuzumab is indicated in combination with lenalidomide and dexamethasone, it induces an immunostimulatory reaction.
The major side effect is an infusion reaction therefore it is mandatory to pre-medicate all patients with decadron, benadryl and an antipyretic medication. Infections and elevation of liver function test could also be observed. Elotuzumab is a humanized monoclonal antibody targeting SLAMF7 (signaling lymphocyte activation molecule family member 7). SLAMF 7 is present in myeloma cells natural killer cells resulting in the killing of myeloma cells, and adding lenalidomide enhanced the action of the natural killer cells. The one year progress free survival was 68% and the two year progress free survival was 57%.
Ixazomib (Ninlaro) is a proteasome inhibitor recently FDA approved for myeloma to be taken in combination with revlimid and decadron. It is an oral medication taken weekly for three weeks every 28 days. The most common side effects are thrombocytopenia, diarrhea, and peripheral neuropathy.
Ixazomib induces apoptosis in myeloma cells. The response rate was 78% for the ixazomib, revlimid and decadron combinations.
Panobinostat (Farydak) was also FDA approved for the treatment of refractory myeloma in combination with velcade and decadron. The addition of panobinostat doubled their disease free survival from 6 to 11 months and 59% of patients saw their cancer disappear. Panobinostat is taken orally. The most common side effects are diarrhea, nausea/vomiting, swelling, anorexia, and fever. It is an HDAC inhibitor histone deacetylase inhibitors. Other drugs and drug combinations are currently being investigated and will be available in the near future making myeloma more and more treatable.