Classification: monoclonal antibody
About Daratumumab (Darzalex®)
Daratumumab is a synthetic (man made) antibody directed against a protein called CD38, which is found on the surface of multiple myeloma cells. An antibody is a part of the immune system that "marks" things (such as germs, bacteria and, in this case, cancer cells) to be destroyed by the immune system. Once daratumumab attaches itself to the cells expressing CD38, it summons the body's immune system to attack and destroy those cells.
How to take Daratumumab
Daratumumab is given by intravenous infusion (IV, into a vein). The dose is dependent upon your size and the infusion time varies depending upon how you tolerate the infusion. The infusion is administered once a week for weeks 1 to 8, every two weeks during weeks 9 to 24, and every four weeks for week 25 until progression of the disease. If a dose is missed, the dose will be administered as soon as possible and the schedule will be adjusted as needed.
Medications are given before and after the infusion to prevent reactions and other complications. These medications include:
- IV corticosteroid (methylprednisolone) to prevent an infusion reaction.
- Acetaminophen (Tylenol) to prevent a fever.
- Oral or IV antihistamine (diphenhydramine/Benadryl) to prevent an infusion reaction.
- You will also receive an oral corticosteroid for the first two days after treatment to reduce the risk of a delayed infusion reaction.
- For patients who have a history of obstructive pulmonary disorder, post-infusion medications may include short and long-acting bronchodilators and inhaled corticosteroids.
- Patients will also be instructed to take an antiviral medication to prevent herpes zoster reactivation. It should be started within 1 week of starting daratumumab and continue for 3 months after completion of treatment.
Possible Side Effects of Daratumumab
There are a number of things you can do to manage the side effects of daratumumab. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
About half of patients have an allergic reaction to daratumumab, most during the first infusion. Almost all reactions occurred during the infusion or within 4 hours of completion of the infusion. Signs of a reaction can include: cough, wheezing, throat tightness, swelling or irritation, nasal congestion, high or low blood pressure, headache, rash, itching, nausea, vomiting, and chills. If you notice any changes in how you feel during the infusion, let your nurse know immediately. The infusion will be stopped if this occurs and your side effects will be managed. If your side effects can be managed, the dose will continue to be administered, possibly at a slower rate. If the reaction is severe, daratumumab will be discontinued.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Some patients receiving daratumumab may experience cough and nasal congestion. These symptoms may be associated with an upper respiratory infection. If these symptoms become bothersome or you have a fever, notify your provider.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your doctor or nurse before scheduling dental appointments or procedures.
- Ask your doctor or nurse before you, or someone you live with, has any vaccinations.
Low Red Blood Cell Count (Anemia)
Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.
Daratumumab can interfere with blood type testing (cross-matching and antibody screening). If you require a blood transfusion, be sure your provider and the blood bank know you have received this medication. This may affect the blood typing results for up to 6 months after the last daratumumab infusion. A type and screen (blood test to check what type of blood you have) may be done prior to treatment with daratumumab.
Low Platelet Count (Thrombocytopenia)
Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.
- Do not use a razor (an electric razor is fine).
- Avoid contact sports and activities that can result in injury or bleeding.
- Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, etc. as these can all increase the risk of bleeding. Unless your healthcare team tells you otherwise, you may take acetaminophen (Tylenol).
- Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 3 months after treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.