Dr. Rifkin on Split Dosing of Daratumumab in Myeloma

Robert M. Rifkin, MD, attending physician, Rocky Mountain Cancer Centers, research lead, Multiple Myeloma, The US Oncology Network, discusses a trial evaluating the safety of split dosing administration of daratumumab (Darzalex) in patients with multiple myeloma.

This is an important time in the myeloma space with the advent of many new therapies, according to Rifkin. In a recent study, Rifkin and colleagues set out to make the administration of the monoclonal antibody daratumumab more convenient in the clinic and in the community. The FDA approved dose of daratumumab is a single long infusion of 16 mg/kg, which can take up to 10 hours. For the study, the team assessed the feasibility of splitting treatment into 2 days.

On each day, daratumumab was diluted with normal saline to a total volume of 500 mL. The drug was administered at 50 mL for 1 hour, and if no infusion events occurred, the dosing was escalated in increments of 50 mL every hour to a maximum of 200 mL. The median infusion duration was 4.5 hours for day 1 of the split first dose and 6.5 hours for the standard dose.

The team demonstrated a decrease in infusion reactions for those who received the split dose of daratumumab, Rifkin says, adding that this approach proved much more convenient for patients and their caregivers. The hope, he added, is that there will be more of a focus on making treatment more feasible for patients with myeloma and their families.