Kathleen Colson, RN, BSN, BS: Monoclonal antibodies can identify cancer cells through a specific protein that is on those cancer cells. And so, once the monoclonal antibodies identify the cancer cells what happens is that they signal the immune system to attack those cells or eliminate them. So, in other words, monoclonal antibodies really trigger the immune system to attack the cancer cells.
Charise Gleason, MSN, NP-BC, AOCNP: I’m a nurse practitioner at Emory Winship Cancer Institute, and I specialize in multiple myeloma and have done so for close to 19 years. And so, our center has been very big in bringing out monoclonal antibodies. We’ve had patients on monoclonal antibodies for years—and on clinical trials—and now in the relapsed setting. It’s one of our main go-to newer drugs at this time.
Kathleen Colson, RN, BSN, BS: In my center, in the relapsed/refractory setting, about one-third of our patients are on monoclonal antibodies. In the upfront setting, newly diagnosed patients on monoclonal antibodies are generally in the setting of a clinical trial.
Wendy Vogel, MSN, FNP, AOCNP: In our institution, we’re seeing monoclonal antibodies used more and more. It has been almost revolutionary to see how far we’ve come in myeloma over the last 15 years, even 10 years ago. Monoclonal antibodies are now being used more with other backbones, and we’re seeing synergistic responses.
Charise Gleason, MSN, NP-BC, AOCNP: In my experience, patients have tolerated monoclonal antibodies extremely well, once you get them through the first dose of therapy. We’ve been using monoclonal antibodies for years in other types of cancers, and so it made sense for the development and the role in myeloma. There has been a big change in myeloma over the last 12 to 15 years with so many new therapies. But I think that monoclonal antibodies are the ones that we’re really adding on the most at this point in therapy.
Wendy Vogel, MSN, FNP, AOCNP: Tolerability has been phenomenal. Monoclonal antibodies have a different side effect profile from some of our traditional therapies, and so patients find that very favorable. In terms of efficacy, we’ve seen quite a bit of good responses from this, which is really exciting in a disease that, even in 2017, is considered incurable.
Kathleen Colson, RN, BSN, BS: In our institute, the use of monoclonal antibodies has been overwhelmingly positive. It is especially encouraging efficacy that we see in the heavily pretreated multiple myeloma patient. For example, daratumumab in combination with lenalidomide and dexamethasone and daratumumab in combination with Velcade (bortezomib) and dexamethasone were approved this past November 2016 with a new indication by the FDA for patients. They only need to receive 1 prior therapy in order to receive these 2 therapies. In both of these clinical trials, which were pivotal, patients in the daratumumab/lenalidomide/dexamethasone group had overall response rates of over 90%, and they had a doubling of their complete response rates. Likewise, in patients receiving the daratumumab/bortezomib/dexamethasone therapy, those patients also had over 80% of overall response rates. They also had a doubling of their complete response rates with their patients. With the elotuzumab in combination with lenalidomide and dexamethasone, they also had about an 80% overall response rate.