Results of the daratumumab monotherapy early access treatment protocol in patients from Brazil with relapsed or refractory multiple myeloma

ABSTRACT Introduction: Daratumumab is a CD38-targeting monoclonal antibody with established efficacy and safety in patients with relapsed or refractory multiple myeloma (RRMM). We report results of an early access protocol (EAP) of daratumumab monotherapy for RRMM in a cohort of Brazilian patients. Methods: Patients with RRMM and ≥3 prior lines of therapy, including a proteasome inhibitor (PI) and an immunomodulatory drug (IMiD), or who were double refractory to both a PI and IMiD received daratumumab, 16 mg/kg, intravenously weekly for 8 weeks, biweekly for 16 weeks, and every 4 weeks thereafter until disease progression, unacceptable toxicity, loss of clinical benefit, or study conclusion or if daratumumab became available with reimbursement. Results: Forty-nine patients received ≥1 dose of daratumumab. The median (range) duration of treatment was 6.4 (0.3-11.8) months, with a median (range) of 8 (1-13) treatment cycles. Grade 3/4 treatment-emergent adverse events (TEAEs) were reported in 38.8% of patients, most frequently neutropenia and pneumonia (10.2% each). Seven (14.3%) patients discontinued treatment due to TEAEs; 3 patients discontinued due to daratumumab-related TEAEs. Serious TEAEs occurred in 38.8% of patients. Infusion-related reactions were reported in 25 (51.0%) patients, were primarily grade 1/2, and the majority (23 patients) occurred during the first infusion. Twenty (40.8%) patients achieved a partial response or better; median progression-free survival was 8.25 (95% confidence interval, 5.55-17.54) months. Conclusion: In this EAP, daratumumab monotherapy in Brazilian patients showed a safety and efficacy profile consistent with clinical studies of daratumumab monotherapy in patients with heavily pretreated RRMM. ClinicalTrials.gov identifier: NCT02477891.

Everolimus as a single agent in refractory or relapsed Hodgkin's lymphoma: the Brazilian Named Patient Program Experience

Abstract Background Despite all the scientific progress that has been made on understanding the disease, prognosis for patients with relapsed and refractory Hodgkin's lymphoma remains poor and the treatment is palliative in the majority of the cases. Thus, the aim of this study was to present the results on the compassionate use of everolimus in a group of patients who were monitored at nine different centers in Brazil. Methods A 10-mg oral dose of everolimus was given to each patient daily. Response time was evaluated from the beginning of medication use until loss of response, toxicity or medical decision to cease treatment. Results Thirty-three patients were evaluated. The median age at the beginning of medication administration was 29 years. Patients had received a median of five prior therapies. Overall response rate was 45.4%, with 13 patients achieving partial response, two achieved clinical response, 14 remained with stable disease, two had disease progression, and two were not evaluated. Patients received a median of 14 cycles. Progression-free survival was nine months, and overall survival was estimated to be 36 months. Three patients used the medication for more than four years. The most frequently reported adverse events were thrombocytopenia and hypercholesterolemia. Three patients had pulmonary toxicity. Grade III and IV adverse events occurred in 39% of the patients. Conclusion Everolimus was found to provide a response in a group of patients with refractory or relapsed Hodgkin's lymphoma who had adequate tolerability to the drug.

Incidência de síndrome de lise tumoral aguda em pacientes portadores de hemopatias malignas / Incidence of acute tumor lysis syndrome in patients with malignant blood diseases

O emprego de quimioterapia em tumores de alta replicaçäo celular é responsável pela liberaçäo de constituintes celulares, que podem levar a sérias alteraçöes metabólicas. Estas alteraçöes compreendem distúrbios no metabolismo do: potássio, cálcio, fosfato, uréia e ácido úrico; que caracterizam a SINDROME de LISE TUMORAL AGUDA (SLTA). No período de 29/03/93 a 23/08/93, foram estudados 20 pacientes com hemopatias malignas, com indicaçäo de tratamento poliquimioterápico. Estes pacientes receberam hiper-hidrataçäo com 2000ml/m2 de soluçäo fisiológico 0,9 por cento e alopurinol 200mg/m2 iniciando-se no dia anterior até o último dia de quimioterapia. O diagnóstico de SLTA foi considerado nos pacientes que nos 4 dias do tratamento, apresentaram duas ou mais das seguintes alteraçöes metabólicas: aumento de 25 por cento nos níveis de potássio, ácido úrico, uréia e fosfato; ou diminuiçäo de 25 por cento no nível de cálcio sérico. A SINDROME DE LISE TUMORAL AGUDA CLINICA (SLTAC), foi definida como SLTAC, associada a condiçöes clínicas que implicassem em risco de vida nenhum dos nossos pacientes apresentou SLTAC e apenas 30 por cento desenvolveram SLTAL, demonstrando que este esquema de tratamento foi efetivo.