[MrPotatohead]

Darzalex and Kyprolis Treatment

by MrPotatohead on Sun Nov 20, 2016 10:31 pm

After almost a year of falling free light chains on Kyprolis (carfilzomib) my response to this treatment began to falter. My next attempt was a combination of Kyprolis and Pomalyst, but side effects ruled that strategy out as well, and I have just begun (as of last Wednesday, November 16th), Kyprolis and Darzalex.

I was diagnosed in March, 2015 with kappa light chain multiple myeloma and went through Revlimid, subcutaneous Velcade, Kyprolis, and Pomalyst. Revlimid worked briefly and Kyprolis did its job for almost a year before petering out. Adding Pomalyst didn't help. Velcade didn't work at all.

My latest regimen consists of Kyprolis and Darzalex (daratumumab). Darzalex is a mono­clonal antibody and Kyprolis is a proteasome inhibitor; I'm hoping this combination will turn the trick. I started this thread to chronicle my progress on it for the benefit of others who may try it, since it is a very new combination.

The protocol for me calls for weekly infusions of Kyprolis and Darzalex. I receive a Kyprolis infusion twice a week for three weeks, followed by one week off. This cycle is repeated indefinitely for Kyprolis: Twice a week for three weeks, followed by one week off.

For Darzalex, I get one infusion a week for eight weeks, at which point I get a Darzalex infusion every other week for weeks 9 to 24, and then an infusion of Darzalex every 4 weeks until progression.

To reduce the chances of infusion reactions, the corticosteroid methylprednisolone and the antihistimine Benadryl (diphenhydramine) were ad­ministered before and after each infusion.

Darzalex can elicit infusion reactions in up to 50% of patients, most commonly during the first infusion, and I did experience a reaction twice during my first infusion, although both were relatively mild.

The infusions are lengthy, with the first Darzalex treatment taking nearly 12 hours. The Kyprolis infusions take about one half an hour.

I will document all of my treatments in this thread and will note any reactions or other adverse consequences that may occur. Hopefully, there will be none.

Last edited by MrPotatohead on Tue Nov 22, 2016 6:15 pm, edited 1 time in total.

[Ron Harvot]

Re: Darzalex and Kyprolis Treatment

by Ron Harvot on Mon Nov 21, 2016 12:53 am

I am pulling for you. Hope this does the trick. Have heard a lot of good things about Darzalex in combination with Revlimid or Velcade. Should work well with Kyprolis.

[MrPotatohead]

Re: Darzalex and Kyprolis Treatment

by MrPotatohead on Mon Nov 21, 2016 9:42 am

Many thanks, Ron!

[joe]

Re: Darzalex and Kyprolis Treatment

by joe on Mon Nov 21, 2016 3:38 pm

Good luck to you. I hope all works and remission is in your future.

I am also on Darzalex. Pomalyst has been added. Have had 14 infusions and after 12 added Pomalyst. I had a probleum with breathing; I also have COPD. My doctor reduced Pomalyst from 3 mg to 2 mg.

Good luck to all of us. May 2017 bring us a cure for myeloma and all cancers.

joe

[MrPotatohead]

Re: Darzalex and Kyprolis Treatment

by MrPotatohead on Mon Nov 21, 2016 8:19 pm

Thank you, joe.

All the best to you and to everyone suffering from multiple myeloma or any other form of cancer.

[goldmine848]

Re: Darzalex and Kyprolis Treatment

by goldmine848 on Mon Nov 21, 2016 8:55 pm

Mr. P, can you tell me the dosage for your steroid, how it is administered, and whether the side effects are better or worse than dex?

[Mike F]

Re: Darzalex and Kyprolis Treatment

by Mike F on Tue Nov 22, 2016 12:55 pm

Thanks for reporting on this for us. The combination of Darzalex with Kyprolis looks to be a major emerging treatment for multiple myeloma, so there are many of us who may follow in your footsteps. Best of luck with this!

[MrPotatohead]

Re: Darzalex and Kyprolis Treatment

by MrPotatohead on Tue Nov 22, 2016 6:55 pm

goldmine848,

I take 100 mg of methyl­pred­nisolone by infusion before each Darzalex infusion. With Darzalex, infusion reactions can occur up to 48 hours afterward. So I may need to take up to five 4 mg tablets by mouth on day 2 and day 3 afterwards (after consulting with my oncologist). This has not been necessary so far, but it's still early.

When I was on Cytoxan, Kyprolis, and dexamethasone, I took 20 mg of dex before each Kyprolis infusion.

The only side effects I noticed on dex were high blood sugar and water retention. I have read on the Forum about people experiencing insomnia and mood swings while taking dex, but I never experienced those effects.

I have experienced no side effects so far on methylprednisolone, but I have only had two doses of it so far.

Last edited by MrPotatohead on Wed Nov 23, 2016 6:46 pm, edited 2 times in total.

[MrPotatohead]

Re: Darzalex and Kyprolis Treatment

by MrPotatohead on Tue Nov 22, 2016 6:58 pm

Thanks very much, Mike F.

[MrPotatohead]

Re: Darzalex and Kyprolis Treatment

by MrPotatohead on Wed Nov 23, 2016 5:32 pm

Today I received my second Darzalex infusion, along with my fourth Kyprolis infusion. (Last week I started the new regimen, with Kyprolis infusions Tuesday and Wednesday and my first Darzalex infusion on Wednesday.)

The Darzalex infusions were preceded by 100 mg infusions of methyprednisolone along with 25 mg infusions of Benadryl (diphenhydramine), and the Kyprolis infusions were preceded by 20 mg infusions of dexamethasone.

I did have a reaction to the second Darzalex infusion in the form of a spike in blood pressure. The infusion was halted for ten minutes while my blood pressure recovered. If temporarily stopping the infusion had not been sufficient to reduce my blood pressure, my doctor was prepared to reduce it with medication. That turned out not to be necessary.

I also had an episode of mild nausea the day after my first Darzalex infusion, which responded to Zofran (ondansetron).

I noticed no other side effects.