Isatuximab
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| ID | DRUG-ISATUXIMAB |
|---|---|
| Tipo | Fármaco |
| Alegais | AçúcarІсатуксімаб |
| Estado | reviewed 2026-04-27 | pending_clinical_signoff |
| Doenças | DIS-MM |
| Fontes | SRC-ESMO-MM-2023 SRC-NCCN-MM-2025 |
Fatos sobre as drogas
| Classe | monoclonal_antibody — anti-CD38 IgG1κ (chimeric, mouse-human) |
|---|---|
| Mecanismo | Binds a distinct, allosteric epitope on CD38 (different from daratumumab's binding site) on plasma cells and other CD38+ populations. Induces myeloma cell death through complement-dependent cytotoxicity (CDC), antibody-dependent cellular cytotoxicity (ADCC), antibody-dependent cellular phagocytosis (ADCP), direct apoptosis (Fc-independent — distinguishes from daratumumab), and immunomodulation via depletion of CD38+ regulatory T-cells and inhibition of CD38 enzymatic activity (NAD+/cADPR axis). Cross- reactivity with daratumumab is partial — clinical activity has been observed after daratumumab failure in some patients but the two agents are treated as the same effective class for sequencing purposes (one-shot anti-CD38 line per CHARTER hierarchy). |
| Dose típica | IV: 10 mg/kg every week during cycle 1 (4 doses), then every 2 weeks from cycle 2 onward. Cycle length 28 days. Pre-medication mandatory before each infusion: dexamethasone (40 mg PO or IV — also part of combination), acetaminophen 650-1000 mg PO, diphenhydramine 25-50 mg IV/PO, H2 blocker (ranitidine or famotidine), and montelukast 10 mg PO (optional, reduces IRRs). Infusion durations: first dose 3-4 hours with rate escalation; subsequent doses 75-90 minutes if first dose tolerated. IV-only — no SC formulation available (contrast with daratumumab Faspro). |
| Ucrânia registada | Falso |
| NSZU reembolsado | Falso |
| Ucrânia verificada pela última vez | 2026-04-27 |
Avisos
- Reativação do vírus da hepatite B — efeito de classe para anticorpos monoclonais anti-CD38; teste de HBsAg + total anti-HBc antes da primeira dose; profilaxia do entecavir (ou do tenofovir se resistência a entecarídeos) se HBSAg+ ou anti- HBc+; monitorização periódica do ADN-VHB através da terapêutica e ≥ 6 meses após a última dose
Notas
Clinical positioning: anti-CD38 mAb in the same class as daratumumab. Two are not concurrently used; choice driven by access, infusion tolerance (lower first-dose IRR with isatuximab), and combination partner. Distinct epitope rationale supports salvage activity after daratumumab failure in selected cases (limited evidence; not protocol-default). Primary trials (citations TBD — see flag in final report): - ICARIA-MM (Attal et al., Lancet 2019) — Isa-Pd vs Pd in relapsed/refractory MM, ≥2 prior lines: PFS 11.5 vs 6.5 months (HR 0.596). - IKEMA (Moreau et al., Lancet 2021) — Isa-Kd vs Kd in relapsed/refractory MM, 1-3 prior lines: PFS not reached vs 19.2 months (HR 0.531); deeper MRD-negativity. - IMROZ (Facon et al., NEJM 2024) — Isa-VRd vs VRd in transplant-ineligible newly-diagnosed MM: PFS benefit (HR ~0.60). Reimbursement under НСЗУ in Ukraine: NOT in place — same access constraint as daratumumab. Patients selected for any isatuximab- containing combination need a documented funding pathway (clinical trial, charitable scheme, or out-of-pocket). HBV screening (HBsAg + anti-HBc) mandatory before first dose; entecavir prophylaxis if HBsAg+ or anti-HBc+ (BBW). Type and screen for r...
Usado por
Esquema terapêutico
REG-ISA-KD-MM-3L- Isatuximab + Carfilzomib + Dexamethasone (Isa-Kd), 28- ciclos diários