Elotuzumab is used to treat multiple myeloma, a type of cancer in the bone marrow in adult patients whose cancer has returned after successful treatment or in patients who showed treatment failure with one to three cancer treating medications.
It is a monoclonal antibody that works by binding to the natural killer (NK) cells, a type of white blood cell and enhances the NK cells to identify and kill the myeloma or the cancer cells.
Elotuzumab should not be used in patients-
Allergic to elotuzumab
Pregnancy and breastfeeding
Children under the age of 18 years
Severe liver disease
The dose of elotuzumab is calculated based on the individual patients body weight and the recommended dose is 10 mg/kg body weight given every week during the first two cycles and for every two weeks for subsequent cycles.
Lenalidomide is also given to the patient as a dose of 25 mg by mouth from day 1 to day 21 of every 28-day cycle of elotuzumab treatment.
Patients should be pre-medicated with the following medications-
Acetaminophen or paracetamol
The dose of elotuzumab is adjusted based on the infusion-related side effects and the treatment with elotuzumab can be permanently stopped if the infusion-related side effects are severe.
Elotuzumab comes in a powder form which should be mixed with sterile water. It should be given intravenously or directly into the vein by a health care provider in a hospital setting.
Two doses of dexamethasone a 28 mg dose given by mouth 3 to 24 hours before and an 8 mg dose given intravenously 45 to 90 minutes should be administered before elotuzumab injection is given.
When elotuzumab is not given on day 8 and day 22 of the 3rd, and the subsequent cycles, the dose of dexamethasone tablet should be increased to 40 mg instead of 28 mg.
Diphenhydramine should be given as a 25 - 50 mg tablet or injection into the vein to prevent any infusion-related allergies.
Ranitidine is given either as a 50 mg injection into the vein or a 150 mg tablet by mouth along with paracetamol 650 mg to 1000 mg tablet to be taken by mouth.
Mix the vial contents in an environment free from contamination and diluted with 0.9% sodium chloride or 5% dextrose solution. The diluted mixture should be used within 24 hours of the diluted or reconstituted procedure.
Patients who are given elotuzumab can experience infusion-related reactions such as fever, chills, and fluctuations in blood pressure. These can be managed by premedicating patients with medications like steroids, antiallergic drugs, and fever-reducing pills.
Patients on elotuzumab treatment should be monitored closely for the development of any infections and cancers such as skin cancer or any solid tumor as elotuzumab may increase the risk of developing cancer.
Monitor patients for any symptoms and signs of liver toxicity by regularly checking the liver enzymes and total bilirubin level. The treatment with elotuzumab can be stopped if the liver enzymes are high and can be started again once the values are normal.
Elotuzumab can interfere with the results of certain medical tests and patients should inform the doctor about elotuzumab therapy before such lab orders are directed.
Gastrointestinal: Loose stools, decreased appetite, constipation, vomiting
Nervous system: Headache, fever, abnormal tiredness, dizziness or lightheadedness, weight loss, burning or numbness of the hands and feet, mood alterations
Blood: Heart rate abnormalities, fluctuations in blood pressure
Respiratory: Cough, lung infection, chest pain, sore throat, shortness of breath
Lab abnormalities: Low levels of lymphocytes, platelets, white blood cells, calcium, bicarbonate and albumin, high levels of blood sugar, blood potassium and liver enzymes
Others: Vision changes, night sweats, skin tags, dark urine and pale stools
Women of childbearing age should check their pregnancy status twice, initially 15 days and 24 hours before starting lenalidomide. Treatment should be initiated only if the tests show a negative result. Pregnancy testing should be done every four weeks in women with regular menstrual cycles.
Women should take effective contraception four weeks before starting lenalidomide therapy, during the treatment, and four weeks after the discontinuation of the lenalidomide therapy.
Lenalidomide is found in the semen and men living with an active female partner should use condoms to avoid pregnancy. Men should not donate sperms during lenalidomide treatment for at least 28 days after the last dose of lenalidomide.
The doctor should be kept informed before prescribing elotuzumab and lenalidomide if the patient is taking or planning to take any prescription, Over-The-Counter (OTC) drugs or herbal supplements to avoid drug-related side effects.
Check the vials for clarity of the solution before administering. If any solid particles or discoloration are seen, discard the solution.
Store elotuzumab vials in a refrigerator between 2°C and 8°C.
Keep the vials in their original pack and protect from excess light and moisture.
Store the diluted solution in a refrigerator between 2°C and 8°C and use within 24 hours from the time of dilution.
If the diluted mixture is kept at room temperature (below 25°C) it should be used within 8 hours.
Do not freeze or shake the vials of elotuzumab or the diluted mixture.
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