What to Know About Empliciti (Elotuzumab)

Monoclonal Antibody Used to Treat Multiple Myeloma

In This Article

Empliciti (elotuzumab) is an anti-cancer chemotherapy drug under the antineoplastic or cytotoxic drug classes. Empliciti is commonly used in combination with other chemotherapy drugs such as Revlimid (lenalidomide) and dexamethasone to treat patients with a form of cancer called multiple myeloma. Empliciti provides antibodies which activate natural killer cells to break down myeloma cells. While this mechanism is effective in killing myeloma cells, Empliciti must be combined with lenalidomide and dexamethasone to fully eliminate the cancer cells each instance the drug is taken. The complementary chemotherapy drugs are provided orally, while Empliciti is an intravenous drug given eight times weekly every two weeks.

Uses

Empliciti is a chemotherapy drug under the classes cytotoxic, meaning toxic to (cancer) cells, and antineoplastic, meaning prevention of tumor growth and development.

The primary use for Empliciti is to treat a type of cancer called multiple myeloma. Empliciti is indicated for use in individuals who have received between one and three prior chemotherapy treatments. This requirement helps ensure an individual is familiar with the chemotherapy process and improves the likelihood an individual will tolerate Empliciti.

Empliciti is a monoclonal antibody, meaning an antibody with a specific target. In this case, it targets SLAMF7, which is a receptor protein on the surface of both myeloma cells and the body's natural killer white blood cells. When Empliciti attaches to a myeloma cell, it provides a place for the natural killer cells to dock and then attack and destroy the myeloma cell. Thus, Empliciti helps the body's immune defense eliminate the cancerous cells.

Before Taking

It is recommended that a patient receive at least one chemotherapy session before taking Empliciti. However, an individual who has not yet received a chemotherapy treatment may still take Empliciti, though dosage will be adjusted to improve medication tolerance. Patients undergo a thorough medical history, medication review, and surgical history as part of an intensive evaluation before being recommended to take Empliciti. Once your doctor ensures there are no medications or medical conditions which will interfere with these chemotherapy drugs, your doctor will prescribe Empliciti to be used in combination with the oral drugs lenalidomide and dexamethasone.

Since most reactions to Empliciti occur following the first infusion, it is recommended that patients have tried other chemotherapy drugs prior in order to decrease the chances of negative side effects occurring. This makes Empliciti often a second-line medication for the treatment of multiple myeloma. There are no major differences between brand-name and generic versions of Empliciti.

Precautions and Contraindications

Your doctor will assess your ability to tolerate other drugs in the same monoclonal antibody class. Your doctor may choose to discontinue other chemotherapy drugs, or modify dosages to accommodate Empliciti. Patients are advised to avoid receiving any immunizations or vaccinations while taking Empliciti.

Women who are breastfeeding or pregnant should not take Empliciti, as the other medications taken in combination with it are hazardous to a fetus or infant. In order for Empliciti to operate as needed to kill cancer cells, it is important to take the full dosage. This means Empliciti is not recommended for use in children.

Adults and geriatric patients must take the same dosage, as long as geriatric patients are evaluated as safe and otherwise healthy enough to do so. Studies regarding the use of Empliciti in an elderly population have not yielded strong results. Therefore, it is still yet to be determined whether elderly patients respond significantly differently to Empliciti than adults do.

Other Monoclonal Antibodies

  • Reopro
  • Humira
  • Amevive
  • Campath
  • Simulect
  • Ilaris
  • Zinplava
  • Prolia
  • Raptiva
  • Xolair
  • Lartruvo

Monoclonal antibodies are highly specific, so they are targeted therapies, with monoclonal antibody drugs each geared towards a distinct condition. They are used to treat cancer in addition to rheumatoid arthritis, multiple sclerosis, lupus, Crohn’s disease, ulcerative colitis, and psoriasis, among others.

Dosage

When taking Empliciti with oral medications lenalidomide and dexamethasone, the manufacturer’s recommended doses for Empliciti are typically 10 milligrams (mg)/kilogram (kg). Individuals who are taking oral medications pomalidomide and dexamethasone with Empliciti are typically 10 mg/kg during the first two cycles and increased to 20 mg/kg from the third cycle and each thereafter.

Due to Empliciti being an intravenous drug, meaning administered through a tube inserted into the vein, infusion rates should immediately be adjusted if a patient develops a reaction.

For individuals who are taking lenalidomide and dexamethasone, Empliciti dosing is specific to the 10 mg/kg dosing. This dosing should be 0.5 milliliters (mL) per minute for the first thirty minutes, followed by 1 mL per minute for the next 30 minutes, and 2 mL per minute after the first hour. If a patient successfully tolerates that dosing schedule, the second dose should be increased to 3 mL per minute for the first 30 minutes and 4 mL per minute for the next thirty minutes. All doses of Empliciti after the first two should be kept at 5 mL per minute, unless a patient has another negative reaction.

Individuals who are taking 20 mg/kg, which is the recommended dosage for individuals taking pomalidomide and dexamethasone, will have a different dosage schedule. These individuals should take 3 mL of Empliciti per minute for the first 30 minutes, followed by 4 mL per minute for the next 30 minutes onward. The second dose and all later doses of Empliciti should then be at the rate of 5 mL per minute.

There are no modifications to Empliciti available, as this is an intravenous drug which is only able to be taken through a tube inserted into the vein. All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

How to Take and Store

Empliciti is to be taken intravenously and is not able to be modified for any other method of administration. Unopened vials of Empliciti should be refrigerated between 35-46 F (2-8 C). Vials of Empliciti should be kept in their original containers until use, as this will protect the fluid from light. Empliciti should not be shaken, frozen, or left unrefrigerated.

Once Empliciti has been diluted, the infused mixture should continue to be refrigerated under the same conditions for the next 24 hours. After 24 hours, this mixture should be used in order to ensure the effectiveness of the medication. An infused mixture of Empliciti may be left at room temperature for no more than eight hours and should be refrigerated immediately after this period of being left out.

While taking Empliciti, there are certain instructions which will improve your body’s tolerance to the drug. It is recommended to drink 2 to 3 quarts of fluid each day. Since Empliciti acts on the immune system, you are advised to take many steps to avoid contagious illness. This means washing your hands often, avoiding crowds and sports which may cause injury, limiting time in the sun while using protective methods when you are exposed to the sun. It also helps to stay well-rested, eat well-balanced meals, and remain as active as possible.

Consult your doctor for specific instructions to follow if you miss a dose of Empliciti. Symptoms will vary and may be harmful if not addressed immediately. It is not known what dose of Empliciti places someone at risk for overdose due to severe toxicity. Patients should be consistently monitored for adverse reactions to Empliciti.

Side Effects

Common side effects of Empliciti include low white and red blood cell counts, decreased appetite, muscle spasms, hyperglycemia, infection, altered mood, low calcium levels, low albumin levels, fluctuating blood pressure readings, fatigue, diarrhea, increased liver enzymes, constipation, high potassium levels, yellowing of skin or eyes, blood in urine, and pain with urination. These side effects are reportedly experienced by greater than 30% of patients taking Empliciti.

Most of these side effects are specific to the combination of Empliciti, lenalidomide, and dexamethasone. Side effects which are common as a result of taking Empliciti, pomalidomide, and dexamethasone include pneumonia, bone pain, difficulty breathing, swelling to the arms and legs, hyperglycemia, mouth pain, mouth sores, chest pain, and night sweats.

Less common side effects of Empliciti include neuropathy (numbness and tingling of the arms and legs), upper respiratory infections, decreased immune function, headaches, weight loss, vomiting, cataracts, and reactions to the infusion.

Severe

The most severe side effect which warrants emergency care is chills along with a fever greater than 100.4 F. These side effects may indicate the possibility of an infection and should be addressed immediately.

Warnings and Interactions

Empliciti negatively interacts with the herb echinacea and you should not be taking both of them at the same time. You should also not take aspirin or aspirin-containing products while taking Empliciti.

Infusion-related reactions are most common during the first dose of Empliciti. It is important to administer the oral medications along with the intravenous Empliciti in appropriate doses to minimize the possibility of this reaction.

Your doctor will assist with the process of taking you off Empliciti when it is time to do so. There are no negative side effects from stopping Empliciti, however, due to the drug being in the form of infusion, it is necessary to have a doctor’s supervision to ensure your safety.

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