Drug Detail:Darzalex faspro (Daratumumab and hyaluronidase-fihj)
Generic Name: DARATUMUMAB 1800mg in 15mL, HYALURONIDASE
Dosage Form: subcutaneous injection
Drug Class: CD38 monoclonal antibodies
Important Dosing Information
- DARZALEX FASPRO is for subcutaneous use only.
- Administer medications before and after administration of DARZALEX FASPRO to minimize administration-related reactions [see Dosage and Administration (2.5)] .
- Type and screen patients prior to starting DARZALEX FASPRO.
Recommended Dosage for Multiple Myeloma
The recommended dose of DARZALEX FASPRO is 1,800 mg/30,000 units (1,800 mg daratumumab and 30,000 units hyaluronidase) administered subcutaneously over approximately 3–5 minutes. Tables 1, 2, 3, and 4 provide the recommended dosing schedule when DARZALEX FASPRO is administered as monotherapy or as part of a combination therapy.
Monotherapy and In Combination with Lenalidomide and Dexamethasone (DARZALEX FASPRO-Rd), Pomalidomide and Dexamethasone (DARZALEX FASPRO-Pd) or Carfilzomib and Dexamethasone (DARZALEX FASPRO-Kd)
Use the dosing schedule provided in Table 1 when DARZALEX FASPRO is administered:
- in combination with lenalidomide and dexamethasone (4-week cycle) OR
- in combination with pomalidomide and dexamethasone (4-week cycle) OR
- in combination with carfilzomib and dexamethasone (4-week cycle) OR
- as monotherapy.
| Weeks | Schedule |
|---|---|
|
|
| Weeks 1 to 8 | weekly (total of 8 doses) |
| Weeks 9 to 24 * | every two weeks (total of 8 doses) |
| Week 25 onwards until disease progression † | every four weeks |
When DARZALEX FASPRO is administered as part of a combination therapy, see Clinical Studies (14.2) and the prescribing information for dosage recommendations for the other drugs.
In Combination with Bortezomib, Melphalan and Prednisone (DARZALEX FASPRO-VMP)
Use the dosing schedule provided in Table 2 when DARZALEX FASPRO is administered in combination with bortezomib, melphalan and prednisone (6-week cycle).
| Weeks | Schedule |
|---|---|
|
|
| Weeks 1 to 6 | weekly (total of 6 doses) |
| Weeks 7 to 54 * | every three weeks (total of 16 doses) |
| Week 55 onwards until disease progression † | every four weeks |
When DARZALEX FASPRO is administered as part of a combination therapy, see Clinical Studies (14.1) and the prescribing information for dosage recommendations for the other drugs.
In Combination with Bortezomib, Thalidomide, and Dexamethasone (DARZALEX FASPRO-VTd)
Use the dosing schedule in Table 3 when DARZALEX FASPRO is administered in combination with bortezomib, thalidomide, and dexamethasone (4-week cycle).
| Treatment phase | Weeks | Schedule |
|---|---|---|
|
||
| Induction | Weeks 1 to 8 | weekly (total of 8 doses) |
| Weeks 9 to 16 * | every two weeks (total of 4 doses) | |
| Stop for high dose chemotherapy and ASCT | ||
| Consolidation | Weeks 1 to 8 † | every two weeks (total of 4 doses) |
When DARZALEX FASPRO is administered as part of a combination therapy, see the prescribing information for dosage recommendations for the other drugs.
In Combination with Bortezomib and Dexamethasone (DARZALEX FASPRO-Vd)
Use the dosing schedule in Table 4 when DARZALEX FASPRO is administered in combination with bortezomib and dexamethasone (3-week cycle).
| Weeks | Schedule |
|---|---|
|
|
| Weeks 1 to 9 | weekly (total of 9 doses) |
| Weeks 10 to 24 * | every three weeks (total of 5 doses) |
| Week 25 onwards until disease progression † | every four weeks |
When DARZALEX FASPRO is administered as part of a combination therapy, see the prescribing information for dosage recommendations for the other drugs.
Recommended Dosage for Light Chain Amyloidosis
In Combination with Bortezomib, Cyclophosphamide and Dexamethasone (DARZALEX FASPRO-VCd)
Use the dosing schedule provided in Table 5 when DARZALEX FASPRO is administered in combination with bortezomib, cyclophosphamide and dexamethasone (4-week cycle).
| Weeks | Schedule |
|---|---|
|
|
| Weeks 1 to 8 | weekly (total of 8 doses) |
| Weeks 9 to 24 * | every two weeks (total of 8 doses) |
| Week 25 onwards until disease progression or a maximum of 2 years † | every four weeks |
When DARZALEX FASPRO is administered as part of a combination therapy, see Clinical Studies (14.2) and the prescribing information for dosage recommendations for the other drugs.
Administration
If a dose of DARZALEX FASPRO is missed, administer the dose as soon as possible and adjust the dosing schedule to maintain the dosing interval.
Recommended Concomitant Medications
Pre-medication
Administer the following pre-medications 1–3 hours before each dose of DARZALEX FASPRO:
- Acetaminophen 650 to 1,000 mg orally
- Diphenhydramine 25 to 50 mg (or equivalent) orally or intravenously
- Corticosteroid (long- or intermediate-acting)
Monotherapy
Administer methylprednisolone 100 mg (or equivalent) orally or intravenously. Consider reducing the dose of methylprednisolone to 60 mg (or equivalent) following the second dose of DARZALEX FASPRO.
In Combination
Administer dexamethasone 20 mg (or equivalent) orally or intravenously prior to every DARZALEX FASPRO administration.
When dexamethasone is the background regimen-specific corticosteroid, the dexamethasone dose that is part of the background regimen will serve as pre-medication on DARZALEX FASPRO administration days [see Clinical Studies (14)] .
Do not administer background regimen-specific corticosteroids (e.g. prednisone) on DARZALEX FASPRO administration days when patients have received dexamethasone (or equivalent) as a pre-medication.
Post-medication
Administer the following post-medications:
- Monotherapy
Administer methylprednisolone 20 mg (or an equivalent dose of an intermediate- or long-acting corticosteroid) orally for 2 days starting the day after the administration of DARZALEX FASPRO. - In Combination
Consider administering oral methylprednisolone at a dose of less than or equal to 20 mg (or an equivalent dose of an intermediate- or long-acting corticosteroid) beginning the day after administration of DARZALEX FASPRO.
If a background regimen-specific corticosteroid (e.g. dexamethasone, prednisone) is administered the day after the administration of DARZALEX FASPRO, additional corticosteroids may not be needed [see Clinical Studies (14)] .
If the patient does not experience a major systemic administration-related reaction after the first 3 doses of DARZALEX FASPRO, consider discontinuing the administration of corticosteroids (excluding any background regimen-specific corticosteroid).
For patients with a history of chronic obstructive pulmonary disease, consider prescribing short and long-acting bronchodilators and inhaled corticosteroids. Following the first 4 doses of DARZALEX FASPRO, consider discontinuing these additional post-medications, if the patient does not experience a major systemic administration-related reaction.
Dosage Modifications for Adverse Reactions
No dose reductions of DARZALEX FASPRO are recommended. Consider withholding DARZALEX FASPRO to allow recovery of blood cell counts in the event of myelosuppression [see Warnings and Precautions (5.3, 5.4)] .
Preparation and Administration
DARZALEX FASPRO should be administered by a healthcare provider.
To prevent medication errors, check the vial labels to ensure that the drug being prepared and administered is DARZALEX FASPRO for subcutaneous use. Do not administer DARZALEX FASPRO intravenously.
DARZALEX FASPRO is ready to use.
Preparation
- Remove the DARZALEX FASPRO vial from refrigerated storage [2°C to 8°C (36°F to 46°F)] and equilibrate to ambient temperature [15°C to 30°C (59°F to 86°F)]. Store the unpunctured vial at ambient temperature and ambient light for a maximum of 24 hours. Keep out of direct sunlight. Do not shake.
- Withdraw 15 mL from the vial into a syringe.
- DARZALEX FASPRO is compatible with polypropylene or polyethylene syringe material; polypropylene, polyethylene, or polyvinyl chloride (PVC) subcutaneous infusion sets; and stainless steel transfer and injection needles. Use the product immediately.
- After the solution of DARZALEX FASPRO is withdrawn into the syringe, replace the transfer needle with a syringe closing cap. Label the syringe appropriately to include the route of administration per institutional standards. Label the syringe with the peel-off label.
- To avoid needle clogging, attach the hypodermic injection needle or subcutaneous infusion set to the syringe immediately prior to injection.
- Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not use if opaque particles, discoloration or other foreign particles are present.
Storage
- If the syringe containing DARZALEX FASPRO is not used immediately, store refrigerated at 2°C to 8°C (36°F to 46°F) for up to 24 hours and/or at room temperature at 15°C to 25°C (59°F to 77°F) for up to 12 hours under ambient light.
- Discard if storage time exceeds these limits.
- If stored in the refrigerator, allow the solution to come to room temperature before administration.
Administration
- Inject 15 mL of DARZALEX FASPRO into the subcutaneous tissue of the abdomen approximately 3 inches [7.5 cm] to the right or left of the navel over approximately 3–5 minutes. No data are available on performing the injection at other sites of the body.
- Rotate injection sites for successive injections.
- Never inject DARZALEX FASPRO into areas where the skin is red, bruised, tender, hard or areas where there are scars.
- Pause or slow down delivery rate if the patient experiences pain. In the event pain is not alleviated by pausing or slowing down delivery rate, a second injection site may be chosen on the opposite side of the abdomen to deliver the remainder of the dose.
- During treatment with DARZALEX FASPRO, do not administer other medications for subcutaneous use at the same site as DARZALEX FASPRO.
