Names and pronunciation
(bel-an′ta-mab ma-foe-doe′tin) Blenrep
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Drug reference
(bel-an′ta-mab ma-foe-doe′tin) Blenrep
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Func. class.: Antineoplastic agent
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Chem. class.: Anti-BCMA
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ACTION: A humanized antibody targeted against B-cell maturation antigen (BCMA) that is expressed on multiple myeloma cells
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USES: Treatment of relapsed/refractory multiple myeloma in those who have received ≥4 prior therapies
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CONTRAINDICATIONS: Hypersensitivity
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Black Box Warning: Ocular toxicity, restricted access Precautions: Bleeding, breastfeeding, driv- ing/operating machinery, geriatric, preg- nancy, infusion-related reactions, requires a specialized care setting, requires an experi- enced clinician, thrombocytopenia, visual impairment Black Box Warning: REMS: Ocular toxicity: is available only through a re- stricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the BLENREP REMS; obtain ophthalmic exams (visual acuity/slit lamp) baseline within 3 wk of first dose, prior to each dose, and for worsening ocular symptoms • Pregnancy/breastfeeding: Obtain pregnancy testing prior to use in females of reproductive potential; contraception is needed during and for 4 mo after the last dose; males with female partners of repro- ductive potential should use contraception during and for 6 mo after the last dose
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SIDE EFFECTS CNS: Fatigue, fever, asthenia GI: Constipation, anorexia, diarrhea, nausea, vomiting, increased LFTs GU: Increased serum creatinine, renal insufficiency, albuminuria META: Decreased serum albumin, hypo- kalemia, hyponatremia, increased gamma- glutamyl transferase, hyperglycemia, hypercalcemia HEMA: Decreased hgb, decreased neutro- phils, lymphocytopenia, thrombocytopenia MS: Arthralgia, back pain, increased CPK EENT: Blurred vision, decreased visual acuity, dry eye syndrome, epithelial kera- topathy, eye irritation, photophobia RESP: URI, pneumonia MISC: Infusion-related reaction, sepsis
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INTERACTIONS Increased: myelosuppression—BCG (intravesical), chloramphenicol (ophthal- mic), cladribine, clozapine, deferiprone, promazine, salicylates NURSING CONSIDERATIONS
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DOSAGE AND ROUTES Multiple myeloma Adult IV: 2.5 mg/kg q3wk until disease progression/unacceptable toxicity Available forms. IV solution preserva- tive-free 100-mg/vial
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Administer: • Allow to warm to room temperature for 10 min • Reconstitute 100 mg/2 mL SWFI (50 mg/mL); gently swirl • Solution should be clear to opales- cent, colorless-yellow-brown liquid; dis- card if particulates are observed • Withdraw needed amount and dilute in a 250-mL NS infusion bag (0.2-2 mg/mL), use only infusion bag of PVC or polyolefin • Mix by gentle inversion; do not shake • Solutions diluted for infusion should be clear and colorless; discard if particu- late matter is observed • Do not admix • Give over ≥30 min using PVC or poly- olefin infusion set, may use a polyether- B sulfone-based filter (0.2 micron) • Do not give with other medications • If refrigerated, allow to warm to room temperature prior to use; use within 6 hr including time to warm and infusion time • Assess for infusion-related reactions • Store vials refrigerated; reconstituted so- lution may be stored refrigerated or room temperature for ≤4 hr; discard if not di- luted within 4 hr; solutions diluted for infu- sion may be stored refrigerated ≤24 hr
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Assess: • Monitor CBC at baseline and as needed • Obtain hepatitis B virus screening with hepatitis B surface antigen (HBsAg), hepati- tis B core antibody (anti-HBc), total Ig or IgG, and antibody to hepatitis B surface an- tigen (anti-HBs) prior to use, may start treatment before results are received • Monitor for bleeding, infusion site reactions
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Evaluate: • Therapeutic response: Decreasing spread of multiple myeloma
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Patient and caregiver information: • To use preservative-free lubricant eye drops and avoid contact lenses, that oph- thalmic testing will be needed during treatment • Identify if pregnancy is planned or suspected, or if breastfeeding; discuss contraception
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PHARMACOKINETICS Onset of response 1.4 mo, peak end of infusion, duration of response ≥6 mo, half-life 14 days
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