Empliciti
Empliciti (elotuzumab) is a monoclonal antibody that’s used to treat a certain type of blood cancer called multiple myeloma. It’s an intravenous infusion that’s given at an infusion center or provider’s office. This medication can cause side effects such as infusion reactions, diarrhea, and low blood cell counts. You typically take Empliciti (elotuzumab) as part of a cancer treatment plan with two medications that you take by mouth (an immunomodulatory drug and dexamethasone).
What is Empliciti (elotuzumab)?
What is Empliciti (elotuzumab) used for?
- Multiple myeloma in people who’ve already taken 1 to 3 therapies; given with lenalidomide (Revlimid) and dexamethasone
- Multiple myeloma in people who’ve already taken at least 2 therapies; given with Pomalyst (pomalidomide) and dexamethasone
How Empliciti (elotuzumab) works
Multiple myeloma is a type of cancer that develops in certain kinds of blood cells called plasma cells (a type of immune cell). The multiple myeloma cancer cells have a protein on their surface called SLAMF7. This protein is also found on the outside of certain other cells in your immune system.
Empliciti (elotuzumab) is a monoclonal antibody that targets the SLAMF7 protein. The medication attaches to SLAMF7 on multiple myeloma cells and the other immune system cells. This tells the immune system to come attack the cancer cell. As a result, the multiple myeloma cancer cells can’t grow and spread as well.
Drug facts
Side effects of Empliciti (elotuzumab)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Low white blood cell count (99%)
- Higher blood sugar levels (89%)
- Low platelets (84%)
- Changes to blood electrolyte levels (78%)
- Tiredness (62%)
- Diarrhea (47%)
- Higher liver enzyme levels (39%)
- Fever (37%)
- Constipation (36%)
- Cough (34%)
- High blood pressure (33%)
- Numbness in fingers and toes (27%)
- Infection (up to 23%)
- Lower appetite (21%)
Less Common Side Effects
- Headache
- Pain in arms or legs
- Vomiting
- Cataracts
Note: These side effects were reported by people taking Empliciti (elotuzumab) with lenalidomide (Revlimid) and dexamethasone. Side effects might differ for people taking this medication with Pomalyst (pomalidomide).
Empliciti (elotuzumab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious reaction during infusion: chest tightness, cough, trouble breathing, fast heartbeat, fever, chills
The following Empliciti (elotuzumab) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Infusion reactions—chest pain, shortness of breath or trouble breathing, feeling faint or lightheaded
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Constipation
- Diarrhea
- Fatigue
- Headache
- Loss of appetite
- Pain, tingling, or numbness in the hands or feet
Pros and cons of Empliciti (elotuzumab)
Pros
- Recommended treatment option for certain people with multiple myeloma who’ve previously had therapy
- Only need infusions once or twice per month after the first two treatment cycles
- Works in a more specific, targeted way than traditional chemotherapy
Cons
- Given intravenously (through a vein), so requires a needle for administration
- Might cause serious infusion-related reactions
- Might cause liver problems, so regular lab test monitoring is required
Pharmacist tips for Empliciti (elotuzumab)
- Empliciti (elotuzumab) is often given together with other medications to treat multiple myeloma, and it can sometimes be difficult to keep track of the treatment schedule. Talk to your provider about using a treatment calendar so all your appointments and treatment doses are written down. You can also consider using an app on your phone to help you remember.
- If you have diarrhea while you’re taking Empliciti (elotuzumab), make sure you drink plenty of fluids. Avoid sugary sports drinks, though, because they can make diarrhea worse. Your provider might recommend over-the-counter diarrhea medications, like loperamide (Imodium A-D), to help.
- Check your temperature at least once a day. Call your provider as soon as possible if you have a fever (a temperature that’s 100.4 degrees Fahrenheit or higher). It’s important for your provider to know if you get sick, and sometimes a fever might be the only sign that you’re sick.
- If you have diabetes and you typically check your blood sugar at home, talk to your provider about what blood sugar levels are unsafe for you. Also ask when you should contact them with your results. You might have higher blood sugar during treatment, especially on days when you take dexamethasone, one of the medications that’s given together with Empliciti (elotuzumab).
- You shouldn’t breastfeed while you’re getting treated with Empliciti (elotuzumab). We don’t know whether the medication passes into human breast milk. But it has a potential risk of harming a baby if it does based on what we know about the way Empliciti (elotuzumab) works. The other medications that are usually given with Empliciti (elotuzumab) can also cause harm to breastfed babies.
Common questions about Empliciti (elotuzumab)
No, Empliciti (elotuzumab) isn’t a chemotherapy medication. Chemotherapy works by attacking cells in the body that are growing quickly, regardless of what type of cell it is. Chemotherapy attacks cancer cells that grow faster than normal, but it can also attack healthy cells that grow quickly, too. Empliciti (elotuzumab) works in a more specific way, so it’s called a targeted therapy. Empliciti (elotuzumab) targets and attaches to a very specific protein called SLAMF7 that’s found on certain cells, including multiple myeloma cancer cells. This allows the medication to attack cancer cells more specifically.
Empliciti (elotuzumab) isn’t typically considered immunotherapy, even though the medication uses and works with the immune system to treat cancer. The term “immunotherapy” usually refers to medications that turn on a specific type of immune cell called T cells to attack cancer. Empliciti (elotuzumab) is a targeted therapy. Instead of using T cells, Empliciti (elotuzumab) attaches directly to multiple myeloma cancer cells and other types of immune cells to fight the cancer. Empliciti (elotuzumab) also doesn’t cause immune-related side effects that can happen with immunotherapy.
Empliciti (elotuzumab) isn’t typically given by itself. It works better to treat cancer when it’s used together with other medications, such as dexamethasone and an immunomodulatory drug like lenalidomide (Revlimid) or Pomalyst (pomalidomide). Empliciti (elotuzumab) is FDA approved and recommended to be given together with those medications rather than by itself.
It’s recommended that you take a blood thinner such as aspirin to prevent blood clots while you’re taking Empliciti (elotuzumab) with immunomodulatory drugs like lenalidomide (Revlimid) or Pomalyst (pomalidomide). We don’t know whether Empliciti (elotuzumab) raises the risk for blood clots. But people who have multiple myeloma and who take these immunomodulatory drugs are at a higher risk for blood clots, and Empliciti (elotuzumab) is usually given along with these immunomodulatory drugs. It’s important to note that there might be reasons why you shouldn’t take a blood thinner, such as having low platelets, so talk with your provider about which choice is best for you.
We don’t know whether Empliciti (elotuzumab) is safe to take during pregnancy. Keep in mind that you’ll need to take Empliciti (elotuzumab) with an immunomodulatory drug, such as lenalidomide (Revlimid) or Pomalyst (pomalidomide), to treat your cancer, and these medications cause serious birth defects and pregnancy loss (miscarriage). Speak with your provider about whether the treatment plan with Empliciti (elotuzumab) is right for you and whether there are safer alternatives if you’re pregnant or thinking of getting pregnant. Your provider will discuss specific birth control requirements if it’s decided that this treatment plan is best for you. Let your provider know right away if you become pregnant during treatment.
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Risks and warnings for Empliciti (elotuzumab)
Empliciti (elotuzumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Infusion-related reactions
Some people taking Empliciti (elotuzumab) developed an infusion reaction during their treatment. Symptoms of an infusion reaction include fever, chills, chest pain or tightness, and changes in blood pressure. Most of the time, these reactions happen when you get your first dose of Empliciti (elotuzumab).
To prevent an infusion reaction, you’ll typically receive several medications before your Empliciti (elotuzumab) treatment; these “premedications” can include diphenhydramine (Benadryl) and acetaminophen (Tylenol). But reactions can still occur even with these medications. Let your nurse know right away if you experience symptoms of an infusion reaction during your treatment.
Infections
People who take Empliciti (elotuzumab) commonly develop infections, such as a cold, pneumonia, and shingles. You’re at risk for infections because your immune system might not work as well when you have multiple myeloma. Additionally, the treatment you take for multiple myeloma, such as Empliciti (elotuzumab) and immunomodulatory drugs, can lower your immune system even more. As a result, your body can’t fight infections as well.
Your provider might recommend you take certain medications, such as antivirals or antibiotics, to help prevent infections. It’s important that you check your body temperature regularly and seek medical attention right away if it’s ever 100.4 degrees Fahrenheit or higher. This means that you have a fever, and it might mean you have an infection that needs further treatment.
New cancers
Though uncommon, some people taking Empliciti (elotuzumab) developed a new cancer. Skin cancers were most common in studies. Your provider will examine you for any new cancers (especially skin cancers) while you’re taking Empliciti (elotuzumab).
Liver problems
Rarely, people taking Empliciti (elotuzumab) had higher levels of liver enzymes on their lab tests. High liver enzymes can result from liver irritation. Your provider will regularly check your liver function with lab tests during treatment. If you have changes in your lab results, you might have to pause Empliciti (elotuzumab) while your provider looks into it.
Interference with lab testing
Empliciti (elotuzumab) can interfere with certain lab tests that are used to track how well your multiple myeloma is responding to treatment. This interference can lead to abnormal results on these lab tests. Your provider should be aware of this lab interference. They’ll discuss with you about your response to Empliciti (elotuzumab) treatment.
Empliciti (elotuzumab) dosage
Typical dosage for Empliciti (elotuzumab)
The dose depends on your body weight and which treatment combination you’re taking. Empliciti (elotuzumab) is given as an infusion through the vein during each 28-day treatment cycle.
For people taking Empliciti (elotuzumab) with lenalidomide (Revlimid) and dexamethasone
- Cycles 1 and 2: The usual dose of Empliciti (elotuzumab) is 10 mg/kg of weight once per week.
- Cycle 3 and onward: The usual dose of Empliciti (elotuzumab) is 10 mg/kg every other week.
For people taking Empliciti (elotuzumab) with Pomalyst (pomalidomide) and dexamethasone
- Cycles 1 and 2: The usual dose of Empliciti (elotuzumab) is 10 mg/kg of weight once per week.
- Cycle 3 and onward: The usual dose of Empliciti (elotuzumab) is 20 mg/kg once every 4 weeks (i.e., on day 1 of each cycle).
What are alternatives to Empliciti (elotuzumab)?
