Multiple Myeloma
Poor response on subsequent therapies is typically seen in patients with relapsed/refractory multiple myeloma (RRMM) who have had 3 prior lines of therapy with immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), and anti-CD38 monoclonal antibodies. In addition, challenges for future treatment options are presented.
Recent studies have illustrated complete response (CR) rates >50% for transplant-eligible patients with multiple myeloma (MM) treated with optimized induction followed by high-dose therapy (HDT) and autologous stem-cell transplantation (ASCT). However, many patients relapse early. Patients who relapse are generally thought to have very low survival rates.
According to data from the phase 2 FORTE trial, 3 different techniques were analyzed and compared to characterize minimal residual disease (MRD), including positron emission tomography/computed tomography (PET/CT), multiparameter flow cytometry (MFC), and next-generation sequencing (NGS).
The combination of carfilzomib (Kyprolis) with lenalidomide (Revlimid) and dexamethasone (KRd) as induction therapy does not improve outcomes in patients newly diagnosed with multiple myeloma compared with the current standard of care with bortezomib (Velcade), lenalidomide, and dexamethasone (VRd).
Cellular therapy is becoming an attractive option for heavily pretreated patients with relapsed or refractory multiple myeloma. According to data presented at the ASCO 2020 virtual annual meeting, 2 chimeric antigen receptor (CAR) T-cell drugs have generated impressive rates of response that are sustainable.
The past week in oncology-related news includes shortages of crucial pediatric cancer drug, results of a study of racial disparities in multiple myeloma, and new drug on the horizon for HER2 metastatic breast cancer.
On September 26, 2019, the FDA approved daratumumab (Darzalex; Janssen) in combination with bortezomib, thalidomide, and dexamethasone for the treatment of newly diagnosed patients with multiple myeloma who are eligible for autologous stem-cell transplant (ASCT). The FDA granted this application priority review.
Once-weekly carfilzomib (Kyprolis) therapy at a higher dose significantly improved progression-free survival (PFS) and reduced the risk of disease progression or death compared with twice-weekly carfilzomib in patients with relapsed or refractory multiple myeloma. The overall safety profile for both regimens in the randomized phase 3 ARROW clinical trial were similar, said co-lead investigator María-Victoria Mateos, MD, PhD, Director, Myeloma Unit, University Hospital Salamanca-IBSAL, Spain, at the 2018 European Hematology Association Congress.
By Wayne Kuznar
The results of the phase 3 OPTIMISMM clinical trial showed a 39% risk reduction in disease progression or death with pomalidomide, bortezomib, and low-dose dexamethasone compared with bortezomib and low-dose dexamethasone alone.
The second-generation chimeric antigen receptor (CAR) T-cell therapy, bb2121, engineered to target B-cell maturation antigen, a protein on the surface of certain myeloma cells, displayed continuing efficacy and safety in an update of a phase 1 clinical trial in patients with relapsed or refractory multiple myeloma.