Daratumumab Plus Triplet Therapy for Transplant-Eligible Patients With Multiple Myeloma
Posted: Tuesday, November 12, 2019
Adding the monoclonal antibody daratumumab to a treatment regimen of bortezomib, thalidomide, and dexamethasone (VTd) provided some benefits in terms of minimal residual disease for patients with high cytogenic risk or International Stage System (ISS) stage III disease, according to a new subgroup analysis of the phase III CASSIOPEIA trial. The results were presented at the 2019 International Myeloma Workshop (Abstract OAB-003) by Pieter Sonneveld, MD, PhD, of Erasmus MC Cancer Institute in The Netherlands, and colleagues.
The investigators stratified 1,085 transplant-eligible patients with newly diagnosed multiple myeloma by ISS stage (I, II, or III) and cytogenetic risk status. Patients were considered to have high cytogenetic risk if they had a 17p deletion in 50% or more cells or a t(4;14) translocation in 30% or more cells, identified by fluorescent in situ hybridization. Patients were randomly assigned to receive either daratumumab plus VTd or VTd alone, with both treatments given in four pretransplant and two post-transplant cycles.
The median follow-up was 18.8 months. For the primary outcome measure, stringent complete response, adding daratumumab to VTd did not significantly improve outcomes for these high-risk patients. However, minimal residual disease negativity was reported to be significantly higher with daratumumab plus VTd than for VTd alone. Of patients at high cytogenic risk, 60% of those treated with daratumumab had no minimal residual disease, compared with 44% of those not receiving daratumumab. Of patients with ISS stage III disease, 64% receiving daratumumab had no minimal residual disease, compared with 46% of those who were not given daratumumab.
“The clinical benefit of these deeper responses will be evaluated with additional follow-up and in part 2 of the study,” the authors wrote.
Disclosure: The study authors’ disclosure information can be found at imw2019boston.org.