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Prashant Kapoor, MD, FACP


Phase III CASTOR Trial: Daratumumab-Based Regimen for Resistant Multiple Myeloma

By: Joshua D. Madera, MS
Posted: Wednesday, January 18, 2023

The use of combination therapy with the monoclonal antibody daratumumab plus bortezomib and dexamethasone (Vd) may improve overall survival for patients with relapsed or refractory multiple myeloma, according to the results of the phase III CASTOR study, published in the Journal of Clinical Oncology. This impact was most pronounced in patients who had previously received one line of therapy, explained Pieter Sonneveld, MD, PhD, of the Erasmus MC Cancer Institute, Rotterdam, the Netherlands, and colleagues.

“These results provide strong rationale for early use of daratumumab to maximize patient benefit,” the investigators concluded.

Patients with relapsed or refractory multiple myeloma were recruited for the study and were randomly assigned to receive treatment with daratumumab plus Vd or Vd alone. Patients were further stratified based on the number of previous treatments they had received and whether they had previously been treated with bortezomib. All patients were subjected to a maximum of eight treatment cycles.

The study authors reported a significant overall survival benefit in patients who were treated with daratumumab plus Vd (hazard ratio = 0.74). The median overall survival was 49.6 and 38.5 months for patients treated with daratumumab plus Vd and Vd, respectively. Furthermore, an overall survival advantage for patients who received daratumumab plus Vd was noted in those who had high-risk cytogenic abnormalities, had received one or two previous lines of therapy, had received previous bortezomib treatment, were aged 65 or older, and had International Staging System stage III disease. Moreover, common treatment-related adverse effects reported in patients receiving daratumumab plus Vd versus Vd included thrombocytopenia (46.1% vs. 32.9%), anemia (16.0% vs. 16.0%), neutropenia (13.6% vs. 4.6%), pneumonia (10.7% vs. 10.1%), and lymphopenia (10.3% vs. 2.5%), respectively.

Disclosure: For full disclosures of the study authors, visit

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