Multiple Myeloma Coverage from Every Angle

Avelumab Plus Hypofractionated Radiotherapy for Resistant Multiple Myeloma

By: Sarah Campen, PharmD
Posted: Friday, March 19, 2021

Avelumab in combination with hypofractionated radiotherapy for patients with relapsed or refractory multiple myeloma and extramedullary disease was associated with a “very modest” systemic clinical benefit, according to a single-arm phase II study published in The Oncologist. The trial was prematurely terminated due to the COVID‐19 pandemic after enrolling just four patients. “In this small data set, radiotherapy with checkpoint inhibition did not appear to activate the antitumor immune response,” explained Jennifer Jones, MD, PhD, of the National Institutes of Health, and colleagues.

The study included patients with relapsed or refractory multiple myeloma who had exhausted standard therapy and had at least one lesion amenable to radiotherapy. All four enrolled patients received avelumab until disease progression or intolerable toxicity and hypofractionated radiotherapy to a focal lesion in cycle 2.

At a median follow‐up of 10.5 months, there were no objective responses, one minimal response, and two cases of stable disease as the best response. The median progression-free survival was 5.3 months; no deaths occurred. At the data cutoff date of November 2020, all patients had discontinued therapy due to disease progression. As for safety, five grade 1 and 2 treatment‐related adverse events were reported.

“…It is unknown whether immune checkpoint inhibitor combination regimens will synergize to produce meaningful clinical benefit,” concluded the authors. “Therefore, excluding clinical trials, PD-1/L1 inhibitors are unlikely to have a role in the multiple myeloma clinic in the near future.”

Disclosure: The authors reported no conflicts of interest.

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