SOHO 2019: Update on the Future of Induction Therapy in Multiple Myeloma
Posted: Monday, September 16, 2019
Although recent trials have demonstrated that induction therapy with lenalidomide, bortezomib, and dexamethasone (RVD) is effective for patients with multiple myeloma, the evolution of immunotherapy remains an important development to improve patient outcomes, according to a review of induction therapy strategies presented at the 2019 Society of Hematologic Oncology (SOHO) Annual Meeting in Houston (Abstract EXABS-MM-410). Amrita Krishnan, MD, of City of Hope, Duarte, California, emphasized that the “the future” of immunotherapy will likely include monoclonal antibodies, cancer vaccines, and adoptive cellular therapy.
“Induction therapy for [multiple myeloma] will continue to evolve to include immunotherapy as a way to deepen responses and prolong remissions, representing another step in the road to a cure,” Dr. Krishnan concluded.
The use of monoclonal antibodies was explored, for example, in the phase III ALCYONE trial. The study investigators compared daratumumab with and without bortezomib, melphalan, and prednisone (VMP) and found that the addition of daratumumab resulted in improvements in response and progression-free survival rates. With the VMP regimen not being widely used in the United States, Dr. Krishnan noted that the MAIA study comparing daratumumab with and without lenalidomide and dexamethasone may be more likely to affect future therapies.
Alternatively, the “kitchen-sink” approach to immunotherapy adds daratumumab to the RVD regimen. Early reporting from the GRIFFIN trial comparing RVD with and without daratumumab followed by autologous stem cell transplantation (ASCT) and consolidation has yielded a 100% response rate in patients treated with the antibody. However, the regimen has raised concerns of increased risk for infection.
Finally, a randomized trial utilizing dendritic cell–based vaccines after ASCT has been completed, and results are pending. Vaccines, according to Dr. Krishnan, will be used to extend progression-free survival after deep remissions from antibody-based induction.
Disclosure: The study authors’ disclosure information can be found at soho2019.com.
