Following on from their discussion around the treatment of smoldering multiple myeloma patients, Professor Maria-Victoria Mateos (University Hospital of Salamanca, Salamanca, Spain) and Professor Paul Richardson (Dana-Farber Cancer Institute, Boston, USA) focus on advances in the treatment of relapsed/refractory multiple myeloma (RRMM) at IMW 2017 in Delhi.
First discussed was the update to the POLLUX trial presented at IMW. After median 17.3 months of follow-up, the addition of daratumumab to lenalidomide and dexamethasone (DRd) demonstrated significantly prolonged PFS compared to lenalidomide and dexamethasone (Rd).
As well as showing “the best PFS in a Phase III RR trial”, the DRd combination also resulted in positive overall and complete response rates.
With the updates of the trial focusing on depth of response and the role of MRD, MRD negativity was observed in over three times as many patients receiving DRd verses Rd, with no MRD-negative, high-risk patients progressing during the study.
Prof Richardson and Prof Mateos then focused discussion on the use of mAbs combined with Pomalidomide and Dexamethasone (POM-D) as a backbone in the treatment of RRMM. A multi-arm, phase 1b study presented at IMW 2017 evaluated daratumumab with POM-D in patients with two or more prior lines of therapy.
Deep, durable responses were observed across all subgroups and the results showed a safety profile consistent with individual therapies, with the exception of a higher incidence of neutropenia.
Another mAb evaluated in combination with POM-D is Isatuximab, with preliminary data presented at IMW suggesting that the combination is well tolerated and clinically active in patients with heavily treated RRMM. With a number of novel agents and combinations producing promising results in RRMM, the options for patients are set to expand.
This is the second part of a larger discussion covering smoldering myeloma which can be viewed here.
This programme has been supported by an unrestricted educational grant from Janssen Pharmaceuticals (A Johnson & Johnson Company).