Update on CASTOR trial: Daratumumab, bortezomib, and dexamethasone for relapsed or refractory myeloma

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Published: 3 Mar 2017
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Dr Suzanne Lentzsch - Columbia University, New York, USA

Dr Lentzsch speaks with ecancer at the 16th International Myeloma Workshop about the CASTOR trial.

The CASTOR trial is a phase III randomised controlled study of daratumumab, bortezomib, and dexamethasone (DVd) versus bortezomib and dexamethasone (Vd) in patients with relapsed or refractory multiple myeloma.

Dr Lentzsch also spoke with ecancer about the future of precision medicine in treating myeloma.

ecancer's filming has been kindly supported by Amgen through the ECMS Foundation. ecancer is editorially independent and there is no influence over content.

Today I will present a poster and I will give an oral poster presentation afterwards. What I’m presenting is a follow-up of the CASTOR trial. The CASTOR trial is a phase III randomised trial that randomises patients with relapsed refractory multiple myeloma into a Velcade dexamethasone arm versus a Velcade dexamethasone and daratumumab arm. We are presenting today follow-up data with a median follow-up of 13 months and what we show is that the outcome is significantly different, that patients who receive daratumumab Velcade-dex in comparison to Velcade-dex have a significantly better progression free survival and also a significantly better response rate. The data are too immature for overall survival; fortunately our patients live so long that the data are not mature to present those data.

We also did do a sub-analysis of what are the factors that really contribute to the outcome. So, for instance, we could identify that patients who received only one prior line of treatment have the best outcome. That suggests that if you treat patients in the relapsed refractory situation earlier, at the first relapse, they might have a better outcome and the difference between daratumumab Velcade-dex and Velcade-dex alone is very high. We also found that daratumumab Velcade and dex induces a significant amount of negative MRD, MRD negativity. Patients who are MRD negative have an excellent outcome and 100% progression free survival with a median follow-up of 13 months, so excellent data.

So, in summary, what we found in our clinical trial is that patients who have an early relapse do much better and that daratumumab Velcade-dex is able to induce MRD negativity with an excellent progression free survival.