Like in any haematology meeting over the last five years or so multiple myeloma is always the superstar disease with a lot of sessions, lot of communications, lot of posters. In this EHA 2019 meeting I would like to emphasise that definitely the monoclonal antibodies are really the stars on the podium. During this EHA meeting, for example, we have in the Presidential Symposium the results of the CASSIOPEIA trial establishing the superiority of daratumumab combined with VTD, bortezomib, thalidomide, dexamethasone, over the classical VTD as an induction regimen prior to stem cell transplantation. We have also the COLUMBA trial looking into comparing intravenous daratumumab versus subcute. It’s a non-inferiority phase III randomised trial which is, again, establishing the use of subcutaneous. Subcutaneous is non-inferior to IV, of course it’s only a five minute infusion which is wonderful for the patient and for the quality of life but also the subcute formula has less side effects apparently.
You have also during this conference the communication about the ICARIA phase III trial testing another anti-CD38 monoclonal antibody, isatuximab, combined with pomalidomide and dexamethasone compared to the classical approved pomalidomide dexamethasone. Again, very nice positive results showing that in a population of relapsed refractory myeloma who received a median of three lines of therapy you can achieve almost twelve months of progression free survival compared to around six months with pomalidomide dexamethasone. So this is another trial bringing a novel antibody in multiple myeloma in the relapsed setting.
But it’s not only about the anti-CD38 monoclonal antibodies, we have now the B-specific antibodies namely AMG420 that is also presented during this EHA 2019 meeting showing also very exciting and promising results. It’s a phase I dose finding study but the study is already suggesting a very high rate of response, up to 70% including MRD negativity at the 420μg/day.
I can continue forever on all of these studies but definitely to make a long story short I would say that the monoclonal antibodies, especially anti-CD38, are becoming a mandatory, I would say, drug as part of any myeloma regimen, whether you consider the front line setting or the relapsed setting. As a matter of fact, the complicated part of the story is how to define the optimal sequence of all of these complications and this is where you need to rely on clinical experience and on the specific features of a given patient. It’s the era of personalised medicine.