LYRA: Maintenance therapy with daratumumab improves depth of response and achieves durable remissions in MM patients

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Published: 17 Dec 2019
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Dr Robert Rifkin - Rocky Mountain Cancer Centers, Denver, USA

Dr Robert Rifkin speaks to ecancer at the 2019 ASH meeting in Orlando about the updated results of the LYRA study, which examined the effect of daratumumab maintenance therapy, following daratumumab in combination with cyclophosphamide, bortezomib, and dexamethasone (CyBorD) for the treatment of multiple myeloma (MM).

Dr Rifkin gives an update on the findings of this study, in which maintenance with daratumumab monotherapy increased the complete response rate in patients with newly diagnosed and relapsed multiple myeloma. This was also associated with durable progression-free and overall survival.

LYRA: Maintenance therapy with daratumumab improves depth of response and achieves durable remissions in MM patients

Dr Robert Rifkin - Rocky Mountain Cancer Centers, Denver, USA

The LYRA study is a study we began about three years ago or so and the idea was several-fold. First of all we wanted to try and teach people how to use daratumumab effectively and gain some information about infusion reactions. In the study schema we actually split the first dose of daratumumab into two equal doses to minimise infusion reactions and shorten infusion times. Thereafter daratumumab was given according to the label.

One of the unique features of the study was that patients were both newly diagnosed and relapsed and were allowed to proceed onto stem cell transplant should the clinical circumstances dictate. In the event the transplant took place the patients were then allowed to re-enter the study and received twelve months of daratumumab given in the maintenance setting. At this ASH we’ll present updated results showing that we got deepening responses during the maintenance and hopefully improvements in progression free survival.

What the results show is that in each group studied, whether you were newly diagnosed or relapsed, but not refractory, with the daratumumab maintenance the greater than or equal to complete response rate rose as did the overall response rate. In addition, preliminary analysis has shown an improvement in progression free survival. However, you have to bear in mind for overall survival, given the advances we’re making in multiple myeloma, the data is still somewhat immature.

I don’t know that this will be a giant practice changing study but what it does is it makes administration of the Dara-CyBorD combination much easier. As you get further into the number of infusions in daratumumab infusion reactions fade away. What will be exciting is when daratumumab is released in the subcutaneous formulation and instead of sitting in the chair for infusions you’ll be in and out of the clinic quite quickly. Hopefully that will lead to an improvement in the patients’ quality of life. Because we are doing quite well in multiple myeloma and we want everything to be an effective treatment that doesn’t negatively impact the patient’s quality of life.

Another important feature of the study, especially for the European audience, is that this is an IMiD free regimen so there’s no lenalidomide, there’s no pomalidomide. This has clear economic and access issues. So this study will be something that’s very relevant and will help us to battle the ever increasing costs of myeloma therapy.