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Jerry Teng CL, Yeh SP, Chen TY, Hung YC, Lin YC, Li SS, Wang MC, Huang SY. Treatment pattern among patients with relapsed/refractory multiple myeloma (RRMM) who had received pomalidomide-based regimens in Taiwan. Hematology 2024; 29:2365096. [PMID: 38958506 DOI: 10.1080/16078454.2024.2365096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND/PURPOSE The treatment landscape of relapsed/refractory multiple myeloma (RRMM) is rapidly evolving in Taiwan. The present study aimed to assess the treatment patterns among RRMM patients in Taiwan. METHODS This retrospective, chart review-based, non-interventional study collected data on RRMM patients (≥20 years old) receiving pomalidomide-based treatment between January 2017 and December 2020 across five sites in Taiwan. RESULTS Median age of the study population was 65.6 years. Approximately 75% patients received a doublet regimen and 25% were on a triplet regimen. Disease progression was the most common cause for switching to pomalidomide-based treatments in doublet (71.2%) and triplet (58.3%) groups. Patients in doublet and triplet groups (>80%) received 4 mg pomalidomide as a starting dose. Overall response rate (ORR: 31.5% and 45.8%) and median progression-free survival (PFS: 4.7 and 6.8 months) were reported in the doublet and triplet regimen. Doublet regimen was discontinued mainly due to disease progression or death (78.1%); however, triplet regimen patients mainly terminated their treatment due to reimbursement limitations (29.2%). Healthcare resource utilization (HRU) was comparable between doublet and triplet groups. CONCLUSION In Taiwan, half of RRMM patients received pomalidomide-based triplet regimens. Triplet regimens showed a trend towards better outcomes with longer PFS and higher response rates compared to doublets. Notably, the duration of triplet use is influenced by reimbursement limitations. This study provides insight into RRMM treatment patterns in Taiwan and the findings suggest that triplet regimens may be a better alternative than doublet regimens.
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Affiliation(s)
- Chieh-Lin Jerry Teng
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Su-Peng Yeh
- Hematology Department, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Yun Chen
- Hematology Department, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yu-Chin Hung
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Yu lin, Taiwan
| | - Yun-Chu Lin
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Sin Syue Li
- Hematology Department, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Chung Wang
- Hematology Department, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shang-Yi Huang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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2
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Kapoor P, Nathwani N, Jelinek T, Pour L, Perrot A, Dimopoulos MA, Huang SY, Spicka I, Chhabra S, Lichtman E, Mateos MV, Kanagavel D, Zhao L, Guillemin-Paveau H, Macé S, van de Velde H, Richardson PG. An open-label, first-in-human, single agent, dose escalation study for the evaluation of safety and efficacy of SAR442085 in patients with relapsed or refractory multiple myeloma. Eur J Haematol 2024; 113:593-605. [PMID: 38993150 DOI: 10.1111/ejh.14270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES Cluster of differentiation 38 (CD38) is a key target on multiple myeloma (MM) cells. This multi-centre, Phase 1, single-agent study (NCT04000282) investigated SAR442085, a novel fragment crystallisable (Fc)-modified anti-CD38 monoclonal antibody (mAb), with enhanced affinity towards Fc-gamma receptor on effector cells in patients with relapsed and/or refractory (RR) MM. METHODS This study comprised two parts: Part-A (dose-escalation involving anti-CD38 mAb pre-treated and naïve patients) and Part-B (dose expansion). Primary endpoints were maximum tolerated dose and recommended Phase 2 dose (RP2D). RESULTS Thirty-seven heavily pre-treated patients were treated in Part A. Part-B (dose-expansion) was not studied. Seven dose-limiting toxicities were reported at DL3, DL5, DL6, and DL7. RP2D was determined to be 5-7·5 mg/kg. Most common treatment-emergent adverse events were infusion-related reactions in 70·3% (26/37) patients. Grade ≥3 thrombocytopenia was reported in 48·6% (18/37). Overall response rate was 70% in anti-CD38 mAb naïve and 4% in anti-CD38 pre-treated patients, with a median progression-free survival of 7·62 (95%CI: 2·858; not calculable) months and 2·79 (95%CI: 1·150; 4·172) months and, respectively. CONCLUSIONS The efficacy of SAR442085 was promising in anti-CD38 mAb naïve patients but did not extend to the larger cohort of anti-CD38 mAb pre-treated patients. This observation, along with transient high-grade thrombocytopenia, could potentially limit its clinical use.
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MESH Headings
- Humans
- Multiple Myeloma/drug therapy
- Multiple Myeloma/mortality
- Male
- Aged
- Female
- Middle Aged
- Treatment Outcome
- Maximum Tolerated Dose
- Drug Resistance, Neoplasm
- Adult
- Aged, 80 and over
- ADP-ribosyl Cyclase 1/antagonists & inhibitors
- ADP-ribosyl Cyclase 1/immunology
- Recurrence
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal/adverse effects
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Affiliation(s)
- Prashant Kapoor
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Comprehensive Cancer Center, California, USA
| | - Tomas Jelinek
- Department of Hematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Aurore Perrot
- Department of Hematology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | | | - Shang-Yi Huang
- Department of Hematology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ivan Spicka
- First Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University and General Hospital, Prague, Czech Republic
| | - Saurabh Chhabra
- Division of Hematology and Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Eben Lichtman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maria-Victoria Mateos
- Hospital Universitario de Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Dheepak Kanagavel
- Research and Development, Sanofi, Research and Development, Vitry-sur-Seine, France
| | - Liang Zhao
- Research and Development, Sanofi, Research and Development, Shanghai, China
| | | | - Sandrine Macé
- Research and Development, Sanofi, Research and Development, Vitry-sur-Seine, France
| | - Helgi van de Velde
- Research and Development, Sanofi, Research and Development, Cambridge, Massachusetts, USA
| | - Paul G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Multiple Myeloma Center, Boston, Massachusetts, USA
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3
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Voorhees P, Suman V, Efebera Y, Raje N, Tuchman S, Rodriguez C, Laubach J, Bova-Solem M, Carlisle D, Usmani S, McCarthy P, Richardson PG. Alliance A061202: ixazomib, pomalidomide, and dexamethasone for patients with lenalidomide-refractory MM in first relapse. Blood Adv 2024; 8:5039-5050. [PMID: 39058954 DOI: 10.1182/bloodadvances.2024013623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
ABSTRACT Optimal therapy for the growing number of patients with lenalidomide (LEN)-refractory multiple myeloma in their first relapse remains poorly defined. We therefore undertook a randomized phase 2 study to evaluate the efficacy and safety of combining the oral proteasome inhibitor ixazomib (IXA) with pomalidomide (POM) and dexamethasone (DEX) in this patient population. The overall response rate (ORR) for POM-DEX was 43.6%, and for IXA-POM-DEX, it was 63.2%. The depth of response, measured by the attainment of at least a very good partial response, favored triplet therapy over doublet therapy (28.9% vs 5.1%; P = .0063). A preplanned interim analysis after 75% of the progression events had occurred demonstrated an improvement in progression-free survival (PFS) that favored IXA-POM-DEX and that crossed the predefined boundary of superiority, leading to release of the study results. With additional follow-up, the median PFS for POM-DEX was 7.5 months (95% confidence interval [CI], 4.8-13.6 months) vs 20.3 months for IXA-POM-DEX (95% CI, 7.7-26.0 months; hazard ratio, 0.437; upper 90% bound = 0.657). The ORR and median PFS for 26 of 30 eligible patients who crossed over from the doublet to the triplet therapy at disease progression was 23.1% and 5.6 months, respectively. Overall survival was similar between the 2 groups. More hematologic toxicities were seen with the triplet therapy, but nonhematologic adverse events were similar between the 2 arms. Our data support further testing of this all-oral triplet therapy in comparison with current standard triplet therapy in the context of phase 3 studies for patients with LEN-refractory disease at first relapse. This trial was registered at www.clinicaltrials.gov as #NCT02004275.
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Affiliation(s)
- Peter Voorhees
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health - Wake Forest School of Medicine, Charlotte, NC
| | - Vera Suman
- Alliance Statistics and Data Center, Rochester, MN
| | - Yvonne Efebera
- Department of Hematology and Oncology, Ohio Health, Columbus, OH
| | - Noopur Raje
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sascha Tuchman
- Division of Hematology, Lineberger Comprehensive Cancer Center, the University of North Carolina, Chapel Hill, NC
| | - Cesar Rodriguez
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob Laubach
- Department of Hematology and Oncology, Dana Farber/Partners Cancer Care, Harvard Medical School, Boston, MA
| | | | - Destin Carlisle
- Alliance for Clinical Trials in Oncology, Protocol Operations Program, Chicago, IL
| | - Saad Usmani
- Department of Medicine, Memorial Sloan Kettering Comprehensive Cancer Center, New York, NY
| | - Philip McCarthy
- Department of Medicine, Transplant and Cellular Therapy Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Paul G Richardson
- Department of Hematology and Oncology, Dana Farber/Partners Cancer Care, Harvard Medical School, Boston, MA
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4
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Yong K, Martin T, Dimopoulos MA, Mikhael J, Capra M, Facon T, Hajek R, Špička I, Baker R, Kim K, Martinez G, Min CK, Pour L, Leleu X, Oriol A, Koh Y, Suzuki K, Casca F, Macé S, Risse ML, Moreau P. Isatuximab plus carfilzomib-dexamethasone versus carfilzomib-dexamethasone in patients with relapsed multiple myeloma (IKEMA): overall survival analysis of a phase 3, randomised, controlled trial. Lancet Haematol 2024; 11:e741-e750. [PMID: 39067465 DOI: 10.1016/s2352-3026(24)00148-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Isatuximab is an anti-CD38 monoclonal antibody approved for the treatment of relapsed or refractory multiple myeloma. Previous analyses of the IKEMA trial showed prolonged progression-free survival in patients with this disease who received isatuximab in combination with carfilzomib-dexamethasone as compared with those who received carfilzomib-dexamethasone alone. Herein, we report the analysis of overall survival from the IKEMA trial. METHODS This prospective, randomised, open-label, active-controlled, phase 3 study included patients with relapsed or refractory multiple myeloma aged 18 years or older, who had received one to three previous lines of treatment from 69 study centres in 16 countries across North America, South America, Europe, and the Asia-Pacific region. Patients were randomly allocated (3:2) to treatment with either isatuximab plus carfilzomib-dexamethasone (isatuximab group) or carfilzomib-dexamethasone (control group). In the isatuximab group, patients received intravenous isatuximab (10 mg/kg on days 1, 8, 15, and 22 of the first 28-day cycle, and days 1 and 15 of subsequent 28-day cycles). In both treatment groups, intravenous carfilzomib (20 mg/m2 on days 1 and 2 of the first cycle; and 56 mg/m2 on days 8, 9, 15, and 16 of the first cycle, and days 1, 2, 8, 9, 15, and 16 of subsequent cycles) and intravenous or oral dexamethasone (20 mg on days 1, 2, 8, 9, 15, 16, 22, and 23) were administered. The primary endpoint of the trial was progression-free survival, which was reported previously. Treatment continued until progression, unacceptable toxicity, or patient request to discontine. The overall survival analysis reported here was planned to be conducted 3 years after the primary progression-free survival analysis in the intention-to-treat population. Additional analyses were conducted on the secondary endpoints of time to next treatment and second-progression-free survival. Reported p values are non-inferential due to hierarchical testing. This trial is registered with ClinicalTrials.gov (NCT03275285). FINDINGS Between Nov 15, 2017, and March 21, 2019, 302 patients were enrolled and randomly allocated: 179 (59%) to the isatuximab group and 123 (41%) to the control group. 169 (56%) patients were male, 133 (44%) were female, 214 (71%) were White, 50 (17%) were Asian, nine (3%) were Black or African American, and three (1%) were multiracial. At data cutoff for this overall survival analysis (Feb 7, 2023), 79 (44%) overall survival events in the isatuximab group and 59 (48%) in the control group had occurred (median follow-up 56·61 months [IQR 54·90-58·02]). Median overall survival (in months) was not reached (NR; 95% CI 52·17-NR) in the isatuximab group and was 50·60 months (38·93-NR) in the control group (hazard ratio [HR] 0·855 [95% CI 0·608-1·202], nominal one-sided p=0·18). Survival probability at 48 months was 59·7% (95% CI 52·0-66·7) in the isatuximab group and 52·2% (95% CI 42·7-60·8) in the control group (based on Kaplan-Meier analysis). Improvements in time to next treatment (HR 0·583 [95% CI 0·429-0·792], nominal one-sided p=0·0002) and second-progression-free survival (0·663 [0·491-0·895], nominal one-sided p=0·0035) were observed in the isatuximab group. The most common treatment-emergent adverse events were infusion reactions (82 [46%] patients in the isatuximab group and four [3%] in the control group) and upper respiratory tract infections (71 [40%] and 34 [28%], respectively). Discontinuations due to treatment-emergent adverse events were similar between treatment groups (24 [14%] in the isatuximab group and 22 [18%] in the control group), despite an additional 30 weeks of exposure in the isatuximab group. 12 (7%) patients in the isatuximab group and six (5%) patients in the control group had a treatment-related adverse event with a fatal outcome during study treatment. INTERPRETATION At the time of the current analysis, a difference in overall survival could not be detected between the treatment groups, and no new safety signals were observed. Collectively, the evidence suggests that isatuximab plus carfilzomib-dexamethasone is a key treatment for patients with relapsed or refractory multiple myeloma. FUNDING Sanofi.
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Affiliation(s)
- Kwee Yong
- Department of Haematology, Cancer Institute, University College London, London, UK.
| | - Thomas Martin
- Department of Hematology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Marcelo Capra
- Centro Integrado de Hematologia e Oncologia, Hospital Mãe de Deus, Porto Alegre, Brazil
| | - Thierry Facon
- Department of Haematology, Lille University Hospital, Lille, France
| | - Roman Hajek
- Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ivan Špička
- Department of Hematology, 1 Faculty of Medicine, Charles University and General Hospital, Prague, Czech Republic
| | - Ross Baker
- Perth Blood Institute, Murdoch University, Perth, Australia
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gracia Martinez
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Chang-Ki Min
- Department of Hematology, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, CHU and CIC Inserm 1402, Poitiers, France
| | - Albert Oriol
- Institut Josep Carreras and Institut Catala d'Oncologia, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kenshi Suzuki
- Myeloma/Amyloidosis Center, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | - Sandrine Macé
- Research and Development, Sanofi, Chilly-Mazarin, France
| | | | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
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5
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McCurdy A, Reece D, Louzada ML, White D, Parkin S, Chu MP, Kotb R, Mian H, Othman I, Su J, Khan A, Gul E, Trudel S. Belantamab mafodotin, pomalidomide, and dexamethasone for triple class exposed/refractory relapsed multiple myeloma: a subgroup analysis of the ALGONQUIN trial. Blood Cancer J 2024; 14:155. [PMID: 39261451 PMCID: PMC11391083 DOI: 10.1038/s41408-024-01135-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/24/2024] [Accepted: 08/28/2024] [Indexed: 09/13/2024] Open
Abstract
Given the early use of triplet and quadruplet regimens, most patients with multiple myeloma (MM) will be exposed and/or refractory to PIs, IMiDs, and anti-CD38 mAbs after first- or second-line treatment. Effective treatment for this group of triple class exposed/refractory (TCE/R) patients is crucial. Here we present a post-hoc subgroup analysis of TCE/R patients treated on the ALGONQUIN study of belantamab mafodotin plus pomalidomide-dexamethasone (belamaf-Pd) for relapsed MM. Of the 99 patients treated on the ALGONQUIN study, 69 were TCE and 56 were TCR and were included in this analysis. Patients had a median of three prior lines of therapy. The ORR was 86.4% in TCE patients and 84.9% in TCR patients, with ≥ very good partial response rates of 64% and 68% respectively. The median progression free survival was 18.3 months in TCE patients and 19.6 months in TCR patients, with overall survival not yet reached and 34.4 months, respectively for TCE and TCR patients. No new safety signals were identified. The most common Grade ≥ 3 AEs were keratopathy (48%), decreased visual acuity (42%), neutropenia (36%), thrombocytopenia (27%), and infection (25%). In this subgroup analysis of the ALGONQUIN study, patients with TCE/TCR disease treated with belamaf-Pd achieved high clinical response rates with durable remissions, comparable to other novel therapeutics in this space.
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Affiliation(s)
| | - Donna Reece
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Martha L Louzada
- London Health Sciences Centre, Victoria & Children's Hospital, London, ON, Canada
| | - Darrell White
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Stephen Parkin
- Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Rami Kotb
- CancerCare Manitoba, Winnipeg, MB, Canada
| | - Hira Mian
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Jiandong Su
- Canadian Myeloma Research Group (CMRG), Vaughan, ON, Canada
| | - Aniba Khan
- Canadian Myeloma Research Group (CMRG), Vaughan, ON, Canada
| | - Engin Gul
- Canadian Myeloma Research Group (CMRG), Vaughan, ON, Canada
| | - Suzanne Trudel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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6
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Decaux O, Fontan J, Perrot A, Karlin L, Touzeau C, Schulmann S, Manier S, Belhadj K, Trebouet A, Zunic P, Schiano De Colella JM, Castel B, Van De Wyngaert Z, Pica GM, Tiab M, Kuhnowski F, Bouketouche M, Rigaudeau S, Benramdane R, Tekle C, Lafore R, Gaucher M, Corre J, Leleu X. Isatuximab plus pomalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma in real-world: The retrospective IMAGE study. Eur J Haematol 2024; 113:290-297. [PMID: 38712850 DOI: 10.1111/ejh.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND IMAGE is a retrospective cohort study of patients enrolled in early access programs (EAPs) in France with relapsed/refractory multiple myeloma (RRMM) receiving isatuximab with pomalidomide and dexamethasone (Isa-Pd). METHODS Patients aged ≥18 years with RRMM who received ≥1 dose of Isa under the EAPs between July 29, 2019 and August 30, 2020 were included. Effectiveness endpoints included progression-free survival (PFS) and response rates. Verbatim terms for adverse events (AEs) were coded using the Medical Dictionary for Regulatory Activities and not graded for severity. RESULTS A total of 294 and 299 patients were included in the effectiveness and safety populations, respectively. IMAGE included patients who received one prior line of treatment (10.2%) and were daratumumab-refractory (19.1%). At median follow-up of 14.2 months, median PFS in the effectiveness population was 12.4 months (95% CI 9.0-15.0). Overall response and very good partial response rates were 46.3% and 27.9%, respectively. Subgroup analyses reflected similar results. In the safety population, 26.4% of patients reported at least one AE; the most common any-grade AE was neutropenia (9.4%). CONCLUSION IMAGE demonstrated Isa-Pd had meaningful effectiveness in median PFS and depth of response and no new safety signals in a real-world context, consistent with clinical trial results.
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Affiliation(s)
- Olivier Decaux
- INSERM, Établissement Français du Sang de Bretagne, Unité Mixte de Recherche (UMR) S1236, Université de Rennes 1, Rennes, France
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire, Rennes, France
| | - Jean Fontan
- Department of Hematology, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France
| | - Aurore Perrot
- CHU de Toulouse, IUCT-O, Service d'Hématologie, UPS, Université de Toulouse, Toulouse, France
| | - Lionel Karlin
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France
| | - Cyrille Touzeau
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | | | - Salomon Manier
- Maladie du sang, CHRU Hôpital Claude Huriez, Lille, France
| | - Karim Belhadj
- Unité Hémopathies Lymphoïdes, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Adrien Trebouet
- Department of Haematology, Bretagne Sud Hospital Centre, Lorient, France
| | - Patricia Zunic
- Department of Haematology, University Hospital Centre, Saint-Pierre, France
| | | | - Brice Castel
- Service de Médecine Interne, Centre Hospitalier de Bigorre, Tarbes, France
| | - Zoé Van De Wyngaert
- Sorbonne Université, AP-HP, Centre de Recherche Saint-Antoine INSERM UMRs938, Service D'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Gian Matteo Pica
- Hématologie, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Mourad Tiab
- Médecine Interne, CHU Vendée, La Roche sur Yon, France
| | | | - Malek Bouketouche
- Oncologie et hématologie, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Sophia Rigaudeau
- Service d'Hématologie Clinique, Centre Hospitalier de Versailles André Mignot, Faculté de Médecine Xavier Bichat, Université Paris Diderot, Paris, France
| | - Riad Benramdane
- Department of Hematology, Centre Hospitalier Pontoise René Dubos, Pontoise, France
| | | | | | | | - Jill Corre
- IUC-T Oncopole, Unité de Génomique du Myélome, Toulouse, France
| | - Xavier Leleu
- Faculte de médecine, INSERM CIC 1402 and U 1313, Centre Hospitalier Universitaire (CHU), Poitiers, France
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7
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Pawlyn C, Schjesvold FH, Cairns DA, Wei LJ, Davies F, Nadeem O, Abdulhaq H, Mateos MV, Laubach J, Weisel K, Ludwig H, Rajkumar SV, Sonneveld P, Jackson G, Morgan G, Richardson PG. Progression-free survival as a surrogate endpoint in myeloma clinical trials: an evolving paradigm. Blood Cancer J 2024; 14:134. [PMID: 39134544 PMCID: PMC11319634 DOI: 10.1038/s41408-024-01109-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024] Open
Abstract
Measurement of overall survival (OS) remains the gold standard for interpreting the impact of new therapies for multiple myeloma in phase 3 trials. However, as outcomes have improved, it is increasingly challenging to use OS as the primary endpoint if timely approval of novel agents is to be ensured to enable maximum benefit for patients. Surrogate endpoints of OS, such as progression-free survival (PFS) and response to treatment, have contributed to approval decisions by the Food and Drug Administration (FDA) and European Medicines Agency as endpoints demonstrating clinical benefit, and the FDA has recently supported the use of minimal residual disease (MRD) as an accelerated approval endpoint in multiple myeloma. This review aims to address situations in which the use of PFS as a surrogate endpoint warrants careful interpretation especially for specific subgroups of patients and considers ways to ensure that studies can be designed to account for possible discordance between PFS and OS. The utility of subgroup analyses, including the potential for those not pre-specified, to identify target populations for new agents is also discussed.
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Affiliation(s)
- Charlotte Pawlyn
- The Institute of Cancer Research, London, UK.
- The Royal Marsden Hospital NHS Foundation Trust, London, UK.
| | - Fredrik H Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - David A Cairns
- Leeds Cancer Research UK Clinical Trials Unit of Leeds, Leeds, UK
| | - L J Wei
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Faith Davies
- Perlmutter Cancer Center, NYU Langone, New York, NY, USA
| | - Omar Nadeem
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Haifaa Abdulhaq
- University of California, San Francisco, Fresno Campus, CA, USA
| | - Maria-Victoria Mateos
- University Hospital of Salamanca; IBSAL; Institute of Cancer Molecular and Cellular Biology; and CIBERONC, Salamanca, Spain
| | | | - Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Heinz Ludwig
- Medical Department Center for Oncology, Hematology and Palliative Medicine, Wilhelminen Cancer Research Institute, Vienna, Austria
| | | | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Graham Jackson
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals Trust, Newcastle Upon Tyne, UK
| | - Gareth Morgan
- Perlmutter Cancer Center, NYU Langone, New York, NY, USA
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8
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Bahlis NJ, Samaras C, Reece D, Sebag M, Matous J, Berdeja JG, Shustik J, Schiller GJ, Ganguly S, Song K, Seet CS, Acosta-Rivera M, Bar M, Quick D, Fonseca G, Liu H, Gentili C, Singh P, Siegel D. Pomalidomide/Daratumumab/Dexamethasone in Relapsed or Refractory Multiple Myeloma: Final Overall Survival From MM-014. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00285-4. [PMID: 39237427 DOI: 10.1016/j.clml.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/17/2024] [Accepted: 07/26/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Patients with relapsed or refractory multiple myeloma (RRMM) who have exhausted lenalidomide benefits require improved therapies. The 3-cohort phase 2 MM-014 trial (NCT01946477) explored pomalidomide in early lines of treatment for lenalidomide-exposed RRMM. In cohort B, pomalidomide plus daratumumab and dexamethasone (DPd) showed promising efficacy (median follow-up 28.4 months), as previously reported. Here, we report final overall survival (OS) in cohort B. METHODS Patients aged ≥ 18 years were treated in 28-day cycles: pomalidomide 4 mg orally daily from days 1 to 21; daratumumab 16 mg/kg intravenously on days 1, 8, 15, and 22 (cycles 1-2), days 1 and 15 (cycles 3-6), and day 1 (cycle ≥ 7); and dexamethasone 40 mg (age ≤ 75 years) or 20 mg (age > 75 years) orally on days 1, 8, 15, and 22. The primary endpoint was ORR. OS and safety were secondary endpoints. RESULTS Among 112 patients enrolled, 85 (75.9%) had lenalidomide-refractory disease and 27 (24.1%) had lenalidomide-relapsed disease. At a median follow-up of 41.9 months (range, 0.4-73.1), median OS was 56.7 months (95% confidence interval, 46.5-not reached). Treatment-emergent adverse events related to, and leading to discontinuation of, pomalidomide, dexamethasone, or daratumumab occurred in 7 (6.3%), 9 (8.0%), and 6 (5.4%) patients, respectively. CONCLUSION With long-term follow-up, our results show favorable OS with DPd. The safety profile was consistent with previous reports, with no new safety signals identified. IMiD agent-based therapy can still be considered in patients with RRMM who experience progressive disease on or after lenalidomide.
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Affiliation(s)
| | | | - Donna Reece
- Princess Margaret Hospital, Toronto, ON, Canada
| | - Michael Sebag
- McGill University Health Centre, Montreal, QC, Canada
| | - Jeffrey Matous
- Colorado Blood Cancer Institute, Sarah Cannon Research Institute, Denver, CO
| | | | | | | | | | - Kevin Song
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | | | - Donald Quick
- Joe Arrington Cancer Research and Treatment Center, Lubbock, TX
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9
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Tagami N, Uchiyama M, Suzuki K, Shirai H, Seto T, Nishina S, Iida S. Isatuximab with pomalidomide-dexamethasone in relapsed/refractory multiple myeloma: post-marketing surveillance in Japan. Int J Hematol 2024; 120:217-228. [PMID: 38811413 DOI: 10.1007/s12185-024-03800-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
This post-marketing surveillance assessed the safety and effectiveness of isatuximab plus pomalidomide and dexamethasone (Isa-Pd) for relapsed or refractory multiple myeloma (RRMM) during real-world use in Japan. Data from 211 individuals with RRMM treated with Isa-Pd in Japan between October 2020 and October 2021 were collected, with follow-up for up to 12 months after initiation of Isa-Pd or until treatment discontinuation. The incidence of adverse drug reactions (ADRs), ADRs of special interest (infusion reactions, bone marrow suppression, infections, cardiac disorders, other ADRs of Grade ≥ 3), and serious ADRs was assessed. Best overall response and overall response rate (ORR) were determined. In the safety analysis set (n = 120), ADR incidence was 57.5%. Most ADRs were hematologic, and serious ADRs occurred in 28.3%. Bone marrow suppression occurred in 46.7% of participants (19.2% serious), infusion reactions in 18.3% (6.7% serious), infections in 11.7% (8.3% serious), and a serious cardiac disorder in one participant; other Grade ≥ 3 ADRs were reported in 3.3% (1.7% serious). In the effectiveness analysis set (n = 108), the most common best overall response was very good partial response (24.1%), and ORR was 51.9%. These findings support the safety and effectiveness of Isa-Pd for RRMM in real-life settings in Japan.
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Affiliation(s)
- Nami Tagami
- Oncology Medical in Specialty Care, Sanofi K.K., Tokyo, Japan
| | - Michihiro Uchiyama
- Department of Hematology, Japanese Red Cross Society Suwa Hospital, Suwa, Japan
| | - Kenshi Suzuki
- Myeloma/Amyloidosis Center, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Heigoroh Shirai
- Oncology Medical in Specialty Care, Sanofi K.K., Tokyo, Japan
| | - Takeshi Seto
- Medical Affairs, Post-Authorization Regulatory Studies, Sanofi K.K., Tokyo, Japan
| | - Satoshi Nishina
- Medical Affairs, Post-Authorization Regulatory Studies, Sanofi K.K., Tokyo, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Institute of Medical and Pharmaceutical Sciences, Nagoya City University, Kawasaki 1, Mizuno-cho, Mizuno-ku, Nagoya City, Aichi, 467-8601, Japan.
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10
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Liu Y, Mo CC, Hartley-Brown MA, Sperling AS, Midha S, Yee AJ, Bianchi G, Piper C, Tattersall A, Nadeem O, Laubach JP, Richardson PG. Targeting Ikaros and Aiolos: reviewing novel protein degraders for the treatment of multiple myeloma, with a focus on iberdomide and mezigdomide. Expert Rev Hematol 2024; 17:445-465. [PMID: 39054911 DOI: 10.1080/17474086.2024.2382897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/30/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION The treatment of multiple myeloma (MM) is evolving rapidly. Quadruplet regimens incorporating proteasome inhibitors, immunomodulatory drugs (IMiDs), and CD38 monoclonal antibodies have emerged as standard-of-care options for newly diagnosed MM, and numerous novel therapies have been approved for relapsed/refractory MM. However, there remains a need for novel options in multiple settings, including refractoriness to frontline standards of care. AREAS COVERED Targeting degradation of IKZF1 and IKZF3 - Ikaros and Aiolos - through modulation of cereblon, an E3 ligase substrate recruiter/receptor, is a key mechanism of action of the IMiDs and the CELMoD agents. Two CELMoD agents, iberdomide and mezigdomide, have demonstrated substantial preclinical and clinical activity in MM and have entered phase 3 investigation. Using a literature search methodology comprising searches of PubMed (unlimited time-frame) and international hematology/oncology conference abstracts (2019-2023), this paper reviews the importance of Ikaros and Aiolos in MM, the mechanism of action of the IMiDs and CELMoD agents and their relative potency for targeting Ikaros and Aiolos, and preclinical and clinical data on iberdomide and mezigdomide. EXPERT OPINION Emerging data suggest that iberdomide and mezigdomide have promising activity, including in IMiD-resistant settings and, pending phase 3 findings, may provide additional treatment options for patients with MM.
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Affiliation(s)
- Yuxin Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
| | - Clifton C Mo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
| | - Monique A Hartley-Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA
| | - Adam S Sperling
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA
| | - Shonali Midha
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew J Yee
- Massachusetts General Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Giada Bianchi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA
| | - Catherine Piper
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
| | - Alice Tattersall
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
| | - Omar Nadeem
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
| | - Jacob P Laubach
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
| | - Paul G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
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11
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Mun SJ, Cho E, Kim HK, Gil WJ, Yang CS. Enhancing acute inflammatory and sepsis treatment: superiority of membrane receptor blockade. Front Immunol 2024; 15:1424768. [PMID: 39081318 PMCID: PMC11286478 DOI: 10.3389/fimmu.2024.1424768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
Conditions such as acute pancreatitis, ulcerative colitis, delayed graft function and infections caused by a variety of microorganisms, including gram-positive and gram-negative organisms, increase the risk of sepsis and therefore mortality. Immune dysfunction is a characterization of sepsis, so timely and effective treatment strategies are needed. The conventional approaches, such as antibiotic-based treatments, face challenges such as antibiotic resistance, and cytokine-based treatments have shown limited efficacy. To address these limitations, a novel approach focusing on membrane receptors, the initiators of the inflammatory cascade, is proposed. Membrane receptors such as Toll-like receptors, interleukin-1 receptor, endothelial protein C receptor, μ-opioid receptor, triggering receptor expressed on myeloid cells 1, and G-protein coupled receptors play pivotal roles in the inflammatory response, offering opportunities for rapid regulation. Various membrane receptor blockade strategies have demonstrated efficacy in both preclinical and clinical studies. These membrane receptor blockades act as early stage inflammation modulators, providing faster responses compared to conventional therapies. Importantly, these blockers exhibit immunomodulatory capabilities without inducing complete immunosuppression. Finally, this review underscores the critical need for early intervention in acute inflammatory and infectious diseases, particularly those posing a risk of progressing to sepsis. And, exploring membrane receptor blockade as an adjunctive treatment for acute inflammatory and infectious diseases presents a promising avenue. These novel approaches, when combined with antibiotics, have the potential to enhance patient outcomes, particularly in conditions prone to sepsis, while minimizing risks associated with antibiotic resistance and immune suppression.
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Affiliation(s)
- Seok-Jun Mun
- Department of Bionano Engineering, Hanyang University, Seoul, Republic of Korea
- Center for Bionano Intelligence Education and Research, Hanyang University, Ansan, Republic of Korea
| | - Euni Cho
- Department of Bionano Engineering, Hanyang University, Seoul, Republic of Korea
- Center for Bionano Intelligence Education and Research, Hanyang University, Ansan, Republic of Korea
| | - Hyo Keun Kim
- Center for Bionano Intelligence Education and Research, Hanyang University, Ansan, Republic of Korea
- Department of Molecular and Life Science, Hanyang University, Ansan, Republic of Korea
| | - Woo Jin Gil
- Center for Bionano Intelligence Education and Research, Hanyang University, Ansan, Republic of Korea
- Department of Molecular and Life Science, Hanyang University, Ansan, Republic of Korea
| | - Chul-Su Yang
- Center for Bionano Intelligence Education and Research, Hanyang University, Ansan, Republic of Korea
- Department of Molecular and Life Science, Hanyang University, Ansan, Republic of Korea
- Department of Medicinal and Life Science, Hanyang University, Ansan, Republic of Korea
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12
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Quach H, Parmar G, Mateos MV, Ailawadhi S, Leleu X. Recent Developments in Convenience of Administration of the Anti-CD38 Antibody Isatuximab: Subcutaneous Delivery and Fast Intravenous Infusion in Patients With Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:358-363. [PMID: 38519329 DOI: 10.1016/j.clml.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/08/2024] [Indexed: 03/24/2024]
Abstract
Isatuximab-based combinations are among the accepted standard-of-care regimens for early-line treatment of patients with relapsed/refractory multiple myeloma (RRMM), based on the results of the Phase 3 ICARIA-MM and IKEMA trials. Further study findings have shown benefit with Isa-based combinations in patients with newly diagnosed MM, as reported from the randomized GMMG-HD7 and CONCEPT trials. Isa is currently approved in various countries for intravenous (IV) administration in patients with RRMM. A more convenient route of administration, such as subcutaneous (SC) injection, and faster IV infusion may substantially increase convenience of treatment. In this review, we outline evidence emerging from clinical trials that shows increasing clinical applicability of Isa across the MM therapeutic spectrum. We then review recent study results demonstrating that new treatment modalities, either SC Isa administration via an on-body delivery system (OBDS) or fast, 30-minute, fixed-volume IV infusion, are safe and effective, and enhance convenience of treatment with Isa for MM patients and healthcare providers. In the recently reported Phase 1b study, the safety profile and efficacy of Isa administered SC plus pomalidomide-dexamethasone were comparable to those observed with Isa administered IV plus pomalidomide-dexamethasone in the control arm and in the ICARIA-MM trial. Analysis of patient-reported outcomes indicated patient confidence in SC Isa administration and satisfaction with treatment delivery by OBDS. These findings point to SC administration as the preferred route for future treatment with Isa-based combinations, as well as to the use of fast, 30-minute IV infusions in settings where SC administration of Isa might not be available.
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Affiliation(s)
- Hang Quach
- Clinical Haematology Service, St Vincent's Hospital Melbourne, University of Melbourne, Vic, Australia.
| | - Gurdeep Parmar
- Illawarra Cancer Care Centre, Wollongong, NSW, Australia
| | - Maria-Victoria Mateos
- University Hospital of Salamanca and Cancer Research Center (IBMCC-CSICUSAL), Salamanca, Spain
| | | | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, CHU and CIC Inserm 1402, Poitiers Cedex, France
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13
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Chen Q, Zhang M, Zheng S, Tong Y, Tan Y. Therapeutic progress in relapsed/refractory multiple myeloma. Ann Hematol 2024; 103:1833-1841. [PMID: 38609727 DOI: 10.1007/s00277-024-05730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024]
Abstract
Improvement in the therapeutics for multiple myeloma (MM) has been continuously developed owing to the application of novel drugs and technologies in the last 20 years. The standard first-line therapy for MM consists of a three-drug induction regimen based on immunomodulatory drugs and proteasome inhibitors combined with autologous stem cell transplantation. However, MM remains incurable; therefore, therapies for relapsed/refractory MM (RRMM) are emerging and evolving rapidly. This study aimed to summarize and review the results of RRMM trials over the past 5 years to provide a holistic overview and insights for practitioners in related fields and to provide additional ideas for clinical trialists. This study shows that daratumumab and isatuximab continue to significantly advance as treatment options. Additionally, novel antibody drugs, such as elotuzumab and selinexor, as well as bispecific antibodies, teclistamab and talquetamab, are currently undergoing clinical research with promising outcomes. However, chimeric antigen receptor-T cell therapy targeting B-cell maturation antigen remains the optimal approach for MM treatment.
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Affiliation(s)
- Qi Chen
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Min Zhang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Shan Zheng
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Yuxin Tong
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Yamin Tan
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China.
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China.
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14
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Wang D, Lin Z, Su M, Zhou Y, Ma M, Li M. Revealing the role of Peg13: A promising therapeutic target for mitigating inflammation in sepsis. Genet Mol Biol 2024; 47:e20230205. [PMID: 38856110 PMCID: PMC11151158 DOI: 10.1590/1678-4685-gmb-2023-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/22/2024] [Indexed: 06/11/2024] Open
Abstract
To investigate the role of Peg13 in modulating the inflammatory response in sepsis, we established Lipopolysaccharide (LPS)-induced 293T cells and mouse models. Peg13 expression was assessed at various time points after infection using RT-qPCR. The levels of high mobility group box 1 (HMGB1) and interleukin-6 (IL-6) were quantified through ELISA. A total of 44 septic patients and 36 healthy participants were recruited to measure Peg13 and HMGB1 levels in the blood. Peg13 demonstrated significant down-regulation in the supernatant of LPS-induced 293T cells and in the blood of LPS-induced mice. Moreover, the levels of proinflammatory cytokines HMGB1 and IL-6 were elevated in both the supernatant of LPS-induced cell models and blood specimens from LPS-induced murine models, and this elevation could be notably reduced by Peg13 suppression. In a clinical context, Peg13 and HMGB1 levels were higher in septic patients compared to healthy subjects. Peg13 exhibited a negative correlation with HMGB1, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) among septic patients. Peg13 mitigates the inflammatory response by reducing the release of proinflammatory cytokines HMGB1 and IL-6 in sepsis, presenting a potential therapeutic target for alleviating inflammation in sepsis treatment.
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Affiliation(s)
- dan Wang
- Shaoxing People’s Hospital, Department of Infectious Diseases, Shaoxing, Zhejiang, People’s Republic of China
| | - Zhiqiang Lin
- Shaoxing People’s Hospital, Department of general surgery, Shaoxing, Zhejiang, People’s Republic of China
| | - Meixia Su
- Shaoxing People’s Hospital, Department of Infectious Diseases, Shaoxing, Zhejiang, People’s Republic of China
| | - Yiqing Zhou
- Shaoxing People’s Hospital, Department of Infectious Diseases, Shaoxing, Zhejiang, People’s Republic of China
| | - Mengjie Ma
- Shaoxing People’s Hospital, Department of Infectious Diseases, Shaoxing, Zhejiang, People’s Republic of China
| | - Minghui Li
- Shaoxing People’s Hospital, Department of Infectious Diseases, Shaoxing, Zhejiang, People’s Republic of China
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15
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Rocchi S, Zannetti BA, Marconi G, Lanza F. Multiple Myeloma: The Role of Autologous Stem Cell Transplantation in the Era of Immunotherapy. Cells 2024; 13:853. [PMID: 38786075 PMCID: PMC11120591 DOI: 10.3390/cells13100853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Upfront high-dose therapy with melphalan (HDM) followed by autologous stem cell transplantation (ASCT) has established itself as a core treatment for newly diagnosed multiple myeloma (NDMM) patients in the past 30 years. Induction therapy, HDM-ASCT, and subsequent consolidation and maintenance therapy comprise the current fundamental framework for MM treatment. The introduction of anti-CD38 monoclonal antibodies such as daratumumab and isatuximab has changed the treatment paradigm for transplant-eligible NDMM patients in that quadruplets have become the new standard induction therapy. The treatment landscape of MM is undergoing a transformative shift with the introduction of potent new immunotherapies, such as chimeric antigen receptor (CAR)-T cells and bispecific antibodies (BsAbs), which are currently used in the relapsed/refractory setting (RRMM) and are already being tested in the NDMM. This review will focus on the incorporation of immunotherapy in the treatment scenario of NDMM patients eligible for ASCT.
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Affiliation(s)
| | | | | | - Francesco Lanza
- Hematology Unit and Romagna Metropolitan Transplant Network—Ravenna, University of Bologna, 40126 Bologna, Italy; (S.R.); (B.A.Z.); (G.M.)
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16
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Barbieri E, Martino EA, Rivolti E, Quaresima M, Vigna E, Neri A, Morabito F, Gentile M. Anti-CD38 monoclonal antibodies in multiple myeloma with gain/amplification of chromosome arm 1q: a review of the literature. Expert Opin Biol Ther 2024; 24:365-381. [PMID: 38757726 DOI: 10.1080/14712598.2024.2357382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/15/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Gain/amplification of 1q (+1q) represents one of the most prevalent cytogenetic abnormalities (CAs) observed in multiple myeloma (MM). Historical studies predating the advent of anti-CD38 monoclonal antibodies (moAbs) implicated + 1q in poor prognoses, prompting its integration into novel staging systems. However, with the emergence of daratumumab and isatuximab, two pivotal anti-CD38 moAbs, the landscape of MM therapy has undergone a profound transformation. AREAS COVERED This review encompasses a comprehensive analysis of diverse study methodologies, including observational investigations, clinical trials, meta-analyses, and real-world database analyses. By synthesizing these data sources, we aim to provide an overview of the current understanding of + 1q in the context of anti-CD38 moAbs therapies. EXPERT OPINION Despite the paucity of available data, evidence suggests a potential mitigating effect of daratumumab on the adverse prognostic implications of + 1q. However, this benefit seems to diminish in patients harboring ≥ 4 copies or with concurrent high-risk CAs. On the other hand, isatuximab demonstrated promising outcomes in the relapsed-refractory setting for + 1q MM patients. Nevertheless, direct comparison between the two compounds is currently challenging. The current evidence firmly supports the integration of anti-CD38 moAb-based therapies as the standard of care for + 1q patients, pending further elucidation.
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Affiliation(s)
- Emiliano Barbieri
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Elena Rivolti
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Micol Quaresima
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Ernesto Vigna
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Antonino Neri
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Massimo Gentile
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Rende, Italy
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17
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van de Donk NWCJ, Zweegman S. Monoclonal Antibodies in the Treatment of Multiple Myeloma. Hematol Oncol Clin North Am 2024; 38:337-360. [PMID: 38151402 DOI: 10.1016/j.hoc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The incorporation of monoclonal antibodies into backbone regimens has substantially improved the clinical outcomes of patients with newly diagnosed and relapsed/refractory multiple myeloma (MM). Although the SLAMF7-targeting antibody elotuzumab has no single- agent activity, there is clinical synergy between elotuzumab and immunomodulatory drugs in patients with relapsed/refractory disease. Daratumumab and isatuximab are CD38-targeting antibodies which have single-agent activity and a favorable safety profile, which make these agents an attractive component of combination regimens. Monoclonal antibodies may cause infusion-related reactions, but with subcutaneous administration these are less frequently observed. All therapeutic antibodies may interfere with assessment of complete response. Next-generation Fc-engineered monoclonal antibodies are in development with the potential to further improve the outcome of patients with MM.
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Affiliation(s)
- Niels W C J van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, the Netherlands.
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, the Netherlands
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18
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Ravi G, Bal S, Joiner L, Giri S, Sentell M, Hill T, Godby KN, Costa LJ. Subsequent therapy and outcomes in patients with newly diagnosed multiple myeloma experiencing disease progression after quadruplet combinations. Br J Haematol 2024; 204:1300-1306. [PMID: 38291707 DOI: 10.1111/bjh.19303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/24/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
The combination of anti-CD38 monoclonal antibodies to a proteasome inhibitor, an immunomodulatory agent and dexamethasone (quadruplet-QUAD) in sequence with autologous stem cell transplantation (ASCT) leads to deep and durable responses in newly diagnosed multiple myeloma (NDMM). Disease progression in the first year post-QUADs is uncommon. We analysed 274 consecutive NDMM patients treated with QUADs + ASCT. After a median follow-up of 21.3 months, 20 patients had disease progression <18 months and 21 had progression ≥18 months after the onset of a QUAD regimen. All patients received subsequent anti-MM therapy, and 38 were evaluated for response. Nine (22.0%) received T-cell redirecting therapy as the next treatment, and 21 (51.2%) at some point in the treatment course. Response to next therapy was 26.3% for patients with progression <18 months and 52.6% for those with progression ≥18 months after the onset of a QUAD regimen. Median PFS on the next therapy was 2.5 months (95% CI 1.5-3.4) for those with progression <18 months and 7.0 months (95% CI 3.6-10.5) for those with progression ≥18 months. Efforts should focus on the early deployment of therapies with new mechanism of action for patients experiencing treatment failure after QUADs.
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Affiliation(s)
- Gayathri Ravi
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Susan Bal
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Laura Joiner
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Smit Giri
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa Sentell
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tiffany Hill
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelly N Godby
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Luciano J Costa
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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19
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de Moraes FCA, Sano VKT, Lôbo ADOM, Kelly FA, Morbach V, Pasqualotto E, Burbano RMR. Efficacy and Safety of Anti-CD38 Monoclonal Antibodies in Patients with Relapsed or Refractory Multiple Myeloma: A Meta-Analysis of Randomized Clinical Trials. J Pers Med 2024; 14:360. [PMID: 38672988 PMCID: PMC11051236 DOI: 10.3390/jpm14040360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
The benefit of associating anti-CD38 monoclonal antibodies to proteasome inhibitor (PI)/immunomodulatory agent (IA) and dexamethasone in the treatment of patients with relapsed or refractory multiple myeloma (MM) remains unclear. PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials that investigated the addition of anti-CD38 monoclonal antibodies to a therapy composed of PI/IA and dexamethasone versus PI/IA and dexamethasone alone for treating relapsed or refractory MM. Hazard ratios (HRs) or risk ratios (RRs) were computed for binary endpoints, with 95% confidence intervals (CIs). Six studies comprising 2191 patients were included. Anti-CD38 monoclonal antibody significantly improved progression-free survival (HR 0.52; 95% CI 0.43-0.61; p < 0.001) and overall survival (HR 0.72; 95% CI 0.63-0.83; p < 0.001). There was a significant increase in hematological adverse events, such as neutropenia (RR 1.41; 95% CI 1.26-1.58; p < 0.01) and thrombocytopenia (RR 1.14; 95% CI 1.02-1.27; p = 0.02), in the group treated with anti-CD38 monoclonal antibody. Also, there was a significant increase in non-hematological adverse events, such as dyspnea (RR 1.72; 95% CI 1.38-2.13; p < 0.01) and pneumonia (RR 1.34; 95% CI 1.13-1.59; p < 0.01), in the group treated with anti-CD38 monoclonal antibody. In conclusion, the incorporation of an anti-CD38 monoclonal antibody demonstrated a promising prospect for reshaping the established MM treatment paradigms.
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Affiliation(s)
| | | | | | | | - Victória Morbach
- Department of Medicine, Feevale University, Novo Hamburgo 93510-235, Brazil;
| | - Eric Pasqualotto
- Department of Medicine, Federal University of Santa Catarina, Florianopolis 88040-900, Brazil;
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20
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Zhou H, Wang Y, Chen J, He A, Jin J, Lu Q, Zhao Y, Li J, Hou M, Su L, Lai X, Wang W, Liu L, Ma Y, Gao D, Lai W, Zhou X, Jing H, Zhang J, Yang W, Ran X, Lin C, Hao J, Xiao T, Huang Z, Zhu Z, Wang Q, Fang B, Wang B, Song Y, Cai Z, Liu B, Zhu Y, Yang X, Kang X, Li J, Chen W. Efficacy and safety of generic pomalidomide plus low-dose dexamethasone in relapsed or refractory multiple myeloma: a multicenter, open-label, single-arm trial. Ann Hematol 2024; 103:855-868. [PMID: 38112795 PMCID: PMC10866745 DOI: 10.1007/s00277-023-05558-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023]
Abstract
This multicenter, open-label, single-arm trial (ClinicalTrials.gov, NCT05236621) was conducted to confirm the efficacy and safety of generic pomalidomide plus dexamethasone in Chinese patients with relapsed or refractory multiple myeloma (RRMM). Total 79 eligible RRMM patients were planned to be included. Patients were treated with generic pomalidomide (4 mg daily on days 1-21, orally) and low-dose dexamethasone (40 mg/day on days 1, 8, 15, and 22, orally; 20 mg for patients aged > 75 years) in 28-day cycles until disease progression with a maximum treatment duration of 2 years. The primary endpoint is the overall response rate (ORR) assessed by the independent review committee per the 2016 International Myeloma Working Group guidelines. A total of 85 eligible patients were included in this study from 32 centers in China, with a median age of 62.0 (range, 39-76) years, a median prior line of therapy of 4 (range, 1-16), and 41.2% patients with high-risk cytogenetics. The ORR was 38.8% (95% confidence interval (CI), 28.44-50.01). The disease control rate was 67.1% (95% CI, 56.02-76.87), meanwhile, the median progression-free survival was 5.55 months (95% CI, 3.68-7.52). Among the treatment-related adverse events (TRAEs), infective pneumonia (17.6%) was the most frequent non-hematologic adverse event, while a decrease in neutrophil count (52.9%) was the most common grade ≥ 3 TRAE. The study results indicated that the generic pomalidomide demonstrated consistent efficacy and a safety profile similar to the branded pomalidomide when combined with low-dose dexamethasone in Chinese RRMM patients.Registration number ClinicalTrials.gov NCT05236621, retrospectively registered on February 11, 2022.
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Affiliation(s)
- Huixing Zhou
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, #8, the South Road of Workers Stadium of Chaoyang District, Beijing, 100020, China
| | - Yafei Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jiao Chen
- Department of Hematology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Aili He
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Quanyi Lu
- Department of Hematology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Ying Zhao
- Department of Hematology, The First People's Hospital of Foshan, Guangzhou, China
| | - Junjun Li
- Department of Hematology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Ming Hou
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Liping Su
- Department of Hematology, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Xun Lai
- Department of Hematology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Center, Kunming, China
| | - Wei Wang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lihong Liu
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanping Ma
- Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Da Gao
- Department of Hematology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wenhong Lai
- Department of Hematology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xin Zhou
- Department of Hematology, Wuxi People's Hospital, Wuxi, China
| | - Hongmei Jing
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Jinqiao Zhang
- Department of Hematology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Yang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuehong Ran
- Department of Hematology, Weifang People's Hospital, Weifang, China
| | - Congmeng Lin
- Department of Hematology, Zhangzhou Municicap Hospital of Fujian Province, Zhangzhou, China
| | - Jianping Hao
- Department of Hematology, The First Affiliated Hospital of Xinjiang Medical University, Urumchi, China
| | - Taiwu Xiao
- Department of Hematology, Liaocheng People's Hospital, Liaocheng, China
| | - Zhenqian Huang
- Department of Hematology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhigang Zhu
- Department of Geriatric Hematologic Oncology, Guangzhou First People's Hospital, Guangzhou, China
| | - Qing Wang
- Department of Hematopathology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Baijun Fang
- Department of Hematology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhenghzou University, Zhengzhou, China
| | - Binghua Wang
- Department of Hemolymph, Weihai Central Hospital, Weihai, China
| | - Yanping Song
- Department of Hematology, Xi'an Central Hospital, Xi'an, China
| | - Zhen Cai
- Bone Marrow Transplantation Center, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Liu
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Yanan Zhu
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Xinai Yang
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Xiaoyan Kang
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Juan Li
- Department of Hematology, First Affiliated Hospital of Sun Yat-Sen University, #58, The 2nd Zhongshan Road, Yuexiu District, Guangzhou, 510062, China.
| | - Wenming Chen
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, #8, the South Road of Workers Stadium of Chaoyang District, Beijing, 100020, China.
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21
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Terpos E, Ntanasis-Stathopoulos I, Gavriatopoulou M, Katodritou E, Hatjiharissi E, Malandrakis P, Verrou E, Golfinopoulos S, Migkou M, Manousou K, Delimpasi S, Symeonidis A, Kastritis E, Dimopoulos MA. Efficacy and safety of daratumumab with ixazomib and dexamethasone in lenalidomide-exposed patients after one prior line of therapy: Final results of the phase 2 study DARIA. Am J Hematol 2024; 99:396-407. [PMID: 38298023 DOI: 10.1002/ajh.27206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 02/02/2024]
Abstract
The use of lenalidomide in frontline therapy for patients with newly diagnosed multiple myeloma (MM) has increased the number of those who become refractory to lenalidomide at second line. In this context, we assessed the efficacy of daratumumab in combination with ixazomib and dexamethasone (Dara-Ixa-dex) in the prospective phase 2 study DARIA. Eligible patients had relapsed/refractory MM (RRMM) after one prior line with a lenalidomide-based regimen. The primary endpoint was overall response rate (ORR). Secondary endpoints included survival outcomes, safety and changes in biomarkers of bone metabolism. Overall, 50 patients were enrolled (median age 69 years, 56% males). 32 (64%) patients were refractory to lenalidomide, and 17 (34%) had undergone autologous transplant. The ORR was 64% (n = 32); whereas 17 (34%) had a very good partial response or better. The median time to first response was 1.0 month. After a median follow-up of 23.4 months, the median PFS and OS were 8.1 and 39.2 months, respectively. Furthermore, significant changes in markers of bone metabolism became evident as early as at 6 months on treatment. Regarding safety, 21 (42%) patients had ≥1 grade 3/4 adverse event (AE); the most common was thrombocytopenia (n = 9, 18%). 14 (28%) patients had ≥1 serious AE (SAE), the most common being acute kidney injury and pneumonia (n = 2, each). Four patients died due to infections. In conclusion, second-line treatment with Dara-Ixa-dex in patients with RRMM pre-treated with a lenalidomide-based regimen resulted in rapid responses along with a favorable effect on bone metabolism.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Eirini Katodritou
- Department of Hematology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Evdoxia Hatjiharissi
- First Department of Internal Medicine, Division of Haematology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Malandrakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evgenia Verrou
- Department of Hematology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | | | - Magdalini Migkou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Sosana Delimpasi
- Department of Hematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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22
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Nadeem O, Ailawadhi S, Khouri J, Williams L, Catamero D, Maples K, Berdeja J. Management of Adverse Events Associated with Pomalidomide-Based Combinations in Patients with Relapsed/Refractory Multiple Myeloma. Cancers (Basel) 2024; 16:1023. [PMID: 38473381 DOI: 10.3390/cancers16051023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Multi-agent regimens incorporating immunomodulatory (IMiD®) agents such as thalidomide, lenalidomide, and pomalidomide have become the preferred standard of care for the treatment of patients with multiple myeloma (MM), resulting in improved survival outcomes. Currently, there are three IMiD agents approved for the treatment of MM: thalidomide, lenalidomide, and pomalidomide. Lenalidomide is commonly used to treat patients with newly diagnosed MM and as maintenance therapy following stem cell transplant or after disease relapse. Pomalidomide, the focus of this review, is approved in patients with relapsed/refractory MM (RRMM). Despite survival benefits, IMiD agents each have different safety profiles requiring consideration both prior to starting therapy and during treatment. Adverse event (AE) management is essential, not only to ensure treatment adherence and thus ensure optimal efficacy but also to maintain patient quality of life. Here, we discuss AEs associated with pomalidomide and present five clinically relevant hypothetical case studies in patients with RRMM to provide scenario-driven guidance regarding treatment selection and AE prevention and management in the clinical setting. Lastly, as new treatment approaches continue to be explored in MM, we also discuss novel cereblon E3 ligase modulator (CELMoD™) agents including iberdomide (CC-220) and mezigdomide (CC-92480).
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Affiliation(s)
- Omar Nadeem
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Sikander Ailawadhi
- Department of Hematology & Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Louis Williams
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - Kathryn Maples
- Department of Pharmacy, Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Jesús Berdeja
- Greco-Hainsworth Centers for Cancer Research, Tennessee Oncology, Nashville, TN 37203, USA
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23
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Trudel S, McCurdy A, Louzada ML, Parkin S, White D, Chu MP, Kotb R, Mian H, Othman I, Su J, Khan A, Gul E, Reece D. Belantamab mafodotin, pomalidomide and dexamethasone in refractory multiple myeloma: a phase 1/2 trial. Nat Med 2024; 30:543-551. [PMID: 38177852 PMCID: PMC10878971 DOI: 10.1038/s41591-023-02703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/10/2023] [Indexed: 01/06/2024]
Abstract
Due to evolving treatment standards for newly diagnosed multiple myeloma, many patients will be triple-class exposed after initial relapses and have poor survival. Novel therapies and combinations are therefore required to improve outcomes. B cell maturation antigen (BCMA)-targeted biologics have emerged as an important new area of therapeutics for relapsed multiple myeloma. The two-part ALGONQUIN trial evaluated various doses and schedules of the anti-BCMA antibody-drug conjugate belantamab mafodotin plus pomalidomide and dexamethasone for patients who are lenalidomide refractory and proteosome inhibitor exposed. The primary endpoints, including evaluating dose-limiting toxicities, establishing the recommended Part 2 dose (RP2D) and overall response rate for patients treated at the RP2D, were met. Secondary efficacy endpoints included progression-free survival and overall survival. Patients treated on study (N = 87) had a median of three previous regimens and 55.2% were triple-class refractory. At the RP2D the most common adverse events were decrease in best-corrected visual acuity (71.1%), keratopathy (65.8%), fatigue (57.9%), infection (47.4%; 7.9% grade ≥3), neutropenia (39.5%) and thrombocytopenia (39.5%). For RP2D patients (n = 38), the overall response rate was 85.3%, ≥very good partial response 75.7% and estimated two-year progression-free survival 52.8% (95% confidence interval, 33.9% to 82.4%), at a median follow-up of 13.9 months. The RP2D schedule was associated with manageable antibody-drug conjugate-associated corneal adverse events and improved tolerability without compromising efficacy. Belantamab mafodotin plus pomalidomide and dexamethasone induced durable responses with promising overall survival in relapsed multiple myeloma, the results of which are yet to be confirmed in the phase 3 DREAMM-8 study. ClinicalTrials.gov Identifier: NCT03715478 .
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Affiliation(s)
- Suzanne Trudel
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
| | | | | | - Stephen Parkin
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Darrell White
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Rami Kotb
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Hira Mian
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | | | - Jiandong Su
- Canadian Myeloma Research Group (CMRG), Vaughan, Ontario, Canada
| | - Aniba Khan
- Canadian Myeloma Research Group (CMRG), Vaughan, Ontario, Canada
| | - Engin Gul
- Canadian Myeloma Research Group (CMRG), Vaughan, Ontario, Canada
| | - Donna Reece
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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24
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Xu L, Wen C, Xia J, Zhang H, Liang Y, Xu X. Targeted immunotherapy: harnessing the immune system to battle multiple myeloma. Cell Death Discov 2024; 10:55. [PMID: 38280847 PMCID: PMC10821908 DOI: 10.1038/s41420-024-01818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/27/2023] [Accepted: 01/15/2024] [Indexed: 01/29/2024] Open
Abstract
Multiple myeloma (MM) remains an incurable hematological malignancy disease characterized by the progressive dysfunction of the patient's immune system. In this context, immunotherapy for MM has emerged as a prominent area of research in recent years. Various targeted immunotherapy strategies, such as monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, chimeric antigen receptor T cells/natural killer (NK) cells, and checkpoint inhibitors have been developed for MM. This review aims to discuss promising experimental and clinical evidence as well as the mechanisms of action underlying these immunotherapies. Specifically, we will explore the design of exosome-based bispecific monoclonal antibodies that offer cell-free immunotherapy options. The treatment landscape for myeloma continues to evolve with the development of numerous emerging immunotherapies. Given their significant advantages in modulating the MM immune environment through immune-targeted therapy, these approaches provide novel perspectives in selecting cutting-edge treatments for MM.
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Affiliation(s)
- Limei Xu
- Department of Hematology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, 272029, Shandong, China
| | - Caining Wen
- Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, 272029, Shandong, China
| | - Jiang Xia
- Department of Chemistry, the Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Hao Zhang
- Department of Hematology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, 272029, Shandong, China.
| | - Yujie Liang
- Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, 272029, Shandong, China.
- College of Rehabilitation Medicine, Jining Medical University, Jining, 272029, Shandong, China.
| | - Xiao Xu
- Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, 272029, Shandong, China.
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China.
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25
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Neupane K, Fortuna GG, Dahal R, Schmidt T, Fonseca R, Chakraborty R, Koehn KA, Mohan M, Mian H, Costa LJ, Sborov D, Mohyuddin GR. Alterations in chromosome 1q in multiple myeloma randomized clinical trials: a systematic review. Blood Cancer J 2024; 14:20. [PMID: 38272897 PMCID: PMC10810902 DOI: 10.1038/s41408-024-00985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
Extra copies of chromosome 1q21 (+1q: gain = 3 copies, amp >= 4 copies) are associated with worse outcomes in multiple myeloma (MM). This systematic review assesses the current reporting trends of +1q, the efficacy of existing regimens on +1q, and its prognostic implications in MM randomized controlled trials (RCTs). Pubmed, Embase and Cochrane Registry of RCTs were searched from January 2012 to December 2022. Only MM RCTs were included. A total of 124 RCTs were included, of which 29 (23%) studies reported on +1q. Among them, 10% defined thresholds for +1q, 14% reported survival data separately for gain and amp, and 79% considered +1q a high-risk cytogenetic abnormality. Amongst RCTs that met the primary endpoint showing improvement in progression free survival (PFS), lenalidomide maintenance (Myeloma XI), selinexor (BOSTON), and isatuximab (IKEMA and ICARIA) were shown to improve PFS for patients with evidence of +1q. Some additional RCT's such as Myeloma XI+ (carfilzomib), ELOQUENT-3 (elotuzumab), and HOVON-65/GMMG-HD4 (bortezomib) met their endpoint showing improvement in PFS and also showed improvement in PFS in the +1q cohort, although the confidence interval crossed 1. All six studies that reported HR for +1q patients vs. without (across both arms) showed worse OS and PFS for +1q. There is considerable heterogeneity in the reporting of +1q. All interventions that have shown to be successful in RCTs and have clearly reported on the +1q subgroup have shown concordant direction of results and benefit of the applied intervention. A more standardized approach to reporting this abnormality is needed.
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Affiliation(s)
- Karun Neupane
- Department of Internal Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, USA
| | - Gliceida Galarza Fortuna
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Riyasha Dahal
- Department of Internal Medicine, Universal College of Medical Sciences, Siddharthanagar, Nepal
| | - Timothy Schmidt
- Department of Hematology-Oncology, University of Wisconsin, Madison, WI, USA
| | - Rafael Fonseca
- Department of Hematology-Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Rajshekhar Chakraborty
- Department of Hematology and Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Kelly Ann Koehn
- Department of Hematology and Oncology, Chub O'Reilly Cancer Center, Springfield, MO, USA
| | - Meera Mohan
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, US
| | - Hira Mian
- Department of Hematology and Oncology, McMaster University, Hamilton, ON, Canada
| | - Luciano J Costa
- Department of Hematology and Oncology, O'Neal Cancer Center, University of Alabama, Birmingham, AL, USA
| | - Douglas Sborov
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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Ye L, Zhou F, Cheng D, Xie M, Yan X, Xue Y, Yang Q, Jia R, Zhong L, Yang L, Zou L, Huang N. Efficacy and safety of anti-CD38 monoclonal antibodies in patients with relapsed/refractory multiple myeloma: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials. Front Oncol 2023; 13:1240318. [PMID: 38144527 PMCID: PMC10746851 DOI: 10.3389/fonc.2023.1240318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Objectives The current study aims to evaluate the safety and efficacy of anti-CD38 monoclonal antibodies (mAbs) among patients with relapsed/refractory multiple myeloma (RRMM) through meta-analysis. Methods As of June 2023, we searched PubMed, Web of Science, Embase and the Cochrane Library. Randomized controlled trials (RCTs) which compared the clinical outcomes of anti-CD38 mAbs plus immunomodulatory drugs (IMiDs) or proteasome inhibitors (PIs) plus dexamethasone and IMiDs (or PIs) and dexamethasone alone for RRMM patients were included. Efficacy outcomes were mainly evaluated with progression-free survival (PFS) and overall survival (OS). The safety was analyzed with hematologic and nonhematologic treatment-emergent adverse events (TEAEs). All results were pooled using hazard ratio (HR), relative risk (RR), and their 95% confidence interval (CI) and prediction interval (PI). Results This meta-analysis included 11 RCTs in total. Compared with IMiDs (or PIs) and dexamethasone alone, anti-CD38 mAbs in combination with IMiDs (or PIs) and dexamethasone significantly prolonged PFS (HR: 0.552, 95% CI = 0.461 to 0.659, 95% PI = 0.318 to 0.957) and OS (HR: 0.737, 95% CI = 0.657 to 0.827, 95% PI = 0.626 to 0.868) in patients with RRMM. Additionally, RRMM patients receiving anti-CD38 mAbs in combination with IMiDs (or PIs) and dexamethasone achieved higher rates of overall response (RR: 1.281, 95% CI = 1.144 to 1.434, 95% PI = 0.883 to 1.859), complete response or better (RR: 2.602, 95% CI = 1.977 to 3.424, 95% PI = 1.203 to 5.628), very good partial response (VGPR) or better (RR: 1.886, 95% CI = 1.532 to 2.322, 95% PI = 0.953 to 3.731), and minimum residual disease (MRD)-negative (RR: 4.147, 95% CI = 2.588 to 6.644, 95% PI = 1.056 to 16.283) than those receiving IMiDs (or PIs) and dexamethasone alone. For TEAEs, the rates of hematologic and nonhematologic TEAEs, including thrombocytopenia, neutropenia, upper respiratory tract infection (URTI), pneumonia, bronchitis, dyspnea, diarrhea, pyrexia, back pain, arthralgia, fatigue, insomnia, and hypertension, were higher in the anti-CD38 mAbs in combination with IMiDs (or PIs) and dexamethasone group than in the IMiDs (or PIs) and dexamethasone group. Conclusion Our study showed that anti-CD38 mAbs in combination with IMiDs (or PIs) and dexamethasone improved PFS and OS, and achieved higher rates of overall response, complete response or better, VGPR or better, and MRD-negative, as well as higher rates of thrombocytopenia, neutropenia, URTI, pneumonia, bronchitis, dyspnea, diarrhea, pyrexia, back pain, arthralgia, fatigue, insomnia, and hypertension in RRMM patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023431071.
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Affiliation(s)
- Lu Ye
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Fei Zhou
- Department of Obstetrics and Gynaecology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Dongdong Cheng
- Department of Publicity, The Third Hospital of Changsha, Changsha, China
| | - Ming Xie
- Department of Science and Education, The Third Hospital of Changsha, Changsha, China
| | - Xiaoli Yan
- Department of Gynecology and Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yuyu Xue
- School of Preclinical Medicine, Chengdu University, Chengdu, China
| | - Qian Yang
- Clinical Medical College, Chengdu Medical College, Chengdu, China
| | - Rong Jia
- Clinical Medical College, Chengdu Medical College, Chengdu, China
| | - Lili Zhong
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Li Yang
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Liqun Zou
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Na Huang
- Department of Radiotherapy, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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Moore DC, Elmes JB, Arnall JR, Strassels SA, Patel JN. Hepatitis B reactivation in patients with multiple myeloma treated with anti-CD38 monoclonal antibody-based therapies: a pharmacovigilance analysis. Int J Clin Pharm 2023; 45:1492-1495. [PMID: 37289318 DOI: 10.1007/s11096-023-01608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Daratumumab and isatuximab are anti-CD38 monoclonal antibodies indicated for the treatment of multiple myeloma. These agents can increase the risk of infectious complications, including viral infections. Cases of hepatitis B virus (HBV) reactivation have been reported in the literature in patients receiving anti-CD38 monoclonal antibody-based therapies. AIM The objective of this analysis was to determine if the association between anti-CD38 monoclonal antibody exposure and the development of hepatitis B reactivation had a detectable reporting signal in the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). METHOD We conducted a post marketing pharmacovigilance analysis by querying the FAERS for reports of HBV reactivation with daratumumab or isatuximab exposure reported between 2015 and 2022. Disproportionality signal analysis was conducted by calculating reporting odds ratios (RORs). RESULTS Sixteen cases of hepatitis B virus reactivation were reported in the FAERS database among patients receiving daratumumab or isatuximab reported between 2015 and 2022. The ROR for HBV reactivation was statistically significant for both daratumumab (ROR 4.76, 95% CI 2.76-8.22) and isatuximab (ROR 9.31, 95% CI 3.00-28.92). CONCLUSION Overall, our analysis demonstrates a significant reporting signal for HBV reactivation with daratumumab and isatuximab.
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Affiliation(s)
- Donald C Moore
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
| | - Joseph B Elmes
- Department of Pharmacy, Levine Cancer Institute, Atrium Health, 100 Medical Park Drive, Concord, NC, 28025, USA
| | - Justin R Arnall
- Specialty Pharmacy Service, Atrium Health, 4400 Golf Acres Drive, Charlotte, NC, 28208, USA
| | - Scott A Strassels
- Department of Pharmacy, Atrium Health, 4400 Golf Acres Drive, Charlotte, NC, 28232, USA
| | - Jai N Patel
- Department of Cancer Pharmacology and Pharmacogenomics, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
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Suzuki K, Yano S. IMiD-Free Interval and IMiDs Sequence: Which Strategy Is Better Suited for Lenalidomide-Refractory Myeloma? Life (Basel) 2023; 13:2229. [PMID: 38004369 PMCID: PMC10672235 DOI: 10.3390/life13112229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
This review discusses immunomodulatory drug (IMiDs) sequencing and IMiD-free interval strategies for lenalidomide-refractory myeloma. IMiDs and proteasome inhibitors (PIs) improve clinical outcomes in patients with myeloma; however, refractoriness to lenalidomide, a category of IMiD, predicts poor outcomes. Next-generation IMiDs, such as pomalidomide, are effective even for lenalidomide-refractory myeloma. Therefore, an IMiD-sequencing strategy from lenalidomide to pomalidomide would be desirable. PIs are an antimyeloma therapeutic agent with another mode of action that might restore cereblon, a target of IMiDs; therefore, an IMiD-free interval via class switching from lenalidomide to PIs may be a promising alternative for lenalidomide-refractory myeloma. Additionally, the anti-CD38 monoclonal antibody is a key drug for salvage therapy in anti-CD38 monoclonal antibody-naïve patients. In clinical practice, safety profiles and social convenience can play important roles in the choice of combination therapy. In the future, the selection of optimal treatments should be based on the status of the immunological environment and genetic alterations. This review aims to discuss IMiDs sequencing and IMiD-free interval strategies for lenalidomide- refractory myeloma.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
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Perez de Acha O, Reiman L, Jayabalan DS, Walker ZJ, Bosma G, Keller AL, Parzych SE, Abbott D, Idler BM, Ribadeneyra D, Niesvizky R, Forsberg PA, Mark TM, Sherbenou DW. CD38 antibody re-treatment in daratumumab-refractory multiple myeloma after time on other therapies. Blood Adv 2023; 7:6430-6440. [PMID: 37648670 PMCID: PMC10598487 DOI: 10.1182/bloodadvances.2023010162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
Monoclonal antibodies targeting CD38 are important for treatment of both newly diagnosed and relapsed multiple myeloma (MM). Daratumumab and isatuximab are anti-CD38 antibodies with the US Food and Drugs Administration approval in multiple different combinations. Despite good initial efficacy, patients inevitably develop drug resistance. Whether patients can be effectively re-treated with these antibodies in subsequent lines of therapy is unclear. Thus far, studies have mostly been limited to clinical retrospectives with short washout periods. To answer whether patients regain sensitivity after longer washouts, we used ex vivo sensitivity testing to isolate the anti-CD38 antibody-specific cytotoxicity in samples obtained from patients who had been exposed to and then off daratumumab for up to 53 months. MM cells from patients who had been off daratumumab for >1 year showed greater sensitivity than those with <1 year, although they still were less sensitive than those who were daratumumab naïve. CD38 expression on MM cells gradually recovered, although, again, not to the level of anti-CD38 antibody-naïve patients. Interestingly, low MM CD38 explained only 45% of cases identified to have daratumumab resistance. With clinical follow-up, we found ex vivo sensitivity predicted subsequent clinical response but CD38 overexpression did not. Patients clinically re-treated with anti-CD38 antibodies had <6 months of clinical benefit, but 1 patient who was daratumumab exposed but not refractory achieved complete response lasting 13 months. We conclude that transient efficacy can be achieved by waiting 1 year before CD38 antibody rechallenge, but this approach may be best used as a bridge to, or after, chimeric antigen receptor T-cell therapy.
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Affiliation(s)
- Olivia Perez de Acha
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lauren Reiman
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - David S. Jayabalan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York-Presbyterian, New York City, NY
| | - Zachary J. Walker
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Grace Bosma
- Department of Biostatistics and Informatics, Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Alana L. Keller
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sarah E. Parzych
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Diana Abbott
- Department of Biostatistics and Informatics, Center for Innovative Design and Analysis, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Beau M. Idler
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Drew Ribadeneyra
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York-Presbyterian, New York City, NY
| | - Ruben Niesvizky
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York-Presbyterian, New York City, NY
| | - Peter A. Forsberg
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Tomer M. Mark
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Daniel W. Sherbenou
- Division of Hematology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO
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Raab MS, Zamagni E, Manier S, Rodriguez‐Otero P, Schjesvold F, Broijl A. Difficult-to-treat patients with relapsed/refractory multiple myeloma: A review of clinical trial results. EJHAEM 2023; 4:1117-1131. [PMID: 38024633 PMCID: PMC10660429 DOI: 10.1002/jha2.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 12/01/2023]
Abstract
Overall outcomes for multiple myeloma have improved due to the availability of new therapies, but patients with relapsed/refractory multiple myeloma harbouring certain factors continue to pose a therapeutic challenge. These challenging features include high-risk cytogenetics, renal impairment, patient characteristics such as age and frailty, and extramedullary disease. Prior refractory status and number of prior lines add further complexity to the treatment of these patients. While newer regimens are available and have suggested efficacy in these patient populations through subgroup analyses, differences in trial definitions and cut-offs make meaningful comparisons difficult. This review aims to examine the available clinical trial data for patients with high-risk cytogenetics, renal impairment, age and frailty and extramedullary disease.
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Affiliation(s)
- Marc S. Raab
- Heidelberg Myeloma Center, Department of Medicine VUniversity HospitalHeidelbergGermany
| | - Elena Zamagni
- Seragnoli Institute of HematologyBologna University School of MedicineBolognaItaly
| | - Salomon Manier
- Department of HematologyUniversity Hospital Center of LilleLilleFrance
| | | | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of HaematologyOslo University Hospital, Oslo, Norway, and KG Jebsen Center for B Cell MalignanciesUniversity of OsloOsloNorway
| | - Annemiek Broijl
- Department of HematologyErasmus MC Cancer InstituteRotterdamThe Netherlands
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LeBlanc R, Mian H, Reece D, Su J, Masih-Khan E, Chu M, Jimenez-Zepeda V, Sebag M, Song K, Louzada M, Kotb R, Visram A, White D, Stakiw J, Reiman A, Aslam M, Bergstrom D, Kaedbey R, Gul E, Venner C. Outcome of carfilzomib/pomalidomide-based regimens after daratumumab-based treatment in relapsed multiple myeloma: A Canadian Myeloma Research Group Database analysis. Eur J Haematol 2023; 111:815-823. [PMID: 37574220 DOI: 10.1111/ejh.14082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Although daratumumab-containing regimens improve multiple myeloma (MM) outcomes, recurrence is inevitable. METHODS AND OBJECTIVE We performed a retrospective study using the Canadian Myeloma Research Group Database to benchmark the efficacy of carfilzomib- or pomalidomide-based therapies immediately following progression on daratumumab treatment. RESULTS We identified 178 such patients; median number of prior lines of therapy was 3, 97% triple-class exposed, and 60% triple-class refractory. In our cohort, 75 received a subsequent carfilzomib-based therapy, 79 received a pomalidomide-based therapy, and 24 received a treatment with both immunomodulatory drug (IMiD) and proteasome inhibitor (PI) using carfilzomib and/or pomalidomide. The median progression-free survival (PFS) and overall survival (OS) for the entire cohort were 4.5 and 14.2 months, respectively. Carfilzomib-based therapy yielded a median PFS and OS of 4.5 and 10.2 months, respectively, compared to 5.2 and 21.7 months for pomalidomide-based therapy. Patients who received both IMiD and PI with carfilzomib and/or pomalidomide had a median PFS and OS of 4.1 and 14.5 months, respectively. CONCLUSION Our observations demonstrate the poor outcome of MM patients when standard regimens based on carfilzomib and/or pomalidomide are utilized directly after daratumumab-based therapy given in the relapsed setting. Novel therapies, including immune therapies, are urgently needed to improve the outcomes of these daratumumab-exposed patients.
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Affiliation(s)
- Richard LeBlanc
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Hira Mian
- Juravinski Cancer Centre (Hamilton-CCO), Hamilton, Ontario, Canada
| | - Donna Reece
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Canadian Myeloma Research Group, Toronto, Ontario, Canada
| | - Jiandong Su
- Canadian Myeloma Research Group, Toronto, Ontario, Canada
| | - Esther Masih-Khan
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Canadian Myeloma Research Group, Toronto, Ontario, Canada
| | - Michael Chu
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Victor Jimenez-Zepeda
- Tom Baker Cancer Center, Department of Hematology, University of Calgary, Calgary, Alberta, Canada
| | - Michael Sebag
- Division of Hematology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kevin Song
- The Leukemia/Bone Marrow Transplant Program of BC, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Martha Louzada
- London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Rami Kotb
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Alissa Visram
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Darrell White
- Division of Hematology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie Stakiw
- Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Antony Reiman
- Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | | | - Debra Bergstrom
- Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Rayan Kaedbey
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Engin Gul
- Canadian Myeloma Research Group, Toronto, Ontario, Canada
| | - Christopher Venner
- BC Cancer Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, British Columbia, Canada
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Zhou Y, Jiang H, Wei H, Xiao X, Liu L, Ji X, Zhou C. Cerebral venous thrombosis in patients with autoimmune disease, hematonosis or coronavirus disease 2019: Many familiar faces and some strangers. CNS Neurosci Ther 2023; 29:2760-2774. [PMID: 37365966 PMCID: PMC10493677 DOI: 10.1111/cns.14321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Cerebral venous thrombosis, a rare stroke, is characterized by neurological dysfunction caused by bleeding and/or infarction resulting from venous sinus thrombosis, the so-called venous stroke. Current guidelines recommend anticoagulants as first-line therapy in the treatment of venous stroke. With complicated causes of cerebral venous thrombosis, treatment is difficult, especially when combined with autoimmune diseases, blood diseases, and even COVID-19. AIMS This review summarizes the pathophysiological mechanisms, epidemiology, diagnosis, treatment, and clinical prognosis of cerebral venous thrombosis combined with autoimmune diseases, blood diseases, or infectious diseases such as COVID-19. CONCLUSION A systematic understanding of particular risk factors that should not be neglected when unconventional cerebral venous thrombosis occurs and for a scientific understanding of pathophysiological mechanisms, clinical diagnosis, and treatment, thus contributing to knowledge on special types of venous stroke.
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Affiliation(s)
- Yifan Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine, School of Engineering MedicineBeihang UniversityBeijingChina
| | - Xuechun Xiao
- Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine, School of Engineering MedicineBeihang UniversityBeijingChina
| | - Lu Liu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Chen Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision MedicineCapital Medical UniversityBeijingChina
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Dimopoulos MA, Terpos E, Boccadoro M, Delimpasi S, Beksac M, Katodritou E, Moreau P, Baldini L, Symeonidis A, Bila J, Oriol A, Mateos MV, Einsele H, Orfanidis I, Kampfenkel T, Liu W, Wang J, Kosh M, Tran N, Carson R, Sonneveld P. Subcutaneous daratumumab plus pomalidomide and dexamethasone versus pomalidomide and dexamethasone in patients with relapsed or refractory multiple myeloma (APOLLO): extended follow up of an open-label, randomised, multicentre, phase 3 trial. Lancet Haematol 2023; 10:e813-e824. [PMID: 37793772 DOI: 10.1016/s2352-3026(23)00218-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The primary analysis of the APOLLO trial, done after a median follow-up of 16·9 months, showed that daratumumab plus pomalidomide and dexamethasone significantly improved progression-free survival versus pomalidomide and dexamethasone. Here, we report the final overall survival and updated safety results from APOLLO. METHODS APOLLO was an open-label, randomised, phase 3 trial conducted at 48 academic centres and hospitals across 12 countries in Europe, that included adults aged 18 years or older with relapsed or refractory multiple myeloma who had an ECOG performance status score of 0-2, had received at least one previous line of therapy, including lenalidomide and a proteasome inhibitor, had a partial response or better to one or more previous lines of antimyeloma therapy, and were refractory to lenalidomide if they had received only one previous line of therapy. An interactive web-response system was used to randomly assign patients (1:1) to receive daratumumab plus pomalidomide and dexamethasone or pomalidomide and dexamethasone; patients were stratified by the number of previous lines of therapy and International Staging System disease stage. Oral pomalidomide (4 mg once daily; days 1-21) and dexamethasone (40 mg once daily; days 1, 8, 15, and 22) were given in 28-day cycles until disease progression or unacceptable toxicity. Daratumumab (1800 mg subcutaneously or 16 mg/kg intravenously) was administered weekly (cycles 1-2), every 2 weeks (cycles 3-6), and every 4 weeks thereafter. The primary endpoint of progression-free survival, which has previously been reported, and the pre-planned secondary endpoint of overall survival were assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT03180736) and is no longer enrolling patients. FINDINGS Between June 22, 2017, and June 13, 2019, 304 patients were randomly assigned: 151 to the daratumumab plus pomalidomide and dexamethasone group and 153 to the pomalidomide and dexamethasone group. The median age was 67 years (IQR 60-72); 143 (47%) patients were female and 161 (53%) were male, and 272 (89%) were White. At a median follow-up of 39·6 months (IQR 37·1-43·7), median overall survival was 34·4 months (95% CI 23·7-40·3) in the daratumumab plus pomalidomide and dexamethasone group versus 23·7 months (19·6-29·4) in the pomalidomide and dexamethasone group (hazard ratio [HR] 0·82 [95% CI 0·61-1·11]; p=0·20). The most common grade 3-4 treatment-emergent adverse events were neutropenia (103 [69%] of 149 with daratumumab plus pomalidomide and dexamethasone vs 76 [51%] of 150 with pomalidomide and dexamethasone), anaemia (27 [18%] vs 32 [21%]), and thrombocytopenia (27 [18%] vs 28 [19%]). Serious treatment-emergent adverse events occurred in 80 (54%) of 149 patients in the daratumumab plus pomalidomide and dexamethasone group and in 60 (40%) of 150 patients in the pomalidomide and dexamethasone group, the most common of which was pneumonia (23 [15%] of 149 vs 13 [9%] of 150). Treatment-emergent adverse events resulting in death occurred in 13 (9%) of 149 patients in the daratumumab plus pomalidomide and dexamethasone group and in 13 (9%) of 150 patients in the pomalidomide and dexamethasone group, with 4 (3%) of 151 adverse events leading to death within 30 days of the last treatment dose thought to be related to study treatment in the daratumumab plus pomalidomide and dexamethasone group (septic shock [n=1]; sepsis [n=1]; bone marrow failure, campylobacter infection, and liver disorder [n=1]; and pneumonia [n=1]) and none in the pomalidomide and dexamethasone group. INTERPRETATION Although the difference in overall survival observed between treatment groups was not significant, the safety profile results with long-term follow-up reported here continue to support the use of daratumumab plus pomalidomide and dexamethasone in patients with relapsed or refractory multiple myeloma. FUNDING European Myeloma Network and Janssen Research & Development.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece.
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Sosana Delimpasi
- Hematology Clinic and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athina, Greece
| | - Meral Beksac
- Department of Hematology, Ankara University, Emniyet, Yenimahalle/Ankara, Turkey
| | - Eirini Katodritou
- Department of Hematology, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Philippe Moreau
- Hematology Department, University Hospital Hôtel-Dieu, Nantes, France
| | - Luca Baldini
- UO Ematologia, Fondazione IRCCS Cà Granda, OM Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras, Patras, Greece
| | - Jelena Bila
- Faculty of Medicine, University of Belgrade, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Albert Oriol
- Institut Català d'Oncologia and Institut Josep Carreras, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Maria-Victoria Mateos
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC, Salamanca, Spain
| | | | | | | | - Weiping Liu
- Janssen Research & Development, Shanghai, China
| | - Jianping Wang
- Janssen Research & Development, Spring House, PA, USA
| | - Michele Kosh
- Janssen Research & Development, Spring House, PA, USA
| | | | - Robin Carson
- Janssen Research & Development, Spring House, PA, USA
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Bisht K, Fukao T, Chiron M, Richardson P, Atanackovic D, Chini E, Chng WJ, Van De Velde H, Malavasi F. Immunomodulatory properties of CD38 antibodies and their effect on anticancer efficacy in multiple myeloma. Cancer Med 2023; 12:20332-20352. [PMID: 37840445 PMCID: PMC10652336 DOI: 10.1002/cam4.6619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND CD38 has been established as an important therapeutic target for multiple myeloma (MM), for which two CD38 antibodies are currently approved-daratumumab and isatuximab. CD38 is an ectoenzyme that degrades NAD and its precursors and is involved in the production of adenosine and other metabolites. AIM Among the various mechanisms by which CD38 antibodies can induce MM cell death is immunomodulation, including multiple pathways for CD38-mediated T-cell activation. Patients who respond to anti-CD38 targeting treatment experience more marked changes in T-cell expansion, activity, and clonality than nonresponders. IMPLICATIONS Resistance mechanisms that undermine the immunomodulatory effects of CD38-targeting therapies can be tumor intrinsic, such as the downregulation of CD38 surface expression and expression of complement inhibitor proteins, and immune microenvironment-related, such as changes to the natural killer (NK) cell numbers and function in the bone marrow niche. There are numerous strategies to overcome this resistance, which include identifying and targeting other therapeutic targets involved in, for example, adenosine production, the activation of NK cells or monocytes through immunomodulatory drugs and their combination with elotuzumab, or with bispecific T-cell engagers.
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Affiliation(s)
| | - Taro Fukao
- Sanofi OncologyCambridgeMassachusettsUSA
| | | | - Paul Richardson
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma CenterDana Farber Cancer Institute, Harvard Medical SchoolBostonMassachusettsUSA
| | - Djordje Atanackovic
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer CenterBaltimoreMarylandUSA
- Department of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Eduardo Chini
- Department of Anesthesiology and Perioperative MedicineMayo ClinicJacksonvilleFloridaUSA
| | - Wee Joo Chng
- Cancer Science Institute of SingaporeNational University of SingaporeSingaporeSingapore
| | | | - Fabio Malavasi
- Department of Medical SciencesUniversity of TurinTorinoItaly
- Fondazione Ricerca MolinetteTorinoItaly
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Wang J, Xu H, Chu XX, Wang W. [The efficacy and safety of bortezomib, pomalidomide and dexamethasone regimen in the treatment of relapsed/refractory multiple myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:602-605. [PMID: 37749045 PMCID: PMC10509612 DOI: 10.3760/cma.j.issn.0253-2727.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Indexed: 09/27/2023]
Affiliation(s)
- J Wang
- Hematology Department, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - H Xu
- Hematology Department, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - X X Chu
- Hematology Department, Yantai Yuhuangding Hospital, Yantai 264000, China
| | - W Wang
- Hematology Department, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
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João C, Bergantim R, Santos J, Afonso C, Bernardo P, Coelho H, Costa C, Esteves G, Freitas JG, Gerivaz R, Jorge A, Macedo A, Montalvão A, Neves M, Pedrosa CL, Pereira S, Roque A, Seabra P, M Silva H, Silveira MP, Tomé A, Trigo F, Sarmento AB, Lúcio P, Geraldes C. [Multiple Myeloma Treatment Guidelines by the Portuguese Group of Multiple Myeloma]. ACTA MEDICA PORT 2023; 36:517-526. [PMID: 37429590 DOI: 10.20344/amp.19037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/11/2023] [Indexed: 07/12/2023]
Abstract
The treatment of multiple myeloma has profoundly changed with the introduction of several innovative therapies. The optimization of therapeutic sequencing through the combined use of the various drugs developed in recent years and the attention given to the characteristics of patients have allowed the reduction of toxicities and increased survival and quality of life of patients with multiple myeloma. These treatment recommendations from the Portuguese Multiple Myeloma Group offer guidance for first-line treatment and progression/relapse situations. These recommendations are given highlighting the data that justify each choice and referring to the respective levels of evidence that support these options. Whenever possible, the respective national regulatory framework is presented. These recommendations constitute an advance towards the best treatment of multiple myeloma in Portugal.
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Affiliation(s)
- Cristina João
- Serviço de Hemato-Oncologia. Fundação Champalimaud. Lisboa; NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Rui Bergantim
- Serviço de Hematologia. Centro Hospitalar São João. Porto; i3S - Instituto de Investigação e Inovação em Saúde. Universidade do Porto. Porto; Cancer Drug Resistance Group. IPATIMUP - Instituto the Patologia Molecular e Imunologia. Universidade do Porto. Porto. Portugal
| | - Joana Santos
- Serviço de Hematologia. Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - Celina Afonso
- Serviço de Hematologia Clínica. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | - Paulo Bernardo
- Serviço de Hematologia Clínica. Hospital da Luz Lisboa. Lisboa. Portugal
| | - Henrique Coelho
- Serviço de Hematologia Clínica. Centro Hospitalar Vila Nova Gaia. Gaia. Portugal
| | - Carlos Costa
- Hematologia Clínica. Instituto CUF Oncologia. Lisboa. Portugal
| | - Graça Esteves
- Serviço de Hematologia e Transplante de Medula. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | | | - Rita Gerivaz
- Serviço de Hematologia. Hospital Garcia de Orta. Almada. Portugal
| | - Ana Jorge
- Serviço de Hematologia Clínica. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal
| | - Ana Macedo
- Serviço de Hematologia. Centro Hospitalar Universitário do Algarve. Algarve; Faculdade de Ciências da Saúde. Universidade da Beira Interior. Covilhã. Portugal
| | - Ana Montalvão
- Unidade de Hematologia-Oncologia. Unidade Local de Saúde do Baixo Alentejo. Beja; Hospital de José Joaquim Fernandes. Beja. Portugal
| | - Manuel Neves
- Serviço de Hemato-Oncologia. Fundação Champalimaud. Lisboa. Portugal
| | - Claúdia L Pedrosa
- Serviço de Hematologia Clínica. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - Susana Pereira
- Serviço de Hematologia. Hospital Santo António dos Capuchos. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
| | - Adriana Roque
- Serviço de Hematologia Clínica. Centro Hospitalar e Universitário de Coimbra. Coimbra; Instituto de Fisiologia. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Patrícia Seabra
- Serviço de Hematologia Clínica. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - Helena M Silva
- Serviço de Hematologia. Centro Hospitalar Tondela-Viseu. Viseu. Portugal
| | - Maria P Silveira
- Hematologia Clínica. Clínica de Oncologia e Radioterapia. Centro Clínico SAMS. Lisboa; Serviço de Imuno-Hemoterapia. Hospital Prof. Doutor Fernando da Fonseca. Amadora. Portugal
| | - Ana Tomé
- Serviço de Hematologia. Hospital Garcia de Orta. Almada. Portugal
| | - Fernanda Trigo
- Serviço de Hematologia. Centro Hospitalar São João. Porto. Portugal
| | - Ana Bela Sarmento
- Serviço de Hematologia Clínica. Centro Hospitalar e Universitário de Coimbra. Coimbra; Laboratório de Oncobiologia e Hematologia. Clínica Universitária de Hematologia e Instituto de Investigação Clínica e Biomédica de Coimbra. Grupo de Investigação em Ambiente, Genética e Oncobiologia. Faculdade de Medicina. Universidade de Coimbra. Coimbra; Centro Académico Clínico de Coimbra. Coimbra. . Portugal
| | - Paulo Lúcio
- Serviço de Hemato-Oncologia. Fundação Champalimaud. Lisboa. Portugal
| | - Catarina Geraldes
- Serviço de Hematologia Clínica. Centro Hospitalar e Universitário de Coimbra. Coimbra; Laboratório de Oncobiologia e Hematologia. Clínica Universitária de Hematologia e Instituto de Investigação Clínica e Biomédica de Coimbra. Grupo de Investigação em Ambiente, Genética e Oncobiologia. Faculdade de Medicina. Universidade de Coimbra. Coimbra; Centro Académico Clínico de Coimbra. Coimbra. Portugal
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Dimopoulos MA, Merlini G, Bridoux F, Leung N, Mikhael J, Harrison SJ, Kastritis E, Garderet L, Gozzetti A, van de Donk NWCJ, Weisel KC, Badros AZ, Beksac M, Hillengass J, Mohty M, Ho PJ, Ntanasis-Stathopoulos I, Mateos MV, Richardson P, Blade J, Moreau P, San-Miguel J, Munshi N, Rajkumar SV, Durie BGM, Ludwig H, Terpos E. Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group. Lancet Oncol 2023; 24:e293-e311. [PMID: 37414019 DOI: 10.1016/s1470-2045(23)00223-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 07/08/2023]
Abstract
Here, the International Myeloma Working Group (IMWG) updates its clinical practice recommendations for the management of multiple myeloma-related renal impairment on the basis of data published until Dec 31, 2022. All patients with multiple myeloma and renal impairment should have serum creatinine, estimated glomerular filtration rate, and free light chains (FLCs) measurements together with 24-h urine total protein, electrophoresis, and immunofixation. If non-selective proteinuria (mainly albuminuria) or involved serum FLCs value less than 500 mg/L is detected, then a renal biopsy is needed. The IMWG criteria for the definition of renal response should be used. Supportive care and high-dose dexamethasone are required for all patients with myeloma-induced renal impairment. Mechanical approaches do not increase overall survival. Bortezomib-based regimens are the cornerstone of the management of patients with multiple myeloma and renal impairment at diagnosis. New quadruplet and triplet combinations, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, improve renal and survival outcomes in both newly diagnosed patients and those with relapsed or refractory disease. Conjugated antibodies, chimeric antigen receptor T-cells, and T-cell engagers are well tolerated and effective in patients with moderate renal impairment.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Frank Bridoux
- Department of Nephrology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Nelson Leung
- Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Simon J Harrison
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Alessandro Gozzetti
- Department of Hematology, University of Siena, Policlinico S Maria alle Scotte, Siena, Italy
| | - Niels W C J van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katja C Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ashraf Z Badros
- Department of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Meral Beksac
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | | | - Mohamad Mohty
- Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM UMRs 938, Paris, France
| | - P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Paul Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Joan Blade
- Department of Hematology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Philippe Moreau
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Jesus San-Miguel
- Cancer Center Clinica Universidad de Navarra, CCUN, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - Nikhil Munshi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Brian G M Durie
- Department of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, First Department of Medicine, Clinic Ottakring, Vienna, Austria
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
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Yadav S, Gundeti S, Bhave A, Deb U, Dixit J, Mishra K. Role of daratumumab in the frontline management of multiple myeloma: a narrative review. Expert Rev Hematol 2023; 16:743-760. [PMID: 37585685 DOI: 10.1080/17474086.2023.2246651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION The prevalence of multiple myeloma (MM) has gradually increased over the last few decades in India due to growing population, better disease awareness, and improved diagnostic procedures. Despite such advances, MM remains an incurable and relapsing disease due to its heterogeneity and genomic instability. With the inclusion of monoclonal antibodies, especially daratumumab in the frontline regimen, the management landscape of MM has improved significantly resulting in better disease control and patient outcomes. AREAS COVERED This review aims to provide an in-depth summary of efficacy and safety of frontline daratumumab therapy in treatment of MM including patients with high-risk cytogenetic profile. EXPERT OPINION Based on the review of literature, daratumumab in frontline therapy has demonstrated improved efficacy in terms of reduction in disease progression or death, and superior minimal residual disease (MRD)-negativity rates with an acceptable safety profile in patients with newly diagnosed MM (NDMM) including patients with high-risk cytogenetic profile. Daratumumab alone or in combination with other drugs has shown similar clinical outcomes in patients with relapsed/refractory MM. Hence, daratumumab can be used upfront in patients with MM.
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Affiliation(s)
- Sanjeev Yadav
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sadashivudu Gundeti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Abhay Bhave
- Department of Hematology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Uttiya Deb
- Medical Affairs, Johnson and Johnson Private Limited, Mumbai, India
| | - Jitendra Dixit
- Medical Affairs, Johnson and Johnson Private Limited, Mumbai, India
| | - Kundan Mishra
- Department of Hematology, Command Hospital, Lucknow, India
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Midha S, Hartley-Brown MA, Mo CC, Hossain S, Nadeem O, O'Donnell EK, Bianchi G, Sperling AS, Laubach JP, Richardson PG. A safety review of recently approved and emerging drugs for patients with relapsed or refractory multiple myeloma. Expert Opin Drug Saf 2023; 22:1049-1071. [PMID: 37906232 DOI: 10.1080/14740338.2023.2274420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Multiple new drugs have been approved over the past 5 years for the treatment of relapsed/refractory multiple myeloma (RRMM), and these are being increasingly widely used. Clinicians need to familiarize themselves with common toxicities associated with these drugs and with novel toxicities requiring specific management and supportive care. AREAS COVERED We review common toxicities associated with agents approved for RRMM in the past 5 years, including the anti-CD38 monoclonal antibody isatuximab, the antibody-drug conjugate belantamab mafodotin, the bispecific antibody teclistamab, the chimeric antigen receptor (CAR) T cell products idecabtagene vicleucel and ciltacabtagene autoleucel, the selective inhibitor of nuclear export compound selinexor, and the drug-peptide conjugate melflufen, as well as toxicities associated with emerging agents for RRMM including additional bispecific antibodies, the BCL-2 inhibitor venetoclax, and the cereblon E3 ligase modulators iberdomide and mezigdomide. We searched the published literature using PubMed, plus congress abstracts, for the above list of drug names or classes and 'myeloma.' EXPERT OPINION Optimal management of toxicities associated with these recently approved and emerging therapies will be critical in maximizing clinical benefit and aiding widespread adoption in routine clinical practice. We summarize current recommendations and guidelines and provide expert insights into supportive care requirements.
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Affiliation(s)
- Shonali Midha
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA
| | - Monique A Hartley-Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA
| | - Clifton C Mo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
| | - Shahrier Hossain
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
| | - Omar Nadeem
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
| | - Elizabeth K O'Donnell
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA
| | - Giada Bianchi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA
| | - Adam S Sperling
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacob P Laubach
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
| | - Paul G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA
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Mian A, Naqvi SAA, Ayaz A, Husnain M, Aljama MA, Mohyuddin GR, Koehn K, Mohan M, Bin Riaz I, Chakraborty R. Incidence of second primary malignancies in patients with multiple myeloma receiving anti-CD38 monoclonal antibodies: A systematic review and meta-analysis. Leuk Res 2023; 131:107324. [PMID: 37285641 DOI: 10.1016/j.leukres.2023.107324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
Anti-CD38 monoclonal antibodies (mAbs) are commonly used for treating newly diagnosed and relapsed/refractory (r/r) multiple myeloma (MM). However, concerns have been raised about the occurrence of second primary malignancies (SPMs) in patients receiving anti-CD38 mAbs. Assessing the safety data for rare adverse events like SPMs is challenging because individual clinical trials are typically focused on the primary endpoint. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) published between January 2005 and April 2022, including patients with newly diagnosed or r/r MM. Our aim was to compare SPM rate with the use of anti-CD38 mAb-based regimens with other anti-myeloma regimens. After a median follow-up of 35.3 months (range: 8.2-56.2), we found that exposure to anti-CD38 mAbs was associated with an increased risk of developing SPMs compared to the control group (6.8% vs. 5.2%; Peto odds ratio [OR]: 1.53 [95% confidence interval (CI): 1.20-1.95]; I2= 0%, p-value for heterogeneity= 0.44). This increased risk was primarily driven by non-melanoma cutaneous cancers (92 vs. 47; Peto OR: 1.77 [95% CI: 1.25-2.51]; I2 = 0%, p-value for heterogeneity = 0.54). However, there was no significant difference in the incidence of solid tumors (including malignant melanoma) (OR: 1.28 [95% CI: 0.85-1.95]) or hematologic SPMs (OR: 1.86; [95% CI: 0.81-4.27]). In conclusion, the use of anti-CD38 mAb-based combination regimens is associated with a higher risk of non-invasive cutaneous SPMs, but not solid tumors or hematologic SPMs. The increased occurrence of non-invasive cutaneous SPMs may be due to enhanced monitoring resulting from longer treatment duration with anti-CD38 mAbs.
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Affiliation(s)
- Agrima Mian
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ahsan Ayaz
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Mohammed A Aljama
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Kelly Koehn
- Department of Hematological Malignancies, Kansas University Medical Center, Kansas City, KS, USA
| | - Meera Mohan
- Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Irbaz Bin Riaz
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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41
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Martin T, Dimopoulos MA, Mikhael J, Yong K, Capra M, Facon T, Hajek R, Špička I, Baker R, Kim K, Martinez G, Min CK, Pour L, Leleu X, Oriol A, Koh Y, Suzuki K, Casca F, Macé S, Risse ML, Moreau P. Isatuximab, carfilzomib, and dexamethasone in patients with relapsed multiple myeloma: updated results from IKEMA, a randomized Phase 3 study. Blood Cancer J 2023; 13:72. [PMID: 37156782 PMCID: PMC10166682 DOI: 10.1038/s41408-023-00797-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 05/10/2023] Open
Abstract
Longer-term outcomes with the anti-CD38 antibody isatuximab in combination with carfilzomib-dexamethasone (Isa-Kd) were evaluated in the randomized Phase 3 trial IKEMA (NCT03275285), in a prespecified, follow-up analysis of progression-free survival (PFS, primary study endpoint), final complete response (CR) using Hydrashift Isa immunofixation assay, minimal residual disease (MRD) negativity, and safety. Enrolled patients had relapsed/refractory multiple myeloma (1-3 prior treatment lines). Isa 10 mg/kg was administered intravenously weekly in cycle 1 then biweekly. Efficacy analyses were performed in the intent-to-treat population (Isa-Kd: n = 179, Kd: n = 123) and safety evaluated in treated patients (Isa-Kd: n = 177, Kd: n = 122). Consistent with the primary interim analysis, the addition of Isa to Kd prolonged PFS (HR 0.58, 95.4% CI: 0.42-0.79; median PFS 35.7 [95% CI: 25.8-44.0] vs 19.2 [95% CI: 15.8-25.0] months). PFS benefit was observed with Isa-Kd across subgroups, including patients with poor prognosis. The stringent CR/CR rate was 44.1% vs 28.5% (odds-ratio: 2.09, 95% CI: 1.26-3.48), the MRD negativity rate 33.5% vs 15.4% (odds-ratio: 2.78, 95% CI: 1.55-4.99) and the MRD negativity CR rate 26.3% vs 12.2%, with Isa-Kd vs Kd. The safety profile of Isa-Kd was similar to that reported in the prior interim analysis. These findings further support Isa-Kd as a standard-of-care treatment for relapsed multiple myeloma patients.Clinical trial information: ClinicalTrials.gov, NCT03275285.
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Affiliation(s)
- Thomas Martin
- Department of Hematology, University of California at San Francisco, San Francisco, CA, USA.
| | | | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Kwee Yong
- Department of Haematology, University College Hospital, London, UK
| | - Marcelo Capra
- Centro Integrado de Hematologia e Oncologia, Hospital Mãe de Deus, Porto Alegre, Brazil
| | - Thierry Facon
- Department of Haematology, Lille University Hospital, Lille, France
| | - Roman Hajek
- Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ivan Špička
- Department of Hematology, 1st Faculty of Medicine, Charles University and General Hospital, Prague, Czech Republic
| | - Ross Baker
- Perth Blood Institute, Murdoch University, Perth, Australia
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gracia Martinez
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, CHU and CIC Inserm, 1402, Poitiers Cedex, France
| | - Albert Oriol
- Institut Josep Carreras and Institut Catala d'Oncologia, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kenshi Suzuki
- Myeloma/Amyloidosis Center, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | | | | | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
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42
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Lesokhin A, LeBlanc R, Dimopoulos MA, Capra M, Carlo‐Stella C, Karlin L, Castilloux J, Forsberg P, Parmar G, Tosikyan A, Pour L, Ribrag V, Ribolla R, Abdallah A, Le Roux N, Dong L, van de Velde H, Mayrargue L, Lépine L, Macé S, Moreau P. Isatuximab in combination with cemiplimab in patients with relapsed/refractory multiple myeloma: A phase 1/2 study. Cancer Med 2023; 12:10254-10266. [PMID: 36866838 PMCID: PMC10225222 DOI: 10.1002/cam4.5753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/25/2023] [Accepted: 02/18/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Given the incurable nature of multiple myeloma (MM), efforts are made to improve the efficacy of anti-CD38 monoclonal antibodies via combinations with other potentially synergistic therapies. This Phase 1/2 trial (NCT03194867) was designed to determine whether cemiplimab (anti-PD-1) enhances the anti-myeloma activity of isatuximab (anti-CD38) in patients with relapsed and refractory multiple myeloma (RRMM), to confirm the feasibility of the combination, determine its efficacy, and further evaluate its safety. METHODS Patients received isatuximab 10 mg/kg once weekly for 4 weeks followed by every 2 weeks (Isa), or isatuximab 10 mg/kg plus cemiplimab 250 mg every 2 (Isa + CemiQ2W) or every 4 weeks (Isa + CemiQ4W). RESULTS Overall, 106 patients with RRMM treated with a median of 4 prior lines were included; 25.5% had high-risk cytogenetics, 63.2% were refractory to proteasome inhibitors and immunomodulatory agents, 26.4% were previously exposed to daratumumab, and 84.0% were refractory to their last treatment line. There were no major changes in the safety or pharmacokinetic profile of isatuximab with the addition of cemiplimab. As assessed by investigators, four patients (11.8%) in the Isa arm, nine patients (25.0%) in the Isa + CemiQ2W arm, and eight patients (22.2%) in the Isa + CemiQ4W arm were responders. Though response rates were numerically higher in cemiplimab-containing arms, differences were not statistically significant and did not translate to improved progression-free or overall survival after a median follow-up of 9.99 months. CONCLUSION Our results suggest a marginal benefit by adding cemiplimab to isatuximab, despite demonstration of target engagement, without additional observed safety issues.
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Affiliation(s)
- Alexander Lesokhin
- Myeloma Service, Department of MedicineMemorial Sloan Kettering Cancer CenterNew York CityNew YorkUSA
| | - Richard LeBlanc
- Division of Hematology, Oncology and Transplantation, Department of MedicineMaisonneuve‐Rosemont Hospital, Université de MontréalMontréalQubecCanada
| | - Meletios A. Dimopoulos
- Department of Clinical TherapeuticsNational and Kapodistrian University of AthensAthensGreece
| | - Marcelo Capra
- Centro Integrado de Hematologia e OncologiaHospital Mãe de DeusPorto AlegreBrazil
| | - Carmelo Carlo‐Stella
- Department of Biomedical SciencesHumanitas UniversityRozzano‐MilanItaly
- Department of Oncology and HematologyIRCCS – Humanitas Research HospitalRozzano‐MilanItaly
| | - Lionel Karlin
- Department of HematologyHôpital Lyon‐Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1LyonFrance
| | - Jean‐Francois Castilloux
- Centre Hospitalier Universitaire de Sherbrooke, Division of Hematology and Medical OncologyUniversité de SherbrookeSherbrookeCanada
| | - Peter Forsberg
- Department of Medicine, Division of HematologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Gurdeep Parmar
- Department of HaematologyWollongong HospitalWollongongNew South WalesAustralia
| | - Axel Tosikyan
- Hôpital du Sacré‐Coeur de MontréalMontréalQubecCanada
| | - Ludek Pour
- Department of Internal MedicineUniversity Hospital BrnoBrnoCzech Republic
| | - Vincent Ribrag
- Department of Hematology, Gustave RoussyUniversité Paris‐SaclayVillejuifFrance
| | - Rossella Ribolla
- Department of HematologyASST Spedali Civili di BresciaBresciaItaly
| | - Al‐Ola Abdallah
- Division of Hematological Malignancies and Cellular TherapeuticsUniversity of KansasLawrenceKansasUSA
| | - Nadia Le Roux
- Sanofi Research & Development on behalf of AltranVitry‐sur‐SeineFrance
| | | | | | | | - Lucie Lépine
- Sanofi Clinical Pharmacokinetics on behalf of ExcelyaChilly‐MazarinFrance
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43
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Kikuchi T, Tsukada N, Nomura M, Kasuya Y, Oda Y, Sato K, Takei T, Ogura M, Abe Y, Suzuki K, Ishida T. Real-world clinical outcomes in patients with multiple myeloma treated with isatuximab after daratumumab treatment. Ann Hematol 2023; 102:1477-1483. [PMID: 37115297 DOI: 10.1007/s00277-023-05218-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Isatuximab and daratumumab are anti-CD38 monoclonal antibodies used to treat refractory multiple myeloma. Isatuximab is often used after unsuccessful daratumumab treatment; however, the clinical benefits of receiving isatuximab after daratumumab treatment have not been fully evaluated. Therefore, this retrospective cohort study assessed the clinical outcomes of 39 patients with multiple myeloma who were administered isatuximab after daratumumab. The median follow-up period was 8.7 months (range 0.1-25.0 months). The overall response rate was 46.2% (18 patients). The 1-year overall survival was 53.9%, with a median progression-free survival of 5.6 months. The median progression-free survival in patients with high and normal lactate dehydrogenase levels was 4.5 and 9.6 months, respectively (P = 0.004). The median progression-free survival in patients with and without triple-class refractory disease was 5.1 months and not reached, respectively (P = 0.001). The median overall survival in patients with high and normal lactate dehydrogenase levels was not reached and 9.3 months, respectively (P = 0.001). The median overall survival in patients with and without triple-class refractory disease was 9.9 months and not reached, respectively (P = 0.038). Our findings provide insight into the optimal use and timing of anti-CD38 antibody therapy.
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Affiliation(s)
- Taku Kikuchi
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan.
| | - Nobuhiro Tsukada
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
| | - Moe Nomura
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
| | - Yuki Kasuya
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
| | - Yuki Oda
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
| | - Kota Sato
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
| | - Tomomi Takei
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
| | - Mizuki Ogura
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
| | - Yu Abe
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
| | - Kenshi Suzuki
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
| | - Tadao Ishida
- Department of Hematology, Japanese Red Cross Medical Center, 4-chōme-1-22 Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan
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44
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Stork M, Spicka I, Radocha J, Minarik J, Jelinek T, Jungova A, Pavlicek P, Pospisilova L, Sedlak F, Straub J, Pika T, Knechtova Z, Fidrichova A, Boichuk I, Sevcikova S, Maisnar V, Hajek R, Pour L. Daratumumab with lenalidomide and dexamethasone in relapsed or refractory multiple myeloma patients - real world evidence analysis. Ann Hematol 2023; 102:1501-1511. [PMID: 37088816 PMCID: PMC10182121 DOI: 10.1007/s00277-023-05188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
We performed real world evidence (RWE) analysis of daratumumab, lenalidomide and dexamethasone (Dara-Rd) versus lenalidomide and dexamethasone (Rd) treatment in relapsed/refractory multiple myeloma patients (RRMM). In total, 240 RRMM patients were treated with Dara-Rd from 2016 to 2022 outside of clinical trials in all major Czech hematology centers. As a reference, 531 RRMM patients treated with Rd were evaluated. Patients' data were recorded in the Czech Registry of Monoclonal Gammopathies (RMG). Partial response (PR) or better response (ORR) was achieved in significantly more patients in Dara-Rd than in Rd group (91.2% vs. 69.9%; p < 0.001). The median progression free survival (PFS) was 26.9 months in the Dara-Rd and 12.8 months in the Rd group (p < 0.001). Median overall survival (OS) was not reached in the Dara-Rd compared to 27.2 months in the Rd group (p = 0.023). In patients with 1-3 previous treatment lines, there was significant PFS benefit of Dara-Rd compared to Rd (median PFS not reached vs. 13.2 months; p < 0.001). In patients with > 3 previous treatment lines, there was no significant PFS benefit of Dara-Rd treatment (7.8 months vs. 9.9 months; p = 0.874), similarly in patients refractory to PI + IMIDs (11.5 months vs. 9.2 months; p = 0.376). In RWE conditions, the median PFS in RRMM patients treated with Dara-Rd is shorter when compared to clinical trials. In heavily pretreated RRMM patients, efficacy of Dara-Rd treatment is limited; best possible outcomes of Dara-Rd are achieved in minimally pretreated patients.
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Affiliation(s)
- Martin Stork
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Ivan Spicka
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jakub Radocha
- 4th Department of Medicine - Hematology, Faculty of Medicine, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Jiri Minarik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Alexandra Jungova
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Petr Pavlicek
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | - Frantisek Sedlak
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jan Straub
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Tomas Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic
| | - Zdenka Knechtova
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Anna Fidrichova
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Ivanna Boichuk
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Sabina Sevcikova
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimir Maisnar
- 4th Department of Medicine - Hematology, Faculty of Medicine, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic.
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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45
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Morè S, Corvatta L, Manieri VM, Olivieri A, Offidani M. Current Main Topics in Multiple Myeloma. Cancers (Basel) 2023; 15:2203. [PMID: 37190132 PMCID: PMC10136770 DOI: 10.3390/cancers15082203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
Multiple Myeloma (MM) remains a difficult to treat disease mainly due to its biological heterogeneity, of which we are more and more knowledgeable thanks to the development of increasingly sensitive molecular methods that allow us to build better prognostication models. The biological diversity translates into a wide range of clinical outcomes from long-lasting remission in some patients to very early relapse in others. In NDMM transplant eligible (TE) patients, the incorporation of mAb as daratumumab in the induction regimens, followed by autologous stem cell transplantation (ASCT) and consolidation/maintenance therapy, has led to a significant improvement of PFS and OS.; however, this outcome remains poor in ultra-high risk MM or in those who did not achieve a minimal residual disease (MRD) negativity. Several trials are exploring cytogenetic risk-adapted and MRD-driven therapies in these patients. Similarly, quadruplets-containing daratumumab, particularly when administered as continuous therapies, have improved outcome of patients not eligible for autologous transplant (NTE). Patients who become refractory to conventional therapies have noticeably poor outcomes, making their treatment a difficult challenge in need of novel strategies. In this review, we will focus on the main points regarding risk stratification, treatment and monitoring of MM, highlighting the most recent evidence that could modify the management of this still incurable disease.
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Affiliation(s)
- Sonia Morè
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy
| | - Laura Corvatta
- Unità Operativa Complessa di Medicina, Ospedale Profili, 60044 Fabriano, Italy
| | | | - Attilio Olivieri
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy
| | - Massimo Offidani
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy
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46
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Dima D, Ullah F, Mazzoni S, Williams L, Faiman B, Kurkowski A, Chaulagain C, Raza S, Samaras C, Valent J, Khouri J, Anwer F. Management of Relapsed-Refractory Multiple Myeloma in the Era of Advanced Therapies: Evidence-Based Recommendations for Routine Clinical Practice. Cancers (Basel) 2023; 15:2160. [PMID: 37046821 PMCID: PMC10093129 DOI: 10.3390/cancers15072160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
Multiple myeloma (MM) is the second most common hematologic malignancy in adults worldwide. Over the past few years, major therapeutic advances have improved progression-free and overall survival, as well as quality of life. Despite this recent progress, MM remains incurable in the vast majority of cases. Patients eventually relapse and become refractory to multiple drug classes, making long-term management challenging. In this review, we will focus on the treatment paradigm of relapsed/refractory MM (RRMM) in the era of advanced therapies emphasizing the available novel modalities that have recently been incorporated into routine practice, such as chimeric antigen receptor T-cell therapy, bispecific antibodies, and other promising approaches. We will also discuss major factors that influence the selection of appropriate drug combinations or cellular therapies, such as relapse characteristics, and other disease and patient related parameters. Our goal is to provide insight into the currently available and experimental therapies for RRMM in an effort to guide the therapeutic decision-making process.
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Affiliation(s)
- Danai Dima
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH 44106, USA
| | - Fauzia Ullah
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH 44106, USA
| | - Sandra Mazzoni
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH 44106, USA
| | - Louis Williams
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH 44106, USA
| | - Beth Faiman
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH 44106, USA
| | - Austin Kurkowski
- Department of Pharmacy, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Chakra Chaulagain
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Maroone Cancer Center, Weston, FL 33331, USA
| | - Shahzad Raza
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH 44106, USA
| | - Christy Samaras
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH 44106, USA
| | - Jason Valent
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH 44106, USA
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH 44106, USA
| | - Faiz Anwer
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Taussig Cancer Institute, Cleveland, OH 44106, USA
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47
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Raje N, Mateos MV, Iida S, Reece D. Clinical evidence for immune-based strategies in early-line multiple myeloma: current challenges in decision-making for subsequent therapy. Blood Cancer J 2023; 13:41. [PMID: 36944635 PMCID: PMC10030780 DOI: 10.1038/s41408-023-00804-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023] Open
Abstract
Almost all patients with multiple myeloma (MM) will eventually develop disease that has relapsed with or become refractory to available treatments and will require additional therapy. However, data are still lacking on how best to sequence regimens in the relapsed/refractory (RR) setting after the failure of early-line lenalidomide, bortezomib, and/or daratumumab, the most commonly used agents in clinical practice today. With the treatment landscape rapidly changing in response to emerging clinical trial data and approvals of several new drugs and additional combinations, it is critically important to focus on patients with RRMM. Variability in patient baseline characteristics, such as the number of prior lines of treatment, refractoriness to prior treatments, prior stem cell transplant, and timing and dosing of prior lenalidomide, makes it difficult to select the best options for patients with RRMM for whom first-line treatments have failed. The aim of this review is to provide both an overview of current therapies and future directions within the RRMM treatment landscape, and a framework for clinicians to choose the most promising next treatment option.
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Affiliation(s)
- Noopur Raje
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
| | - María-Victoria Mateos
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Donna Reece
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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48
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Martino EA, Bruzzese A, Iaccino E, Mendicino F, Mimmi S, Lucia E, Olivito V, Neri A, Morabito F, Vigna E, Gentile M. Isatuximab in multiple myeloma. Expert Opin Biol Ther 2023; 23:315-318. [PMID: 36943846 DOI: 10.1080/14712598.2023.2193289] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Affiliation(s)
| | | | - Enrico Iaccino
- Department of Experimental and Clinical Medicine, University "Magna Graecia" of Catanzaro, Italy
| | | | - Selena Mimmi
- Department of Experimental and Clinical Medicine, University "Magna Graecia" of Catanzaro, Italy
| | - Eugenio Lucia
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | | | - Antonino Neri
- Scientific Directorate IRCCS of Reggio Emilia, I42123 Reggio Emilia, EmiliaRomagna, Italy
| | | | - Ernesto Vigna
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Massimo Gentile
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Rende, Italy
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49
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Periplocin Overcomes Bortezomib Resistance by Suppressing the Growth and Down-Regulation of Cell Adhesion Molecules in Multiple Myeloma. Cancers (Basel) 2023; 15:cancers15051526. [PMID: 36900317 PMCID: PMC10001131 DOI: 10.3390/cancers15051526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
Multiple myeloma (MM) is an incurable hematological malignant disorder of bone marrow. Patients with MM receive multiple lines of chemotherapeutic treatments which often develop bortezomib (BTZ) resistance and relapse. Therefore, it is crucial to identify an anti-MM agent to overcome the BTZ resistance of MM. In this study, we screened a library of 2370 compounds against MM wild-type (ARP1) and BTZ-resistant type (ARP1-BR) cell lines and found that periplocin (PP) was the most significant anti-MM natural compound. We further investigated the anti-MM effect of PP by using annexin V assay, clonogenic assays, aldefluor assay, and transwell assay. Furthermore, RNA sequencing (RNA-seq) was performed to predict the molecular effects of PP in MM followed by verification through qRT-PCR and Western blot analysis. Moreover, ARP1 and ARP1-BR xenograft mice models of MM were established to confirm the anti-MM effects of PP invivo. The results showed that PP significantly induced apoptosis, inhibited proliferation, suppressed stemness, and reduced the cell migration of MM. The expression of cell adhesion molecules (CAMs) was suppressed upon PP treatment in vitro and in vivo. Overall, our data recommend PP as an anti-MM natural compound with the potential to overcome BTZ resistance and downregulate CAMs in MM.
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50
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McMillan A, Basu S, Karunanithi K, Parkins E, Lau EYM, Cook G, Parrish C, Al-Kaisi F, Pratt G, Shafeek S, Jenkins S, Memon D, Bygrave C, Papanikolaou X, Maisel T, Hassan S, Moosai S, Chander G, Rakesh P, Kishore B, Karim F, Talbot G, Wandroo F, Yong K, Popat R. Daratumumab, bortezomib and dexamethasone at first relapse for patients with multiple myeloma: A real-world multicentre UK retrospective analysis. Br J Haematol 2023; 201:682-689. [PMID: 36822820 DOI: 10.1111/bjh.18703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/15/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
Daratumumab, bortezomib and dexamethasone (DVd) is approved for patients with relapsed multiple myeloma following the CASTOR phase 3 clinical trial. This retrospective multicentre analysis assesses the overall response rate (ORR) and progression-free survival (PFS) in routine clinical practice for patients at first relapse treated with DVd incorporating weekly bortezomib. Data were collected from 296 sequential patients treated across 15 UK centres. After a median follow-up of 21 months, the ORR was 82% (26% partial response, 56% very good partial response or better) and the median PFS was 16 months [95% confidence interval (CI) 12-20 months]. Results were similar regardless of prior lenalidomide exposure. The median time to next treatment was 20 months (95% CI 15-25 months) and the estimated overall survival at two years was 74%. Patients with high-risk features (by cytogenetics, International Staging System or extramedullary disease) and those treated within 18 months of initiation of progression-free treatment, or within 12 months of autologous stem cell transplant, had significantly inferior outcomes. The grade 2 and 3 peripheral neuropathy rate was 7%. DVd with weekly bortezomib was effective in a heterogenous real-world population at first relapse with a low rate of peripheral neuropathy. However, high-risk patients had inferior outcomes and should be considered for alternative treatments.
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Affiliation(s)
- Annabel McMillan
- University College London Hospitals NHS Foundation Trust, London, UK.,Whittington Health NHS Trust, London, UK
| | - Supratik Basu
- The Royal Wolverhampton Hospitals NHS Trust and University, Wolverhampton, UK.,West Midlands Research Consortium (WMRC, CRN-West Midlands), Birmingham, UK
| | - Kamaraj Karunanithi
- West Midlands Research Consortium (WMRC, CRN-West Midlands), Birmingham, UK.,University Hospitals of North Midlands NHS Trust, Staffordshire, UK
| | | | | | - Gordon Cook
- CRUK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Christopher Parrish
- CRUK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Guy Pratt
- West Midlands Research Consortium (WMRC, CRN-West Midlands), Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Salim Shafeek
- West Midlands Research Consortium (WMRC, CRN-West Midlands), Birmingham, UK.,Worcestershire Royal Hospital, Worcestershire, UK
| | - Stephen Jenkins
- West Midlands Research Consortium (WMRC, CRN-West Midlands), Birmingham, UK.,Russell Hall Hospital, Dudley, UK
| | - Danish Memon
- West Midlands Research Consortium (WMRC, CRN-West Midlands), Birmingham, UK.,Russell Hall Hospital, Dudley, UK
| | | | - Xenofon Papanikolaou
- University College London Hospitals NHS Foundation Trust, London, UK.,The Lister Hospital, London, UK
| | | | | | - Shivir Moosai
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gurvin Chander
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pallav Rakesh
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bhuvan Kishore
- West Midlands Research Consortium (WMRC, CRN-West Midlands), Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Farheen Karim
- The Royal Wolverhampton Hospitals NHS Trust and University, Wolverhampton, UK.,West Midlands Research Consortium (WMRC, CRN-West Midlands), Birmingham, UK
| | - Georgina Talbot
- The Royal Wolverhampton Hospitals NHS Trust and University, Wolverhampton, UK.,West Midlands Research Consortium (WMRC, CRN-West Midlands), Birmingham, UK
| | - Farooq Wandroo
- West Midlands Research Consortium (WMRC, CRN-West Midlands), Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Kwee Yong
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Rakesh Popat
- University College London Hospitals NHS Foundation Trust, London, UK
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