New Myeloma Therapies Are ‘A Huge Improvement for the Field’

CURESpring 2023
Volume 22
Issue 1

Triplet therapy demonstrates improved remission and survival rates, with manageable side effects for patients who are ineligible for transplant.

Darzalex (daratumumab), Revlimid (lenalidomide) and dexamethasone combined, which is a triplet therapy, resulted in a significant overall survival (the time when a patient with cancer is still alive) benefit for patients with relapsed or refractory multiple myeloma, according to recent study results.

Specifically, overall survival was 67.6 months with the triplet therapy at a median follow-up of 79.7 months compared with 51.8 months with Revlimid and dexamethasone combined. The results were published in the Journal of Clinical Oncology. This trend followed through into most subgroups, including patients over the age of 65 and those who have been treated with one, two or three prior lines of therapy.

“This report showed that the overall survival was continuing to look good and that the triplet combination was improving not (only) time in remission but also the overall survival of patients,” Dr. Robert Z. Orlowski, a co-author on the study and a professor of medicine in the department of myeloma at The University of Texas MD Anderson Cancer Center in Houston, said in an interview with CURE®.

Of note, it was previously reported that the triplet therapy also significantly improved progression-free survival (time during and after treatment when the patient lives without disease progres- sion) compared with the doublet in this patient population (56 months versus 34 months, respectively). Orlowski called this a “huge improvement.”

“I would definitely say these (results) are very significant,” he said. “And this is now considered one of the standards of care for patients (who) have newly diagnosed symptomatic myeloma who are not candidates for stem cell transplant.”

There are now clinical trials under design that are adding a fourth drug to this new standard of care. Orlowski explained that they do this because although the outcome was improved with the triplet therapy, not all patients had a benefit.

“The thought is that if we add the right fourth drug, there’s a possibility that we could extend the benefits even further,” he said. “We’re hopeful that with the right combination, we may be able to cure patients of myeloma, not just put them into a remission from which many of them can still ultimately relapse.”

The most common side effects, which occurred in at least 10% of patients, reported in those who received the triplet therapy compared with the doublet included neutropenia (low white blood cell count; 57.6% versus 41.6%), anemia (19.8% versus 22.4%), pneumonia (17.3% versus 11%), throm- bocytopenia (low blood platelet count; 15.5% versus 15.7%) and diarrhea (10.2% versus 3.9%). Orlowski explained that it is common for side effects to increase, as they did here, when adding a third drug to a regimen. However, most of the side effects were able to be managed because they had experience doing so already.

“What that translates into is that patients have a much better outcome. They have relatively fewer additional side effects, (which) means a better quality of life,” he said. “We want patients not (only) to live longer but (also) be able to enjoy that time.”

Orlowski also said it is important to look at the results in the context of where multiple myeloma treatment was 20 years ago, for example. During that period, the average time a patient had lived was about 3 years. Now there are therapies, such as this one, that keep them in remission for 56 months or longer.

“This means they will live even longer, because even if you come out of remission, you still have other treatment options available,” Orlowski said. “Coming out of remission doesn’t mean you’re done, so this is just a huge improvement for the field.”

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