COMy 2021 | Treatment options for transplant-ineligible patients with multiple myeloma
Maria-Victoria Mateos, MD, PhD, University of Salamanca, Salamanca, Spain discusses alternative pathways for transplant-ineligible patients with newly diagnosed multiple myeloma. In addition to the current standard of care which consists of bortezomib, melphalan and prednisone (VMP) or bortezomib, lenalidomide, and dexamethasone (VRd), the addition of monoclonal antibodies such as daratumumab has increased overall survival and progression free survival, especially in frail and elderly patients. Dr Mateos also describes the Phase III MAIA trial (NCT02252172), which assessed daratumumab with lenalidomide and dexamethasone in transplant-ineligible patients with newly diagnosed multiple myeloma. This interview took place during the 7th World Congress on Controversies in Multiple Myeloma (COMy), 2021.
Transcript (edited for clarity)
In 2021, the management of a transplant-ineligible and newly diagnosed myeloma patient is clearly evolving. We have to start from a VMP continuous therapy with a len-dex or VRd, as the classical standard of cares. And the new combinations are basically based on the incorporation of the monoclonal antibodies, anti-CD38. And the reality today is based on the monoclonal antibody daratumumab in combination with either VMP or lenalidomide and dexamethasone...
In 2021, the management of a transplant-ineligible and newly diagnosed myeloma patient is clearly evolving. We have to start from a VMP continuous therapy with a len-dex or VRd, as the classical standard of cares. And the new combinations are basically based on the incorporation of the monoclonal antibodies, anti-CD38. And the reality today is based on the monoclonal antibody daratumumab in combination with either VMP or lenalidomide and dexamethasone. And VRd plus the anti-CD38 monoclonal antibodies are being evaluated in clinical trials that are going on.
VMP plus daratumumab is a new standard of care because of the significant benefit and not only in the progression-free survival, but also in overall survival. And in addition, the benefit has been sustained across the different groups of patients, especially based on the frailty. And this is important because we can face elderly patients, frail patients that can benefit from this combination. Dara-len-dex is another standard of care, and I have to see that the median progression-free survival for dara-len-dex in the MAIA study has not been reached yet, but it is expected that to be from my point of view, the longest one we’ve seen today in a Phase III clinical study conducted in transplant-ineligible, newly diagnosed myeloma patient.
And just to remark also the benefit across the different groups of patients and especially patients with high-risk cytogenetic abnormalities, medium PFS 45 months, and these would be the first choice for this population. And again, the addition of daratumumab to len-dex significantly improved the outcome, not only for the fitter patients, but also for the frail population.
So in summary, I think that the future is definitely based on the incorporation of the anti-CD38 monoclonal antibodies to the current standard of cares. And in fact, this has been recognized by the recent European guidelines that were published just this summer weeks ago.
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Disclosures
Honoraria from lectures and participation in boards from: Janssen, BMS-Celgene, Abbvie, Amgen, Takeda, GSK, Sanofi, Oncopeptides, Pfizer, Regeneron, Adaptive, Roche, Bluebird-bio, Sea-Gen.
