EHA 2023 | MASTER final analysis: quadruplet induction therapy, ASCT & MRD-adapted treatment cessation in NDMM
Luciano Costa, MD, PhD, UAB School of Medicine, Birmingham, AL, gives an update on the results of the final analysis of the MASTER trial (NCT03224507), which evaluated the outcomes of measurable residual disease (MRD)-adapted treatment cessation in patients with newly diagnosed multiple myeloma (NDMM) treated with daratumumab, carfilzomib, lenalidomide, and dexamethasone (Dara-KRd). After a median follow-up of 42 months, the study reported that the majority of patients who stopped therapy remained MRD-negative and experienced a three-year progression-free survival (PFS) of over 80%. Conversion to MRD positivity after treatment cessation was manageable. Dr Costa also highlights the need to implement novel agents in patients with ultra-high-risk disease who are at a higher risk of disease progression. This interview took place at the 28th Congress of the European Hematology Association (EHA) 2023 in Frankfurt, Germany.
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Transcript (edited for clarity)
Here at EHA 2023, we’re presenting the final analysis of the MASTER trial, which was a trial for patients with newly diagnosed myeloma, that include induction therapy with Dara-KRd, autologous transplant, and then MRD-adapted consolidation with additional Dara-KRd and treatment cessation for patients with confirmed MRD-negativity. And here we present the final analysis with a median follow up of 42 months...
Here at EHA 2023, we’re presenting the final analysis of the MASTER trial, which was a trial for patients with newly diagnosed myeloma, that include induction therapy with Dara-KRd, autologous transplant, and then MRD-adapted consolidation with additional Dara-KRd and treatment cessation for patients with confirmed MRD-negativity. And here we present the final analysis with a median follow up of 42 months. And what we saw in the trial is that the majority of the patients can achieve and maintain minimal residual disease negativity. And, according to the protocol design, those patients were able to stop therapy – so that was achieved in 71% of the patients, which is really great. And what we present here is mostly about updating how those people do long-term. And the good news is the majority of the patients remain MRD-negative being followed without any further therapy, with excellent three years progression-free survival that is, you know, over 80% for both patients with zero or one high-risk chromosome abnormality.
We also give some insight into what happened to the patients who don’t stay MRD-negative. We have some progressions, most of which are rescued with subsequent therapy, we also have some patients with MRD resurgence without progression, but for the most part can be controlled – or some of those patients even driven back to MRD-negativity – with re-institution of therapy. And as we had seen prior analysis, the problem remains for the patients with ultra high-risk disease, they have a higher rate of progression, even if you take all the patients in the protocol but also among the ones who stop therapy. We have seen unfortunately that that is the case in other studies, even if you continue therapy with a monoclonal antibodies IMiDs or IMiDs and proteasome inhibitors. So I think that really helps to frame the group for a good candidate for further interventions that would probably, for example, bring bispecific antibodies or CAR-T cell into earlier lines of therapy.
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Disclosures
Sanofi: Consultancy, Honoraria; Adaptive Biotechnologies: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria, Research Funding; Genentech: Research Funding; AbbVie: Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding.
