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ASCO 2026 | Dara-KRd versus Dara-VRd for newly diagnosed myeloma: insights from a meta-analysis
M. Bakri Hammami, MD, Moffitt Cancer Center, Tampa, FL, discusses the findings of a meta-analysis comparing daratumumab combined with carfilzomib, lenalidomide, and dexamethasone (Dara-KRd) and daratumumab combined with bortezomib, lenalidomide, and dexamethasone (Dara-VRd) in newly diagnosed multiple myeloma (MM). While Dara-KRd achieved higher early rates of measurable residual disease (MRD) negativity following induction and demonstrated better tolerability, Dara-VRd provided superior two-year progression-free survival (PFS), highlighting the effectiveness of both approaches and the need to balance efficacy against toxicity when selecting between these regimens. This interview took place during the 2026 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
This particular meta-analysis looked at two of the most powerful regimens that we use for newly diagnosed multiple myeloma, namely DKRd or daratumumab that is added to carfilzomib and revlimid, compared to daratumumab added to bortezomib and revlimid. And those are, again, two regimens that we use pretty extensively for newly-diagnosed multiple myeloma. And we had many trials that looked at these, but never in a head-to-head trial comparing those two regimens...
This particular meta-analysis looked at two of the most powerful regimens that we use for newly diagnosed multiple myeloma, namely DKRd or daratumumab that is added to carfilzomib and revlimid, compared to daratumumab added to bortezomib and revlimid. And those are, again, two regimens that we use pretty extensively for newly-diagnosed multiple myeloma. And we had many trials that looked at these, but never in a head-to-head trial comparing those two regimens. And both of them are listed as recommended for newly diagnosed multiple myeloma, so we did this study to kind of look at those two regimens and if there is a particular preference in terms of two main objectives, the safety and the efficacy of these two regimens.
In terms of the efficacy, in the first period, right after the induction, there was a preference for daraKRd showing higher rates of MRD negativity, actually reaching to twice more than daraRVd. But that didn’t persist until the end of the study period. We noticed that MRD negativity by the end of second or third years, it becomes almost the same between both regimens. Similarly, the overall survival was the same. However, progression-free survival was favoring daraRVd by the end of the study period, which suggests multiple things. It could be that both regimens are very, very effective against myeloma, and that is a given. But it also has some implications with regards to the maintenance therapy that we use after the induction regimen. And we discussed that in the paper that will be coming forth.
In terms of the safety, actually, the regimen DKRd was the favorable regimen there. There was lower rates of treatment discontinuation. There was lower rates of grade 3 adverse events, lower rates of serious adverse events, and overall a better safety profile, which all in all, if you put it together, it suggests that both regimens, again, can be used. The choice should be based on the patient’s preference for what’s the goal of their therapy. Is it maximum efficacy or safety? And that’s what we argue in our paper.
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