Highlighting Therapeutic Options in Later Lines for Multiple Myeloma

Kenneth C. Anderson, MD, Kraft Family Professor of Medicine at Harvard Medical School and program director of Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics at Dana-Farber Cancer Institute, discusses the therapies for patients who have multiple myeloma and have developed drug resistance.

FDA-approved regimens for patients with lenalidomide (Revlimid) and bortezomib (Velcade) refractory disease is daratumumab (Darzalex), pomalidomide (Pomalyst), and dexamethasone. The 9-month progression-free survival rate is 86% for this regimen, according to Anderson.

The data for the combination of carfilzomib (Kyprolis), dexamethasone, and daratumumab was reported at the American Society of Hematology Annual Meeting, and it was shown to be well tolerated and superior to carfilzomib and dexamethasone in a randomized trial.

Another regimen in the second-line setting is elotuzumab (Empliciti), pomalidomide, and dexamethasone regimen demonstrated superiority over pomalidomide and dexamethasone, which led to an FDA approval.

Anderson says that isatuximab (Sarclisa), a CD38 antibody, has been approved based on a trial of isatuximab, pomalidomide, and dexamethasone versus pomalidomide and dexamethasone. Isatuximab is different from daratumumab because it reacts with a different epitope and it has a direct mechanism of killing cancer cells that daratumumab doesn’t have, he explains; daratumumab depletes natural killer cells whereas isatuximab does not. Whether isatuximab will work in patients who are refractory to daratumumab is still uncertain.

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