Quadruplets Seen as Top Option in Transplant-Ineligible Multiple Myeloma Due to Efficacy
Samer A. Al'Hadidi, MD, MS, discusses the response and survival of 2 quadruplet therapy trials for patients with transplant-ineligible multiple myeloma.
Samer A. Al'Hadidi, MD, MS, a hematologist/oncologist and assistant professor in the Department of Internal Medicine, Division of Hematology and Oncology at the University of Arkansas for Medical Sciences, discusses 2 quadruplet therapy trials for patients with transplant-ineligible multiple myeloma from a Case-Based Roundtable event.
During the event, Al’Hadidi discussed the relevancy of the phase 3 IMROZ (NCT03319667) and CEPHEUS (NCT03652064) trials in the multiple myeloma space. IMROZ, which investigated isatuximab (Sarclisa), lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (Isa-RVd) vs RVd only, showed progression-free survival (PFS) superiority with the quadruplet.
CEPHEUS looked at daratumumab (Darzalex), lenalidomide, bortezomib, and dexamethasone (Dara-RVd) and demonstrated deeper responses, along with improved PFS. These responses included complete response (CR) and minimal residual disease (MRD) negativity.
Differences in toxicity were also discussed, including potentially higher grades of neutropenia and infections, but Al’Hadidi noted that these adverse events (AEs) should be watched for with triplet and quadruplet therapy.
TRANSCRIPTION:
0:10 | The IMROZ and CEPHEUS studies, both of those studies were aimed to study transplant non-eligible or transplant not intended patients. They included patients who are older, on average, where transplant was not either offered or not planned by the patient and the treating physician. In the case of IMROZ data, the PFS was better with the use of Isa-RVd compared to RVd. And in the case of CEPHEUS study, there was deeper responses with shorter follow-up for that study specifically, and also improved progression-free survival in patients who got Dara-RVd, compared to RVd. Responses were also deeper, including CR or better or MRD-negative or better.
1:00 | We also discussed the possibility of AE differences. In the case of the IMROZ study, for example, there were cases where patients may get grade 3 or higher neutropenia, hematological toxicities, and infections. We discussed the fact that such AEs could have happened with the use of triplet-based regimens, and we need to be careful about those AEs regardless of the use of triplet or quadruplet, specifically in older and more frail patients.
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