Welcome to the second day of our recap of the latest findings on myeloma treatments reported at the International Myeloma Society (IMS) meeting in Rio De Janeiro, Brazil. Today gave us important updates on new treatment combinations for newly diagnosed multiple myeloma (NDMM), particularly patients ages 65 years and older, as well as a new report on real-world experience with CAR T-cell therapy for relapsed/refractory multiple myeloma (RRMM).
Several abstracts presented on Thursday highlighted recent findings on approved and investigational treatment combinations for patients with NDMM ages 65 years and older.
In the first abstract (Abstract OA–51) Dr. Nisha Joseph from Emory University and colleagues reported that adults ages 65 and older greatly benefited from D-VRd in the real-world (outside of a clinical trial), with 95% of patients living disease-free 4 years after treatment compared to 65% who received VRd. Their real-world analysis included 420 patients with NDMM ages 65 and older who received a stem cell transplant.
The researchers conclude that other studies have shown inconsistent results, their data reflecting real-world clinical practice suggests that these patients can and do benefit from the addition of daratumumab upfront.
The second abstract (Abstract OA–52) researchers from France showed that adding weekly Velcade to Sarclisa plus Revlimid and dexamethasone (Isa-VRd) significantly increased the minimal residual disease (MRD) negativity (which means that no myeloma cells were detected) rate to 53% compared to 26% in patients who were treated with IsaRd (without Velcade). The BENEFIT study included 106 patients with NDMM ages 65-79 years who were not considered for a stem cell transplant. The findings further support Isa-VRd as a new standard of care for patients with NDMM who were deemed ineligible for a stem cell transplant, regardless of age.
While adding Darzalex or Sarclisa to standard of care triplet combinations has emerged as the new standard of care for patients with NDMM, ongoing clinical trials continue to evaluate other novel first-line treatment strategies, particularly for adults ages 65 and older and individuals with kidney disease. In this study (Abstract OA–55) of 75 patients who were deemed ineligible for a transplant, researchers from Spain reported that iberdomide (a next-generation immunomodulatory agent related to Revlimid and Pomalyst) when combined with Darzalex and dexamethasone (IberDd) was highly effective and had a manageable safety profile. Infections (84%) and low white blood cell counts (80%) were the most common side effects reported and were mostly low-grade. The trial included mostly older patients (median patient age was 75 years) and almost half of patients had mild kidney disease. The authors conclude that these data further support the continued evaluation of iberdomide in patients with NDMM.
The final abstract (Abstract OA-11) presented by Dr. Surbhi Sidana from Stanford University and colleagues revealed long-term follow up results on 236 patients with relapse/refractory multiple myeloma (RRMM) who received Carvykti (ciltacabtagene autoleucel), one of the CAR T-cell therapies that is FDA-approved. One unique aspect of their analysis was that 54% of the patients would not have met eligibility criteria for CARTITUDE-1, a clinical trial that led to the approval of Carvykti. Among the patients in their analysis were 14% who had prior BCMA therapy (which is the same target for Carvykti) and 4% who received prior bispecific antibodies (another type of immunotherapy).
Dr. Sidana and colleagues reported high levels of response rates among patients and side effects similar to those reported previously. Cytokine release syndrome or flu-like symptoms, neurological side effects, and infections were the most common side effects observed. These findings support that patients who received prior BCMA therapy or bispecific antibody may benefit from Carvykti.
Stay tuned tomorrow for what will be the biggest day of clinical trial updates in the treatment of myeloma at IMS 2024.
