Real-World Daratumumab Response Across Lines of Therapy for Patients With MM

A recent real-world study suggests that daratumumab-based regimens are an effective treatment option for multiple myeloma (MM) across all lines therapy, presenting the strongest response in the first-line setting.

Daratumumab has been approved for the treatment of MM among both previously-treated and newly-diagnosed patients. Shebli Atrash, MD, Levine Cancer Institute, Charlotte, NC, and colleagues aimed to examine real-world treatment responses among patients initiating daratumumab across different lines of therapy.

Using data from two clinical sites in the United States, a retrospective chart review was constructed to examine 202 adult patients with MM who initiated daratumumab between January 2018 and May 2020. An electronic case report form was used to collect data, while ensuring anonymity among all participants.

This study observed treatment patterns, overall response rates (ORR), and proportion of patients with very good partial response (VGPR) or better, stratifying this data by first-line therapy, second-line therapy, or third-line therapy.

The average age of participants at diagnosis was 65.3 years, and 68.1 years at daratumumab initiation. Of the 202 participants, 109 (54%) were male, 104 (51.5%) were White, and 65 (32.2%) were Black or African American. In this review study, 64 participants (31.7%) received a stem cell transplant prior to the line of daratumumab initiation.

Daratumumab was initiated among 21 patients (10.4%) as a first-line treatment, 53 patients (26.2%) as a second-line treatment, and 128 patients (63.4%) as a third-line treatment. The median follow-up time was 6.2 months among first-line patients, and 13.8 months for second- and third-line patients.

The most common first-line regimen was daratumumab with bortezomib, lenalidomide with or without dexamethasone (47.6% of first-line participants). Daratumumab with lenalidomide with or without dexamethasone was the second most common first-line regimen (38.1% of first-line participants).

The most common second-line regimen was daratumumab plus lenalidomide with or without dexamethasone (28.3% of second-line participants). Daratumumab plus pomalidomide with or without dexamethasone, and daratumumab plus bortezomib with or without dexamethasone (24.5% of second-line participants) were also popular treatments for second-line therapy.

The most common third-line regimen was daratumumab plus pomalidomide with or without dexamethasone (48.4% of third-line participants).

The ORR among patients initiating daratumumab lines of therapy was 100% for first-line, 81.6% for second-line, and 76% among third-line. The proportion of patients with VGPR or better was 73.3% among first-line participants, 65.3% among second-line participants, and 51% among third-line participants. The median time to treatment response among patients post-initiation was between 2.6 and 2.8 months.

“In this study, patients initiated on DARA [daratumumab] had high ORR and rates of VGPR or better, including an ORR of 100% among 1L [first-line] DARA users,” concluded Dr Atrash, adding, “These findings suggest that DARA-based regimens are an effective treatment option across all lines of therapy, with highest response rate in 1L.”—Marta Rybczynski