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Progression-Free Survival Benefits of Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone For Multiple Myeloma
The FDA has previously approved daratumumab for patients with multiple myeloma. Further research into the treatment’s safety and efficacy in combination with other therapies was performed by Pieter Sonneveld, MD, Erasmus MC Cancer Institute, Rotterdam, Netherlands, and colleagues, who sought to evaluate subcutaneous daratumumab in combination with bortezomib, lenalidomide, and dexamethasone (VRd) for patients with a new diagnosis of multiple myeloma.
In Dr Sonneveld’s trial, 709 patients participated and received subcutaneous daratumumab in combination with VRd induction and consolidation therapy with lenalidomide maintenance therapy (D-VRd group) or VRd induction therapy and lenalidomide maintenance therapy without subcutaneous daratumumab (VRd group). All patients were eligible for transplantation and had a new diagnosis of multiple myeloma. The goal of this study was to find a higher benefit to progression-free survival (PFS) rates with the combination therapy of D-VRd. Dr Sonneveld and colleagues also sought to improve patients’ overall response rate to treatment or for patients to achieve minimal residual disease (MRD)–negative status.
In their results they found that after 47.5 months, disease progression and risk of death were lower in patients in the D-VRd group than in the VRd group. Patients in the D-VRd group had PFS rates of 84.3%, while patients in the VRd group’s rate was 67.7%. They also found that the overall response rate to D-VRd was better (87.9%) than in the VRd group (70.1%), and the D-VRd group had improved MRD-negative status (75.2% vs 47.5%). In the VRd group, 10 more patients died than in the D-VRd group (44 vs 34). Dr Sonneveld and colleagues did find that the adverse event rates that occurred in both groups were similar to each other. The most common adverse events were neutropenia and thrombocytopenia.
“The addition of subcutaneous daratumumab to VRd induction and consolidation therapy and to lenalidomide maintenance therapy conferred a significant benefit with respect to progression-free survival among transplantation-eligible patients with newly diagnosed multiple myeloma,” the authors wrote.
In conclusion, Dr Sonneveld and colleagues were able to complete their initial goals in this study and found that PFS rates, MRD-negative status, and patients’ overall response rate were all improved in the D-VRd group in comparison to the VRd group.
Source: Sonneveld P, Dimopoulos MA, Boccadoro M, et al. Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma. The New England Journal of Medicine. Published online December 12, 2023. doi:10.1056/nejmoa2312054
