Dr Shah Highlights Benefits of Pomalidomide in Patients With MM

Nina Shah, MD, Professor of Clinical Medicine, University of California San Francisco, presented pomalidomide as a superior treatment versus carfilzomib for patients with multiple myeloma (MM) after first relapse during the virtual Great Debates & Updates in Hematologic Malignancies.

Dr Shah emphasized the importance of patient factors in myeloma therapy selection, especially for patients who relapse. These characteristics include age, frailty, performance status, lifestyle, drug metabolism, and comorbidities. Other important factors to evaluate include drug toleration, disease burden, and previous treatment exposure.

“The OPTIMISMM study looked at pomalidomide, bortezomib, and dexamethasone versus bortezomib-dexamethasone in relapsed or refractory (R/R) MM for patients with 1 to 3 prior regimens. Patients who received the triplet combo had better outcomes with the addition of pomalidomide,” explained Dr Shah.

In a subgroup of patients with 1 prior line of therapy, the median progression-free survival (PFS) rate was 20.73 months with the triplet regimen versus 11.64 months with the doublet regimen. Further, Dr Shah highlighted response depth from the addition of pomalidomide, with 52.7% of patients having a very good partial response (VGPR) versus 18.3% for those who received the doublet regimen.

“The APOLLO study was very important as well, which looked at subcutaneous daratumumab plus pomalidomide and dexamethasone versus pomalidomide and dexamethasone alone in patients with R/R MM,” continued Dr Shah.

Overall, 85% of patients had 2 or more previous line of therapy and were refractory to lenalidomide. The triplet regimen was potent and showed improved responses versus pomalidomide-dexamethasone with a median PFS rate of 12.4 months versus 6.9 months. Similarly, the overall response rate (ORR) and depth of response was significantly better in the triplet treatment.

Dr Shah also shared insights on treatment-related adverse events (TEAEs) with pomalidomide relative to cytopenias. Pomalidomide combinations are associated with increased neutropenia and infections. However, these events are typically grade 1 or 2.

Notably, results of a phase 1 study of carfilzomib, pomalidomide, and dexamethasone in heavily pretreated patients (6 prior lines) achieved a 50% ORR. This regimen was also studied for cost effectiveness versus pomalidomide-dexamethasone in this patient population.

“In a matched adjusted indirect comparison analysis, pomalidomide-dexamethasone was more cost-effective. Carfilzomib is not a cheap drug, it’s IV, and there’s a lot of associated costs. As expenses increase, pomalidomide-dexamethasone outweighs carfilzomib significantly as the most cost-effective option,” elaborated Dr Shah.

Real world outcome data from the study show that patients who received pomalidomide-dexamethasone had 23 visits in the first year of treatment that totaled to 25 hours versus 78 visits that totaled to 156 hours for those who received the triplet regimen.

“Clinical trial data is not the real world. We have patients with MM who are running a marathon in their journey of disease because this is an incurable disease. We have to think about dosing modifications, toxicities, patient preferences, and logistics,” concluded Dr Shah.-Alexa Stoia