Daratumumab (DARA) in combination with bortezomib plus dexamethasone (D-Vd) or lenalidomide plus dexamethasone (D-Rd) in relapsed or refractory multiple myeloma (RRMM): Subgroup analysis of the phase 3 CASTOR and POLLUX studies in patients (pts) with early or late relapse after initial therapy.

Authors

null

Andrew Spencer

Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, Australia

Andrew Spencer , Philippe Moreau , Maria-Victoria Mateos , Hartmut Goldschmidt , Kenshi Suzuki , Mark-David Levin , Pieter Sonneveld , Sung-Soo Yoon , Saad Zafar Usmani , Katja Weisel , Donna Ellen Reece , Tahamtan Ahmadi , Huiling Pei , Wendy Garvin Mayo , Xue Gai , Jodi Carey , Robin L. Carson , Meletios A. Dimopoulos

Organizations

Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, Australia, Hematology Department, University Hospital Hôtel-Dieu, Nantes, France, University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain, University Hospital Heidelberg, Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany, Japanese Red Cross Medical Center, Department of Hematology, Tokyo, Japan, Albert Schweitzer Hospital, Dordrecht, Netherlands, Erasmus MC Cancer Institute, Rotterdam, Netherlands, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, Memorial Sloan Kettering Cancer Center, New York, NY, Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada, Genmab US, Inc., Plainsboro, NJ, Janssen Research & Development, LLC, Titusville, NJ, Janssen Research & Development, LLC, Raritan, NJ, Janssen Research & Development, LLC, Beijing, China, Janssen Research & Development, LLC, Spring House, PA, National and Kapodistrian University of Athens, Athens, Greece

Research Funding

Pharmaceutical/Biotech Company

Background: High-risk multiple myeloma (MM) is often defined based on cytogenetic abnormalities (ie, t[4;14], t[14;16], and/or del17p); however, pts who relapse early (12-18 months) after initial therapy are considered a functional high-risk group that is also associated with poor prognosis. DARA, a human IgGκ monoclonal antibody targeting CD38, is approved in combination with standard-of-care regimens for MM. In the phase 3 CASTOR and POLLUX studies, D-Vd and D-Rd significantly improved progression-free survival (PFS), regardless of cytogenetic risk, and achieved higher rates of complete response or better (≥CR) and minimal residual disease (MRD)–negativity vs Vd or Rd alone in pts with RRMM. Post hoc analyses of CASTOR and POLLUX evaluated D-Vd vs Vd and D-Rd vs Rd in pt subgroups with 1 prior line of therapy based on timing of relapse (early or late) after initiation of the first line of therapy. Methods: In CASTOR and POLLUX, pts with RRMM and ≥1 prior line of therapy were randomized to D-Vd/Vd or D-Rd/Rd, respectively. The primary endpoint was PFS. In this analysis, the early relapse subgroup included pts with 1 prior line of therapy who relapsed <18 months after initiating their first line of therapy; pts with 1 prior line of therapy who relapsed ≥18 months after initiating their first line of therapy were included in the late relapse subgroup. Results: 49 and 186 pts from CASTOR and 99 and 196 pts from POLLUX were included in the early relapse and late relapse subgroups, respectively. Median follow-up was 72.6 months (CASTOR) and 79.7 months (POLLUX). PFS consistently favored the DARA-containing regimens across subgroups (Table). In CASTOR, ≥CR rates were higher with D-Vd vs Vd in the early relapse (21% vs 17%; P = 0.7360) and late relapse (51% vs 14%; P<0.0001) subgroups. In POLLUX, ≥CR rates were higher with D-Rd vs Rd in the early relapse (53% vs 12%; P<0.0001) and late relapse (62% vs 38%; P = 0.0012) subgroups. MRD-negativity rates (10–5) were higher with D-Vd/D-Rd vs Vd/Rd regardless of relapse timing (CASTOR: early, 13% vs 0%; P = 0.1476; late, 23% vs 3%; P<0.0001; POLLUX: early, 30% vs 4%; P = 0.0006; late, 34% vs 14%; P = 0.0009). Conclusions: These post hoc analyses of CASTOR and POLLUX showed PFS and depth of response benefits of DARA-containing regimens in patients with 1 prior line of therapy, regardless of relapse timing (early or late). Our results support the use of D-Vd and D-Rd in RRMM, including in pts who are considered functional high risk. Clinical trial information: NCT02136134 and NCT02076009.

Median PFS, months
D-Vd
Vd
HR (95% CI);
P value
D-Rd
Rd
HR (95% CI);
P value
Early relapse
15.4
9.0
0.51 (0.26-1.00); P = 0.0488
36.9
11.7
0.41 (0.26-0.65);
P = 0.0002
Late relapse
27.7
7.9
0.20 (0.14-0.29); P <0.0001
69.3
29.7
0.53 (0.37-0.77);
P = 0.0007

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Hematologic Malignancies—Plasma Cell Dyscrasia

Track

Hematologic Malignancies

Sub Track

Multiple Myeloma

Clinical Trial Registration Number

NCT02136134 and NCT02076009

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 8052)

DOI

10.1200/JCO.2022.40.16_suppl.8052

Abstract #

8052

Poster Bd #

475

Abstract Disclosures