Quadruplets come of age for newly diagnosed multiple myeloma
Mené dans 25 pays sur 706 patients atteints d'un myélome multiple récemment diagnostiqué et inéligibles à une greffe autologue de cellules souches, cet essai de phase III évalue l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la toxicité de l'ajout du daratumumab à un traitement combinant bortézomib, melphalan et prednisone (durée médiane de suivi : 40,1 mois)
To say that the management of newly diagnosed multiple myeloma has changed in the past decade is a cliché. Deep responses are considered an important goal for both transplant-eligible and transplant-ineligible multiple myeloma, not only to help alleviate sequelae of disease but also to improve both progression-free survival and overall survival. Daratumumab, a human IgG
κ CD38-targeting monoclonal antibody, was initially introduced in the schema of relapsed or refractory multiple myeloma as monotherapy in 2015
· Daratumumab has now made its way to newly diagnosed multiple myeloma in combination with existing regimens, with three phase 3 clinical trials reading out favourably to its addition to induction, consolidation, and maintenance phases of treatment. Of these three trials, ALCYONE and MAIA
used daratumumab in combination therapies to treat transplant-ineligible, newly diagnosed multiple myeloma, showing benefit in progression-free survival as the primary endpoint ( appendix). CASSIOPIEA used daratumumab in a combination therapy to treat transplant-eligible, newly diagnosed multiple myeloma, and showed improvement in post-induction complete response rates as the primary endpoint. The main downside appears to be an increase in grade 1 or 2 infection rates, which is an important clinical consideration but did not affect survival outcomes.
The Lancet , commentaire, 2018