Joshua Richter, MD
Joshua Richter, MD, Assistant Professor of Medicine, Hematology, and Medical Oncology at the Tisch Cancer Institute at Mount Sinai in New York, offered his thoughts on the CANDOR study, noting that the findings point to “a new and exciting treatment regimen for our patients with relapsed and refractory multiple myeloma.”
He continued: “For those patients who cannot tolerate (or are refractory to) immunomodulatory drugs, the combination of carfilzomib, dexamethasone, and daratumumab offers a highly effective triplet regimen with deep and durable responses. With an objective response rate of 84.3%, this regimen is on par with other triplet regimens in the early-relapse setting. The median progression-free survival has not yet been reached in the carfilzomib, dexamethasone, and daratumumab (KdD) arm. Similar regimens, such as daratumumab, lenalidomide/dexamethasone in the POLLUX trial, had a median progression-free survival of just over 44 months.1 However, the CANDOR study did allow lenalidomide-refractory patients (33% of subjects), denoting an overall more refractory group of patients than the comparator triplet trials.”
Dr. Richter further noted that the rate of treatment discontinuation due to adverse events was similar in both the carfilzomib/dexamethasone (Kd) and KdD arms, and the rate of grade ≥ 3 cardiac failure in the KdD arm was 3.9%. “This is encouraging, as we are able to move from a doublet to a triplet (and therefore enhance responses) in most patients now, without resulting in a marked increase in toxicity,” he commented.
“Overall, the KdD regimen offers an [immunomodulatory drug]-sparing triplet with high (and rapid) efficacy and manageable toxicity in the early-relapse setting. This is likely to become one of the standard regimens in the clinic,” Dr. Richter concluded. ■
DISCLOSURE: Dr. Richter has served on the speakers bureau for Celgene and Janssen and served as a consultant or advisor for Celgene, Janssen, Karyopharm, Oncopeptides, Adaptive Biotechnologies, and Antengene.
REFERENCE
1. Dimopoulos MA, San-Miguel J, Belch A, et al: Daratumumab plus lenalidomide and dexamethasone vs lenalidomide and dexamethasone in relapsed or refractory multiple myeloma: Updated analysis of POLLUX. Haematologica 103:2088-2096, 2018.
