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Expert Point of View: Sagar Lonial, MD, FACP


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Sagar Lonial, MD, FACP, the Anne and Bernard Gray Family Chair in Cancer, Chair and Professor of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, commented on the APOLLO trial for The ASCO Post. “APOLLO is a highly awaited study, as the use of daratumumab plus pomalidomide/dexamethasone is a commonly used regimen in the context of relapsed myeloma progressing on lenalidomide maintenance.”

“The study demonstrated significant activity, though in a later line of therapy than is often used for most patients with relapsed myeloma treated in the United States,” he pointed out. Since just 11% of patients enrolled in APOLLO had received one prior line of therapy, it is not possible to know the specific magnitude of benefit to be achieved in an earlier-relapse population, explained Dr. Lonial. “There is no reason to think the depth and duration of response in an earlier line of therapy wouldn’t be better, but that is extrapolating outcomes.”

Sagar Lonial, MD, FACP

Sagar Lonial, MD, FACP

“In the aggregate, the depth of response afforded by the addition of daratumumab was significant, both as measured by conventional response (ie, complete response) as well as by using more sensitive techniques, such as minimal residual disease [also known as measurable residual disease],” he further noted.

Most Patients Now Switched to Subcutaneous Dosing

Overall, Dr. Lonial concluded, the data “confirm the frequent use of this combination in relapsed myeloma” and show that subcutaneous dosing is preferred.

“We’ve switched to subcutaneous daratumumab for everyone except a few patients who report a few more side effects compared with the intravenous form, but that’s not very many at all,” he said. “Subcutaneous daratumumab is easier to administer, similar in cost, and better from the patient aspect.”

DISCLOSURE: Dr. Lonial holds stock or other ownership interests in TG Therapeutics; has served as a consultant or advisor to AbbVie, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen Oncology, Juno Therapeutics, Merck, Novartis, and Takeda; has received research funding from Bristol Myers Squibb, Celgene, and Takeda; and has held other relationships with TG Therapeutics.

 


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