Philip McCarthy, MD
Commenting on the updated results of the MAIA trial1 for The ASCO Post was Philip McCarthy, MD, Professor of Oncology and Internal Medicine and Director of the Transplant and Cellular Therapy Center at Roswell Park Comprehensive Cancer Center, Buffalo, New York. Dr. McCarthy described how the results from MAIA and other trials of daratumumab are building upon each other to validate this drug’s benefit in multiple myeloma.
“It is very exciting to see the most recent update of the MAIA trial, which first demonstrated a progression-free survival benefit in 2019.2 The results are very mature, with a median follow up of more than 4.5 years,” he said.
“Dr. Facon and colleagues presented the study update at EHA 2021, now showing an overall survival benefit for transplant-ineligible patients newly diagnosed with multiple myeloma receiving induction therapy with daratumumab plus lenalidomide and dexamethasone (D-Rd) when compared with lenalidomide/dexamethasone (Rd) treatment until disease progression or toxicity. The overall survival benefit with D-Rd was seen even with the option for crossover to the study arm for patients given Rd who experienced disease progression,” he noted.
“This is an older population for whom subsequent salvage therapies could be problematic due to comorbidities. Thus, a high overall response rate, prolonged duration of therapy, and tolerability are important,” he emphasized.
Dr. McCarthy further noted how the current study differs from some previous studies in that patients on both arms received therapy until disease progression or toxicity and not for a fixed duration. “This is consistent with the current standard of continuing therapy to control disease long term,” he said.
What Next?
“We look forward to the updated results of the CASSIOPEIA3 and GRIFFIN4 trials comparing daratumumab/lenalidomide with lenalidomide alone for maintenance therapy after induction therapy and autologous stem cell transplantation,” Dr. McCarthy continued. “Future studies will examine the role of daratumumab/lenalidomide along with other agents alone or in combination for long-term disease control,” he said.
“As patients with myeloma are able to derive increasing long-term benefit from continued therapy,” Dr. McCarthy stated, “the use of tests such as minimal residual disease evaluation of the bone marrow by flow cytometry and/or next-generation sequencing as well as mass spectrometry evaluation of monoclonal proteins in the peripheral blood will be evaluated as surrogate markers for long-term outcome.”
DISCLOSURE: Dr. McCarthy has received honoraria from Bristol Myers Squibb, Celgene, Janssen, Karyopharm Therapeutics, Oncopeptides, Sanofi, and The Binding Site; has served as a consultant or advisor to Bluebird Bio, Bristol Myers Squibb, Celgene, Janssen, Karyopharm Therapeutics, Magenta, Sanofi, and The Binding Site; and has received institutional research funding from Celgene.
REFERENCES
1. Facon T, Kumar SK, Plesner T, et al: Overall survival results with daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: Phase 3 MAIA study. EHA 2021 Virtual Congress. Abstract LB1901. Presented June 12, 2021.
2. Facon T, Kumar S, Plesner T, et al: Daratumumab plus lenalidomide and dexamethasone for untreated myeloma. N Engl J Med 380:2104-2115, 2019.
3. Moreau P, Attal M, Hulin C, et al: Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): A randomised, open-label, phase 3 study. Lancet 394:29-38, 2019.
4. Voorhees PM, Kaufman JL, Laubach J, et al: Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma: The GRIFFIN trial. Blood 136:936-945, 2020.
