
Daratumumab and Hyaluronidase-fihj–Based Quadruplet Regimen Approved in MM
Daratumumab/hyaluronidase-fihj plus bortezomib, lenalidomide, and dexamethasone is now approved by the FDA to treat newly diagnosed multiple myeloma (MM) in patients eligible for autologous stem cell transplant.
On July 30, the FDA approved the use of a novel induction/consolidation quadruplet therapy for newly diagnosed
This news follows J&J’s request for priority review by the FDA, meaning the pharma giant was requesting that a decision on the regimen’s approval be handed down in 6 months.3
The new treatment can be initiated as early as initial MM diagnosis in patients with previously untreated disease. An incurable blood cancer, MM is the second most common blood cancer in the world, with 35,000 new diagnoses expected in 2024 in the US alone.1
Data from the ongoing open-label, randomized, active-controlled PERSEUS study (
In PERSEUS, 709 patients were randomized 1:1 to D-VRd (n = 355) or VRd (n = 354), and they had to be 70 years or younger with an ECOG performance status of 0 to 2 to qualify for study enrollment.5 Similar to GRIFFIN, in which the PFS saw a 71% improvement (HR, 0.29; 95% CI, 0.06-1.48) with the quadruplet therapy,4 in PERSEUS, there was a 60% reduction in risk of disease progression or death (HR, 0.40; 95% CI, 0.29-0.57; P < .0001).
Treatment cycles in PERSEUS were 28 days. For those receiving D-VRD, there were 4 induction cycles with 1800-mg subcutaneous daratumumab, 1.3 mg/m2 subcutaneous bortezomib, 5 mg oral lenalidomide, and 40 mg oral or intravenous dexamethasone. Consolidation was delivered over 2 cycles of 1800-mg daratumumab and an identical VRd regimen.5
The most common adverse effects seen with D-VRd—those occurring in 20% or more of patients—were peripheral neuropathy, fatigue, edema, pyrexia, upper respiratory infection, constipation, diarrhea, musculoskeletal pain, insomnia, and rash.1
Further, there was a demonstrated significant advantage in both overall MRD negativity rate and MRD negativity among those who also achieved a complete response or better between the D-VRd and VRd cohorts, respectively1:
- Overall: 57.5% vs 32.5%
- Complete response or better: 76.6% vs 58.5%
“There is a continued need for innovation and therapies that employ different targets and combinations to provide patients with treatment options at diagnosis and throughout the course of their disease,” Amrita Y. Krishnan, MD, professor and director of the Judy and Bernard Briskin Multiple Myeloma Center, City of Hope, said
Subcutaneous Darzalex Faspro was first approved by the FDA in May 2020 for indications in MM that included new diagnosis, transplant ineligibility, and relapsed or refractory disease.6 At that time, it was approved as a fixed-dose treatment, and with this newest approval, the recommended dose is 1800-mg daratumumab/30,000 units hyaluronidase.2
References
1. Darzalex Faspro (daratumumab and hyaluronidase-fihj)-based quadruplet regimen approved in the U.S. for patients with newly diagnosed multiple myeloma who are transplant-eligible. News release. Johnson & Johnson. July 30, 2024. Accessed July 31, 2024.
2. FDA approves daratumumab and hyaluronidase-fihj with bortezomib, lenalidomide, and dexamethasone for multiple myeloma. News release. FDA. July 30, 2024. Accessed July 31, 2024.
3. Priority review. FDA. January 4, 2018. Accessed July 31, 2024.
4. Shaw M. Final GRIFFIN trial data confirm daratumumab benefit against MM. The American Journal of Managed Care®. July 10, 2024. Accessed July 31, 2024.
5. Sonneveld P, Dimopoulos MA, Boccadoro M, et al. Daratumumab, bortezomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2024;390(4):301-313. doi:10.1056/NEJMoa2312054
6. U.S. Food and Drug Administration approves Darzalex Faspro (daratumumab and hyaluronidase-fihj), a new subcutaneous formulation of daratumumab in the treatment of patients with multiple myeloma. News release. May 1, 2020. Accessed July 31, 2024.
Newsletter
Stay ahead of policy, cost, and value—subscribe to AJMC for expert insights at the intersection of clinical care and health economics.