A Review of the Treatment for Multiple Myeloma - Episode 9

Daratumumab in the Treatment Landscape for MM

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Keith Stewart, MB, ChB: I want to move on, because we’re getting close to the end here. I just want to ask sort of rapid-fire here. The 2 trials with daratumumab have been in elderly, nontransplant-eligible patients. How is this going to impact your use of that drug in a younger population, or do you have to wait for RVd [lenalidomide, bortezomib, dexamethasone]—daratumumab trials?

Rafael Fonseca, MD: Honestly, I don’t know what we’re waiting for but I’m still waiting. I’m using KRd [carfilzomib, lenalidomide, dexamethasone] as frontline.

Keith Stewart, MB, ChB: It’s not covered by insurance, right?

Rafael Fonseca, MD: Yeah. But I’m not sure…people could play around the system. But I think we’ll have the results of the clinical trials pretty soon. And it’s important to know as well, too, that we know that there’s myelosuppression with daratumumab. We see that in combination with IMiDs [immunomodulatory drugs]. I don’t think it’s the case, but we just need to make sure of the whole process of stem cell collection and everything is correct.

Keith Stewart, MB, ChB: And that there are no infectious deaths to overcome worse than the myeloma.

Rafael Fonseca, MD: Sure.

Andrzej Jakubowiak, MD, PhD: Well we have first evidence, which will be presented at this meeting in transplant setting from the CASSIOPEIA trial, which is using a triplet but…

Keith Stewart, MB, ChB: That was...thalidomide, dexamethasone with or without daratumumab.

Andrzej Jakubowiak, MD, PhD: With or without daratumumab, and in transplantation. This is first evidence that daratumumab is improving the outcome in these patients, depths of response, and some other parameters. I think that the writing is already on the wall. We will be using antibody, with triplets.

Keith Stewart, MB, ChB: Have you started using it? I mean, if I’m a payer though, I’m going to wait for those trials before I pay for it.

Andrzej Jakubowiak, MD, PhD: After the clinical trial I would not be able to do it. I will not get approval. But we are in the fortunate position that we have almost every patient segment able to enroll in quadruplet therapy with antibody.

Keith Stewart, MB, ChB: And are you hearing from patients or other community providers you interact with about where they think daratumumab is going to be in younger patients?

Mary E. DeRome: People are very interested in daratumumab and in the monoclonal antibody therapies in general. I think people are looking forward to that. They know it’s coming, and they’re looking forward to having access to that in the frontline.

Keith Stewart, MB, ChB: Well, I think what we heard, then, is that both for younger and older patients, triplets are sort of the current standard. We’re hearing a lot of enthusiasm for using daratumumab to replace 1 of the drugs or perhaps add. But we do feel there’s a little bit of a requirement for some more trials to make sure the safety signal is reasonable. I think we also heard from all of you that MRD [minimal residual disease]—negative status is optimal, and it may 1 day give us a reason to not have to treat for years on end if these drugs are as affective as we think they would be.