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1.
Blood. 2017 Aug 24;130(8):974-981. doi: 10.1182/blood-2017-05-785246. Epub 2017 Jun 21.

Daratumumab plus pomalidomide and dexamethasone in relapsed and/or refractory multiple myeloma.

Author information

1
Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY.
2
Indiana University School of Medicine and Simon Cancer Center, Richard L. Roudebush VA Medical Center, Indianapolis, IN.
3
Baylor Institute for Immunology Research, Dallas, TX.
4
Unité d'Immuno-hématologie, Assistance Publique-Hôpitaux de Paris, Centre d'Investigations Cliniques 1427, Hôpital Saint Louis Lariboisière, Paris, France.
5
Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
6
James P. Wilmot Cancer Center, University of Rochester Strong Memorial Hospital, Rochester, NY.
7
Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
8
The Judy and Bernard Briskin Myeloma Center, City of Hope, Duarte, CA.
9
Columbia University Medical Center, New York, NY.
10
Division of Hematology-Oncology, Tufts Medical Center, Boston, MA.
11
Janssen Research & Development, Raritan, NJ; and.
12
Janssen Research & Development, Spring House, PA.

Abstract

Daratumumab plus pomalidomide and dexamethasone (pom-dex) was evaluated in patients with relapsed/refractory multiple myeloma with ≥2 prior lines of therapy who were refractory to their last treatment. Patients received daratumumab 16 mg/kg at the recommended dosing schedule, pomalidomide 4 mg daily for 21 days of each 28-day cycle, and dexamethasone 40 mg weekly. Safety was the primary end point. Overall response rate (ORR) and minimal residual disease (MRD) by next-generation sequencing were secondary end points. Patients (N = 103) received a median (range) of 4 (1-13) prior therapies; 76% received ≥3 prior therapies. The safety profile of daratumumab plus pom-dex was similar to that of pom-dex alone, with the exception of daratumumab-specific infusion-related reactions (50%) and a higher incidence of neutropenia, although without an increase in infection rate. Common grade ≥3 adverse events were neutropenia (78%), anemia (28%), and leukopenia (24%). ORR was 60% and was generally consistent across subgroups (58% in double-refractory patients). Among patients with a complete response or better, 29% were MRD negative at a threshold of 10-5 Among the 62 responders, median duration of response was not estimable (NE; 95% confidence interval [CI], 13.6-NE). At a median follow-up of 13.1 months, the median progression-free survival was 8.8 (95% CI, 4.6-15.4) months and median overall survival was 17.5 (95% CI, 13.3-NE) months. The estimated 12-month survival rate was 66% (95% CI, 55.6-74.8). Aside from increased neutropenia, the safety profile of daratumumab plus pom-dex was consistent with that of the individual therapies. Deep, durable responses were observed in heavily treated patients. The study was registered at www.clinicaltrials.gov as #NCT01998971.

PMID:
28637662
PMCID:
PMC5570682
DOI:
10.1182/blood-2017-05-785246
[Indexed for MEDLINE]
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2.
Blood. 2017 Sep 7;130(10):1189-1197. doi: 10.1182/blood-2017-03-775122. Epub 2017 May 1.

Pembrolizumab, pomalidomide, and low-dose dexamethasone for relapsed/refractory multiple myeloma.

Author information

1
University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD.
2
Department of Pathology, University of Chicago, Chicago, IL; and.
3
Memorial Sloan Kettering Cancer Center, New York, NY.

Abstract

Programmed death 1 (PD-1) receptor and its ligand (PD-L1) facilitate immune evasion in multiple myeloma (MM). We hypothesized that pembrolizumab, PD-1-antibody, can enhance antimyeloma cellular immunity generated by pomalidomide, leading to improved clinical responses. In this single-center, phase 2 study, 48 patients with relapsed/refractory MM (RRMM) received 28-day cycles of pembrolizumab, 200 mg IV every 2 weeks, pomalidomide 4 mg daily for 21 days, and dexamethasone 40 mg weekly. Patients had a median of 3 (range: 2-5) lines of therapy, median age 64 (range: 35-83) years, and had received both an immune modulatory drug (IMiD) and proteasome inhibitor: (35 [73%] of 48) were refractory to both; (31 [70%]) had received an autologous transplant, and (30 [62%]) had high-risk cytogenetics. Adverse events grade 3 to 4 occurred in (19 [40%] of 48 patients), including hematologic toxicities (19 [40%]), hyperglycemia (12 [25%]), and pneumonia (7 [15%]). Autoimmune events included pneumonitis (6 [13%]) and hypothyroidism (5 [10%]), mostly ≤ grade 2. Objective responses occurred in (29 [60%] of 48) patients, including stringent complete response/complete response (4 [8%]), very good partial response (9 [19%]), and partial response (16 [33%]); median duration of response was 14.7 months. At median follow-up of 15.6 months, progression-free survival (PFS) was 17.4 months and overall survival was not reached. Analyses of pretreatment marrow samples revealed a trend for increased expression of PD-L1 in responding patients and longer PFS with increased T-lymphocyte infiltrates, irrespective of PD-1 expression. Pembrolizumab, pomalidomide, and low-dose dexamethasone have acceptable safety and durable responses in RRMM patients. This trial was registered at www.clincialtrials.gov as #NCT02289222.

PMID:
28461396
DOI:
10.1182/blood-2017-03-775122
[Indexed for MEDLINE]
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