Dr Callander on Investigational Maintenance Regimens in Multiple Myeloma

Natalie S. Callander, MD, associate professor, Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health; director, University of Wisconsin Carbone Cancer Center Myeloma Clinical Program, discusses the significance of the phase 3 ATLAS (NCT02659293), phase 2 FORTE (NCT02203643), and phase 2 MASTER (NCT03224507) trials in patients with multiple myeloma.

The University of Wisconsin School of Medicine and Public Health participated in the minimal residual disease (MRD)–guided MASTER trial, which evaluated the quadruplet consolidation regimen comprised of daratumumab (Darzalex), lenalidomide (Revlimid), carfilzomib (Kyprolis), and dexamethasone (KRd) in patients with newly diagnosed multiple myeloma who had undergone autologous hematopoietic cell transplantation, Callander says. At a median follow-up of 25.1 months, 80% of patients had achieved MRD negativity. The 2-year progression-free survival (PFS) rate was 87%.

Additionally, findings from the FORTE trial support the use of carfilzomib plus lenalidomide as maintenance therapy in this population, Callander explains. In the maintenance setting, FORTE randomized patients with newly diagnosed multiple myeloma to receive either carfilzomib plus lenalidomide or lenalidomide alone after induction and consolidation therapies. At a median follow-up of 37.3 months from maintenance randomization, the 3-year PFS rate was 75% in patients who received carfilzomib plus lenalidomide vs 65% in those who received lenalidomide alone.

Another trial, ATLAS, is investigating KRd vs lenalidomide alone as maintenance therapy in patients with newly diagnosed multiple myeloma who have undergone autologous stem cell transplant. Findings from the interim analysis from this trial showed that, at a median follow-up of 33.8 months, patients who received KRd achieved a median PFS of 59.1 months vs 41.4 months for those who received lenalidomide alone.

Although more research is necessary to determine the most effective maintenance strategy for patients with newly diagnosed multiple myeloma, the data from ATLAS support the use of triplet combinations in the maintenance setting, which may be particularly beneficial for high-risk patients, Callander concludes.