Dr. Landgren on Questions After POLLUX and CASTOR Studies in Myeloma

C. Ola Landgren, MD, PhD, chief of Myeloma Service at Memorial Sloan Kettering Cancer Center, discusses unanswered questions following the results of the phase III POLLUX and CASTOR studies, which explored the addition of daratumumab (Darzalex) to lenalidomide (Revlimid) and dexamethasone or bortezomib (Velcade) and dexamethasone, respectively.

It is very exciting to see how the monoclonal antibodies are moving down the pipeline into the myeloma field, Landgren explains. The FDA approved the use of daratumumab as a single agent in November 2015, and now the agency gave approval of daratumumab in combination with lenalidomide/dexamethasone and bortezomib/dexamethasone, based on the results of these studies, he adds.

These regimens are changing the treatment landscape here in the United States, as many patients will start receiving monoclonal antibodies as their relapsed treatment. For patients who are treated at academic centers, they will typically receive a 3-drug combination of an immunomodulatory proteasome inhibitor, and a low-dose steroid with or without transplant. If they relapse, then daratumumab in combination with either lenalidomide/dexamethasone or bortezomib/dexamethasone are very valid options, he says.

However, there are still other options beyond these combinations. Regimens explored in the ASPIRE, TOURMALINE-MM1, and ELOQUENT trials are also promising, Landgren adds.