Dr. Richter on the Utility of Isatuximab in Relapsed/Refractory Myeloma

Joshua Richter, MD, an assistant professor of medicine, and a hematologist/oncologist at Mount Sinai Hospital, discusses the utility of isatuximab-irfc (Sarclisa) in relapsed/refractory multiple myeloma.

The field is more familiar with daratumumab (Darzalex), which has been approved for some time, says Richter. However, earlier this year, the new anti-CD38 monoclonal antibody isatuximab was approved based on results from the phase 3 ICARIA-MM trial.

In the study, patients with relapsed/refractory myeloma were treated with either isatuximab plus pomalidomide (Pomalyst) and dexamethasone (Pd) or Pd alone. Although, daratumumab plus pomalidomide and dexamethasone is often used, its use is based on earlier phase 3 data, while the regimen of daratumumab plus Pd was based on phase 1/2 data from the EQUULEUS trial. 

In the ICARIA-MM study, the field is provided with a direct head-to-head comparison and the superiority of isatuximab plus Pd is demonstrated. These findings are important because many patients progress on lenalidomide in the second-line setting; they receive it either as maintenance after transplantation or continuously during induction therapy. These data support another option for patients with myeloma who are progressing on lenalidomide (Revlimid), adds Richter.

The regimen of isatuximab plus carfilzomib (Kyprolis) and dexamethasone, which was utilized in the phase 3 IKEMA study, represents another regimen that is highly advantageous for patients who are either progressing with very aggressive disease in the second-line setting or those for whom an immunomodulatory drug backbone is either not enough or not appropriate, adds Richter.

The combination of isatuximab plus carfilzomib and dexamethasone is an extremely effective regimen for patients with more aggressive relapses, concludes Richter.