Bita Fakhri, MD, MPH, a professor of medicine in the Division of Hematology/Oncology at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the data behind the frontline approval of daratumumab (Darzalex) in combination with bortezomib (Velcade), melphalan, and prednisone (VMP) in multiple myeloma.

In May 2018, the FDA approved daratumumab plus VMP for the treatment of patients with newly diagnosed disease who are ineligible for stem cell transplant. The decision was based on phase III findings from the ALCYONE study. The study had outstanding results, Fakhri says, meeting all its efficacy endpoints. The progression free survival at about 16 months was significantly better in the daratumumab with VMP group compared with VMP alone. The objective response rate was also much higher, notes Fakhri.

VMP is a primarily European regimen that is not often utilized by American physicians, states Fakhri. However, the approval dispels the notion that elderly and frail patients cannot tolerate combination therapy. Not only did these patients benefit in the trial, but they were able to tolerate it very well. The toxicity profiles were similar compared with the younger population, adds Fakhri.

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Dr. Fakhri on Daratumumab Plus VMP in Multiple Myeloma

Bita Fakhri, MD, MPH, a professor of medicine in the Division of Hematology/Oncology at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the use of carfilzomib (Kyprolis) in the treatment of patients with multiple myeloma.

Currently, physicians use 2 factors to pick a regimen for a patient—transplant eligibility versus ineligibility and the genomics of their disease, says Fakhri. In transplant-ineligible patients, the use of carfilzomib, lenalidomide (Revlimid), and dexamethasone (KRd) is not universally endorsed because there is the risk of pulmonary toxicity. However, in the relapsed/refractory setting, physicians have encouraging phase II data that indicate an improvement in progression-free and overall survival.

Based on the data in this setting, it makes sense to choose KRd as induction therapy for relapsed patients, states Fakhri. Another important aspect to consider is the regimen’s toxicity profile. Bortezomib (Velcade) is known to cause debilitating neuropathy, so a patient who has bad neuropathy should be kept away from that agent, Fakhri says.

Bita Fakhri, MD, MPH

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Dr. Fakhri on Daratumumab Plus VMP in Multiple Myeloma

Dr. Fakhri on the Use of Carfilzomib in Multiple Myeloma