Dr. Lonial on the OPTIMISMM and ELOQUENT-3 Trials in Myeloma

Sagar Lonial, MD, professor and chair, Department of Hematology & Medical Oncology, Emory University School of Medicine, chief medical officer, Winship Cancer Institute of Emory University, discusses the OPTIMISMM and ELOQUENT-3 trials in patients with relapsed/refractory multiple myeloma.

Two large trials were presented at the 2018 ASCO Annual Meeting and the 2018 European Hematology Association Congress that used pomalidomide (Pomalyst) as part of a triplet regimen, says Lonial. The first trial, known as OPTIMISMM, examined the combination of pomalidomide, bortezomib (Velcade), and dexamethasone (PVd) versus bortezomib and low-dose dexamethasone (Vd) alone. The phase III trial was conducted in patients with relapsed/refractory myeloma with prior exposure to lenalidomide (Revlimid), explains Lonial.

The trial showed a median progression-free survival (PFS) of 11.20 months with PVd compared with 7.10 months with bortezomib and low-dose dexamethasone (Vd) alone (HR, 0.61; 95% CI, 0.49-0.77; P <.0001).

ELOQUENT-3 looked at the addition of elotuzumab (Empliciti) to pomalidomide and dexamethasone and found that the regimen cut the risk of disease progression or death by 46% compared with pomalidomide and dexamethasone alone. Median PFS was 10.3 months (95% CI, 5.6-not evaluable) with the elotuzumab combination compared with 4.7 months (95% CI, 2.8-7.2) with pomalidomide plus dexamethasone (HR, 0.54; 95% CI, 0.34-0.86; P = .0078). The results of the trial put the regimen alongside daratumumab (Darzalex), pomalidomide, and dexamethasone, says Lonial. This suggests that if patients get daratumumab earlier, elotuzumab, pomalidomide, and dexamethasone would be a good salvage therapy.