Nina Shah, MD: Ola, in thinking about different options, we’ve talked about DKd [daratumumab, carfilzomib, dexamethasone], but what about the IKEMA trial using isatuximab? Can you summarize that trial briefly? Talk about where you might use isatuximab, its toxicities, and the outcomes that are in a way still pending.

Ola Landgren, MD, PhD: The CANDOR trial uses carfilzomib with daratumumab-dexamethasone. This other study, IKEMA, somewhat mirrors the design. It’s carfilzomib-dexamethasone, but instead of daratumumab, we have isatuximab, the other CD38-targeted monoclonal antibody that we have in multiple myeloma. The dosing for carfilzomib in this study is the same as in the CANDOR study. It’s twice a week. The difference between the antibodies from a clinical point of view is that the isatuximab is still an infusional drug. It’s an IV [intravenous] drug. Daratumumab is both IV and subcutaneous. It was developed in CANDOR as IV but has been updated as also subcutaneous.

The IKEMA regimen is the alternative. It’s FDA approved. All the clinicians are wondering if you could go from CANDOR to IKEMA or from IKEMA to CANDOR. How does that work? We don’t have any data to show sequence, which is similar to most other regimens, where we have these same questions. My gut feeling is that it’s probably a good idea to go to some other therapy in between, because after all, they target the similar thing, the CD38 molecule. We can look at these antibodies, and they’re slightly different. The mechanisms of action aren’t identical. The molecular details of these drugs aren’t identical. But in my experience, the clinical difference isn’t that strong, so I’d throw another therapy in between. As for the adverse effect profile, they’re very similar to each other in a very simple way.

Nina Shah, MD: Yes, and it’s sometimes hard to know the true differences between these 2 studies because they’re done separately. It’s hard to compare, and the patients might be a bit different between the 2. We know that the median PFS [progression-free survival] of IKEMA is still pending for the isatuximab-carfilzomib-dexamethasone arm, so we’ll see what happens. But the control arm also did very well. You brought up a good point about prior CD38 therapy.

Transcript Edited for Clarity