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How Is Daratumumab Used to Treat Myeloma?

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Published on April 7, 2020

Key Takeaways

Daratumumab (Darzalex) has come a long way since it was first FDA-approved in 2016. At first, it was being used for myeloma patients who had been on prior therapies, and now it’s in development for many other uses to treat myeloma in multiple settings. Where are things in this process?

From a recent conference, a panel of experts including Dr. Nina Shah of UC San Francisco and Dr. Faith Davies of NYU Langone discuss the evolution of daratumumab and how it is being looked at in clinical trials today. Watch as the experts cover its use in combination and maintenance therapy and what side effects to watch out for.

This program is sponsored by GSK and Karyopharm. These organizations have no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.

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Transcript | How Is Daratumumab Used to Treat Myeloma?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jenny Ahlstrom:                                 

Hello, my name is Jenny Ahlstrom, and I’m the founder of Myeloma Crowd, and welcome to Patient Power. Today we have with us three myeloma experts at the ASH Hematology 2019 meeting. And we’re really thrilled to have them with us and to talk about all the amazing advances that are happening. So, thank you, doctors, for coming.

We have with us Faith Davies from NYU, we have Larry Anderson from UT Southwestern, and we have Nina Shah from University of California in San Francisco, UCSF, and there’s so much to talk about.                     

There’s a lot going on also in the CD38 category with daratumumab (Darzalex) and isatuximab (Sarclisa) is getting closer to approval. And a new Takeda drug is being developed going after this same CD38 target.

So sometimes people are talking about using daratumumab or those types of drugs as maintenance therapy, which we haven’t really heard before. And new combinations, like the CANDOR study that’s combining carfilzomib (Kyprolis)that’s a whole different topic.

Dr. Shah:                      

Yeah, I think daratumumab has had this whole evolution. Four years ago, it was just something you used as the last thing, and now it’s developed so rapidly. So now, and then it was the first relapse we’d use it, now it’s we use it up front. So, there are four trials looking at daratumumab up front and all of those, thus far, have been positive.

Although the GRIFFIN study, which is going to published at this meeting also, is not positive from progression-free survival yet. It’s positive from depth of response. 

So, what’s happening is we’re going to start using daratumumab more in the front-line setting and then the question will be maintenance. And there are a couple of trials looking at that. There’s one with the Southwestern Oncology Cooperative Group, SWOG. And there’s another trial, where if you’re MRD-positive after transplant, you can be randomized to get lenalidomide (Revlimid) or lenalidomide and daratumumab. And the end point is MRD, which I think is actually a cool end point, trying to see if we can get patients into MRD negativity as a surrogate really, for survival because we know it does correlate.

So, I think daratumumab is going to move to be part of our sort of natural front-line, potentially maintenance therapy, and then it’ll be what next.

Dr. Anderson:               

And do we need to stay on it indefinitely? Should we stop it at two years? Those are other questions with daratumumab maintenance as well.

Dr. Davies:                    

And it’s been—I guess it’s two things I want to say. First one is around daratumumab. And from a patient perspective, just being really careful around infections, because we do know that patients can sometimes get some unusual infections, so coughs and chest infections and so on, particularly when patients have been having it for a wee while, so that was one thing.

But also, there’s been other information at this meeting about maybe using proteasome inhibitors as maintenance, so ixazomib with maintenance. And then obviously, we all know the data of lenalidomide (Revlimid) at maintenance. And so, we now have a choice of different potential maintenance therapies. Some of them are not approved by the FDA for maintenance yet, but there’s evidence there to suggest they’re going to be beneficial.

And again, we always come down to which is the best option for patients. And I think we’re in the same situation. I’m not sure at the moment we know which is the best option. However, we have three very good options. And it may be, in the long run, as Dr. Shah said, the best option is actually putting two of them together, two of those things, so.

Jenny Ahlstrom:                          

Right. And when you have a monoclonal antibody maybe and you’re adding that to maintenance, maybe there’s not a lot of that extra side effect to it, so you can do that. Or for high-risk patients, maybe you should be using that proteasome inhibitor or…?

Dr. Anderson:               

...yeah, high-risk, we routinely use a proteasome inhibitor plus an -imid maintenance. I’m not sure what you guys are doing.

Dr. Shah:                      

Yeah, we do. We give consolidation after transplant and use a modified version of that for maintenance. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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