Current Clinical Algorithms and Recent Therapeutic Advances in the Management of Multiple Myeloma and Related Blood Disorders (Video Program)Case discussion: A 76-year-old man with relapsed/refractory MM receives pomalidomide with daratumumab
3:16 minutes.
TRANSCRIPTION:
DR LOVE: How about, Rafael, if you do your 76-year-old man who got the dara/pom? And, again, maybe just try to kind of get the highlights there and see if we can pose something to Noopur? DR FONSECA: Sure. I have this case of this gentleman who’s age 76, a world traveler who’s been through multiple lines of therapy, who was facing a relapse. Just to recap briefly, he was treated first with thalidomide and dexamethasone many years ago, then got melphalan and prednisone in November of 2006 and completed a year’s worth of treatment. So we’re going way back here. DR LOVE: You took care of him then? DR FONSECA: I intervened a little bit later than that. I met him later. And then he had biochemical evidence of relapse. And we started him on lenalidomide/dexamethasone in 2010, which he carried on for 6 years. He was a happy camper. He was traveling. He would come in for his refills, started spacing out appointments, but ultimately what we found is that the free light chain started going up on this patient. And we actually talked about the many treatment options, but given some of the data that had been emerging, he was very interested in continuing with an IMiD-based approach. So we actually talked about starting daratumumab/pomalidomide and dexamethasone. DR LOVE: What about adding in elo? DR FONSECA: Well, that’s an option. That was another option that was discussed with him. But a very well-versed individual, I think — had started to see some of the early data regarding dara-based combinations. And that’s how we went with this particular combination. Just prior to that, we actually had tried ixazomib/Rd. And that was based, again, on this notion, “I don’t really want to come for infusions. Is there something you can do?” He did well, tolerated it well, but didn’t have the effect, and the patient progressed. By June, we had a free light chain in the midforties. We use milligrams per deciliter here, so 460, if your lab uses milligrams per liter. So we were at 46. And we started that. And now it’s October, so it’s 4 months into it, and that has normalized. And this is in a patient who was clearly progressing on lenalidomide and dexamethasone. And he’s doing very well. He tolerated the infusions very, very well. And we’re going to be soon switching to the monthly infusion of the daratumumab. So here’s a person who’s been able to come along now for greater than 11 years on therapy and is strictly into a complete response again based on the parameters that we have. DR LOVE: Now, you chose to give him pomalidomide. DR FONSECA: Yes. DR LOVE: With daratumumab. What about a proteasome inhibitor? DR FONSECA: That could be done. DR LOVE: Why, in this man, did you choose pomalidomide? DR FONSECA: Just because we had used ixazomib, and we didn’t get the results we wanted. But also — and we can talk more about this, and it’s still an interesting point of debate — I like more the IMiDs with daratumumab than the proteasome inhibitors with daratumumab. Both have the same hazard ratios, both studies, but when you look at the time, look at progression-free survival, I think dara/Rd is probably the best clinical trial we’ve ever had for progression-free in myeloma, relapsed/refractory. And we think probably similar results will come out with pomalidomide. |