Drug that improves survival in multiple myeloma

Morbidity in Spain multiple myeloma (MM) accounts for about three cases per 100,000 inhabitants per year. It is a disease that Usually appears between the sixth and seventh decades of life.often diagnosed by chance. Spain is in a privileged position As for its diagnosis and treatment, thanks to the professionals who make up its health care system, who are “very well trained” and have “great international prestige.” In addition to the high level of health care, there is access to numerous clinical studies that allow patients to be treated with innovative treatments.

In this context, Paula Rodriguezhematologist at the University Hospital of Navarra, summarized the latest therapeutic options presented in the latest Congress of the European Hematology Association (EHA), with an emphasis on the capabilities offered by the fours, that is, using four drugs instead of three (a monoclonal agent, proteasome inhibitor, immunomodulator and corticosteroid) to treat this disease in newly diagnosed patients, achieving higher response rates, deeper prognosis and increased progression-free survival; and with daratumumab as one of the greatest heroes because of the benefits it offers.

“Daratumumab is a drug that we already know very well, the fundamental basis for the treatment of myeloma. We have been using it for many years, first in relapse and now as a first-line treatment. It has several advantages, as it combines very well with other common treatments and has a very manageable safety profile,” the doctor explains. Adding this option ultimately improves the quality of responses and increases the likelihood that patients achieve a deep response, according to the specialist.

“In myeloma, we know that achieving a complete response with negative minimal residual disease is the way to ensure that that patient either never relapses, or if they do relapse, they do so as late as possible,” he says.

Johnson & Johnson recently announced the results of three studies confirming the effectiveness of treatment regimens based on the drug. Darlaex (daratumumab) significantly improve patient outcomes across a range of profiles. The first of these is a phase 3 study called Perseus, which demonstrates deepening of responses and maintenance of negative minimal residual disease when the drug is used with this drug together with bortezomib, lenalidomide and dexamethasone (D-VRd) followed by a maintenance regimen. with daratumumab subcutaneously and lenalidomide (DR) for the treatment of people with newly diagnosed multiple myeloma who are candidates for transplant. These outcomes, in turn, were associated with superior progression-free survival with the daratumumab-based quadruple regimen compared with VRD in this group.

But what do these results mean? Rodriguez insists that it is The study sets a paradigm, a new standard. He also explains that minimal residual disease is an “earlier” marker that can predict progression-free survival. “If relapse never occurs or relapse is delayed, the patient will need fewer lines of treatment, and the more effective the treatment, the faster the improvement,” he concludes.

“Daratumumab is a fundamental part of myeloma treatment”

Treatment of various stages of myeloma

The phase 3 Maia study is focusing on people aged 45 to 90 who are not transplant candidates, with an average age of 73. Rodriguez describes the results as “robust” and stresses that this is the longest overall survival recorded to date among older people.. Follow-up data in this report detail a median overall survival of 7.5 years for daratumumab plus lenalidomide and dexamethasone, with a 33 percent reduction in the risk of death compared with lenalidomide plus dexamethasone (Rd) in people with newly diagnosed multiple myeloma who are not transplant candidates, demonstrating the efficacy of this drug in the first-line setting in this type of profile.

But not only can this drug be used as a first-line treatment, it also has its place in support of new diagnoses of transplant candidates. The doctor explains that there was already scientific evidence that using daratumumab at this stage was a better therapeutic option, as it increased progression-free survival than not using any drug. However, the question remained whether this positive result was maintained when the patient was treated with the same drug in the early part of MM, and was resolved with Cassiopeia Phase 3 Study“We see that those who have higher rates of negative response to residual disease are the ones who are using this drug as an injection, consolidation and maintenance treatment,” he says.

The Future of Myeloma Treatment

Despite all the advances and the addition of new indications to the well-known drug, there is still a long way to go. At the moment, It is impossible to predict this pathology.that is, treating it at a precancerous stage in general. But yes, for those people who have a high level of progression, mainly due to clinical trials.

“This is what is currently being assessed. It is true that myeloma is a disease that develops from a precancerous pathology, but today we are not sure of the factors that allow us to predict with 100% which patients will progress to myeloma and which will not. “So, the treatment of asymptomatic myeloma is offered in the context of clinical trials for patients with MM at high risk of progression to an active form,” he defends.