CASSIOPEIA: daratumumab added to bortezomib, thalidomide and dexamethasone before and after transplant in newly diagnosed myeloma
Adding the antibody daratumumab to a standard three-drug induction and consolidation around autologous transplant deepened responses and delayed progression in newly diagnosed myeloma, establishing four-drug induction.
Overview
Phase 3 trial of 1,085 transplant-eligible patients with newly diagnosed multiple myeloma randomised to bortezomib, thalidomide and dexamethasone with or without daratumumab for induction and consolidation around autologous stem cell transplant.
Stringent complete response after consolidation was 29 percent with daratumumab against 20 percent without, measurable residual disease negativity 64 versus 44 percent, and progression-free survival was improved (hazard ratio 0.47 at the first analysis).
- Stringent complete response 29 percent vs 20 percent after consolidation.
- Measurable residual disease negativity 64 percent vs 44 percent; 18-month progression-free survival 93 percent vs 85 percent.
Quadruplet induction with a CD38 antibody became the standard for transplant-eligible patients in Europe. PERSEUS later did the same with the lenalidomide-based backbone used elsewhere.
- Thalidomide-based backbone is used less in the United States.
- The second randomisation to daratumumab maintenance showed benefit mainly in those who had not received daratumumab induction.
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