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Zamagni E, Tacchetti P, Pantani L, Cavo M. Anti-CD38 and anti-SLAMF7: the future of myeloma immunotherapy. Expert Rev Hematol 2018; 11:423-435. [PMID: 29582696 DOI: 10.1080/17474086.2018.1456331] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION the high expression of a number of surface antigens on malignant plasma cells, the bone marrow micro-environment and immune effector T cells, makes these appealing targets for immune therapy with monoclonal antibodies (mAbs). Areas covered: Two mAbs, anti-CD38 daratumumab (Dara) and anti-SLAMF7 elotuzumab (Elo), have achieved recent regulatory approval for relapsed or refractory MM (RRMM) and are currently being explored as possible treatment options in novel combinations and different settings. This review discusses the current landscape and possible development of anti-CD38 and anti-SLAMF7 mAbs. Expert commentary: Three phase III trials demonstrated a significant advantage in terms of response and PFS when Dara or Elo are combined with lenalidomide-dexamethsone (Rd) or bortezomib-dexamethsone (Vd), in comparison to doublet regimens, for patients with RRMM. Treatment algorithms including Dara- or Elo-based triplets may be defined on the basis of disease and patients' characteristics, as well as of their prior exposure to different classes of novel agents. Evaluation of these agents in new combination regimens, including second and third generation PIs and IMiDs, are under investigation. Moreover, use of mAbs in phases of the disease where the immune system is less compromised, such as newly diagnosed MM or even high-risk smoldering myeloma, appears logical.
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Affiliation(s)
- Elena Zamagni
- a "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Paola Tacchetti
- a "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Lucia Pantani
- a "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Michele Cavo
- a "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
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Siegel DS, Dimopoulos MA, Ludwig H, Facon T, Goldschmidt H, Jakubowiak A, San-Miguel J, Obreja M, Blaedel J, Stewart AK. Improvement in Overall Survival With Carfilzomib, Lenalidomide, and Dexamethasone in Patients With Relapsed or Refractory Multiple Myeloma. J Clin Oncol 2018; 36:728-734. [DOI: 10.1200/jco.2017.76.5032] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose In the ASPIRE study of carfilzomib, lenalidomide, and dexamethasone (KRd) versus lenalidomide plus dexamethasone (Rd) in patients with relapsed or refractory multiple myeloma, progression-free survival was significantly improved in the carfilzomib group (hazard ratio, 0.69; two-sided P < .001). This prespecified analysis reports final overall survival (OS) data and updated safety results. Patients and Methods Adults with relapsed multiple myeloma (one to three prior lines of therapy) were eligible and randomly assigned at a one-to-one ratio to receive KRd or Rd in 28-day cycles until withdrawal of consent, disease progression, or occurrence of unacceptable toxicity. After 18 cycles, all patients received Rd only. Progression-free survival was the primary end point; OS was a key secondary end point. OS was compared between treatment arms using a stratified log-rank test. Results Median OS was 48.3 months (95% CI, 42.4 to 52.8 months) for KRd versus 40.4 months (95% CI, 33.6 to 44.4 months) for Rd (hazard ratio, 0.79; 95% CI, 0.67 to 0.95; one-sided P = .0045). In patients receiving one prior line of therapy, median OS was 11.4 months longer for KRd versus Rd; it was 6.5 months longer for KRd versus Rd among patients receiving ≥ two prior lines of therapy. Rates of treatment discontinuation because of adverse events (AEs) were 19.9% (KRd) and 21.5% (Rd). Grade ≥ 3 AE rates were 87.0% (KRd) and 83.3% (Rd). Selected grade ≥ 3 AEs of interest (grouped terms; KRd v Rd) included acute renal failure (3.8% v 3.3%), cardiac failure (4.3% v 2.1%), ischemic heart disease (3.8% v 2.3%), hypertension (6.4% v 2.3%), hematopoietic thrombocytopenia (20.2% v 14.9%), and peripheral neuropathy (2.8% v 3.1%). Conclusion KRd demonstrated a statistically significant and clinically meaningful reduction in the risk of death versus Rd, improving survival by 7.9 months. The KRd efficacy advantage is most pronounced at first relapse.
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Affiliation(s)
- David S. Siegel
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Meletios A. Dimopoulos
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Heinz Ludwig
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Thierry Facon
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Hartmut Goldschmidt
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Andrzej Jakubowiak
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Jesus San-Miguel
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Mihaela Obreja
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Julie Blaedel
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - A. Keith Stewart
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
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Frerichs KA, Nagy NA, Lindenbergh PL, Bosman P, Marin Soto J, Broekmans M, Groen RWJ, Themeli M, Nieuwenhuis L, Stege C, Nijhof IS, Mutis T, Zweegman S, Lokhorst HM, van de Donk NWCJ. CD38-targeting antibodies in multiple myeloma: mechanisms of action and clinical experience. Expert Rev Clin Immunol 2018; 14:197-206. [PMID: 29465271 DOI: 10.1080/1744666x.2018.1443809] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Multiple myeloma (MM) is generally an incurable hematological malignancy with heterogeneous overall survival rates ranging from a few months to more than 10 years. Survival is especially poor for patients who developed disease that is refractory to immunomodulatory drugs and proteasome inhibitors. Areas covered: This review will discuss the importance of CD38-targeting antibodies for the treatment of MM patients to improve their outcome. Expert commentary: Intense immuno-oncological laboratory research has resulted in the development of functionally active monoclonal antibodies against cell surface markers present on MM cells. In this respect, CD38-targeting antibodies such as daratumumab, MOR202, and isatuximab, have high single agent activity in heavily pretreated MM patients by virtue of their pleiotropic mechanisms of action including Fc-dependent effector mechanisms and immunomodulatory activities. Importantly, CD38-targeting antibodies are well tolerated, with infusion reactions as most frequent adverse event. Altogether, this makes them attractive combination partners with other anti-MM agents. Daratumumab is already approved as monotherapy and in combination with lenalidomide-dexamethasone as well as bortezomib-dexamethasone in pretreated MM patients. Furthermore, results from studies evaluating CD38-targeting antibodies in newly diagnosed MM patients are also promising, indicating that CD38-targeting antibodies will be broadly used in MM, resulting in further improvements in survival.
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Affiliation(s)
- Kristine A Frerichs
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Noemi Anna Nagy
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Pieter L Lindenbergh
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Patty Bosman
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Jhon Marin Soto
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Marloes Broekmans
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Richard W J Groen
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Maria Themeli
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Louise Nieuwenhuis
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Claudia Stege
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Inger S Nijhof
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Tuna Mutis
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Sonja Zweegman
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
| | - Henk M Lokhorst
- a Department of Hematology , VU University Medical Center , Amsterdam , The Netherlands
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Comeau JM, Kelly K, Jean GW. The role of elotuzumab in the treatment of relapsed or refractory multiple myeloma. Am J Health Syst Pharm 2018; 75:55-66. [PMID: 29317395 DOI: 10.2146/ajhp160554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The pharmacology, pharmacokinetics, clinical efficacy and safety, cost, and place in therapy of elotuzumab for treatment of relapsed or refractory multiple myeloma (MM) are reviewed. SUMMARY Elotuzumab is a humanized monoclonal antibody that targets the signaling lymphocytic activation molecule (SLAM) protein SLAMF7 and facilitates an antibody-dependent cellular cytotoxicity interaction between myeloma cells and natural killer cells. Elotuzumab has U.S. marketing approval for use in combination with lenalidomide and dexamethasone in patients with relapsed or refractory MM who have received 1-3 previous therapies; this regimen is among the preferred regimens for relapsed or refractory MM recommended by the National Comprehensive Cancer Network (NCCN). A Phase III trial involving 321 patients demonstrated a median progression-free survival duration of 19.4 months with elotuzumab plus lenalidomide and dexamethasone versus 14.9 months with lenalidomide and dexamethasone alone (hazard ratio for progression or death, 0.70; 95% confidence interval, 0.57-0.85; p < 0.001). Common adverse effects of elotuzumab-lenalidomide-dexamethasone therapy include hematologic toxicities, fatigue, pyrexia, diarrhea, constipation, muscle spasms, and cough. Elotuzumab plus bortezomib and dexamethasone is an NCCN-recommended alternative option for relapsed or refractory MM. CONCLUSION While elotuzumab plus lenalidomide and dexamethasone is a promising regimen for patients with MM, it is only one of several regimens recommended by NCCN for relapsed or refractory MM. Key factors in patient selection for elotuzumab therapy include adverse effects, prior treatments received, and cost considerations.
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Affiliation(s)
- Jill M Comeau
- University of Louisiana at Monroe, College of Pharmacy, Monroe, LA .,Feist-Weiller Cancer Center, LSU Health, Shreveport, LA
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