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Pour L, Szarejko M, Bila J, Schjesvold FH, Spicka I, Maisnar V, Jurczyszyn A, Grudeva-Popova Z, Hájek R, Usenko G, Thuresson M, Norin S, Jarefors S, Bakker NA, Richardson PG, Mateos MV. Efficacy and safety of melflufen plus daratumumab and dexamethasone in relapsed/refractory multiple myeloma: results from the randomized, open-label, phase III LIGHTHOUSE study. Haematologica 2024; 109:895-905. [PMID: 37646660 PMCID: PMC10905085 DOI: 10.3324/haematol.2023.283509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
Melphalan flufenamide (melflufen), a first-in-class alkylating peptide-drug conjugate, plus dexamethasone was approved in Europe for use in patients with triple-class refractory relapsed/refractory multiple myeloma (RRMM) with ≥3 prior lines of therapy and without prior autologous stem cell transplantation (ASCT) or with a time to progression >36 months after prior ASCT. The randomized LIGHTHOUSE study (NCT04649060) assessed melflufen plus daratumumab and dexamethasone (melflufen group) versus daratumumab in patients with RRMM with disease refractory to an immunomodulatory agent and a proteasome inhibitor or who had received ≥3 prior lines of therapy including an immunomodulatory agent and a proteasome inhibitor. A partial clinical hold issued by the US Food and Drug Administration for all melflufen studies led to financial constraints and premature study closure on February 23rd 2022 (data cut-off date). In total, 54 of 240 planned patients were randomized (melflufen group, N=27; daratumumab group, N=27). Median progression-free survival (PFS) was not reached in the melflufen group versus 4.9 months in the daratumumab group (Hazard Ratio: 0.18 [95% Confidence Interval, 0.05-0.65]; P=0.0032) at a median follow-up time of 7.1 and 6.6 months, respectively. Overall response rate (ORR) was 59% in the melflufen group versus 30% in the daratumumab group (P=0.0300). The most common grade ≥3 treatment-emergent adverse events in the melflufen group versus daratumumab group were neutropenia (50% vs. 12%), thrombocytopenia (50% vs. 8%), and anemia (32% vs. 19%). Melflufen plus daratumumab and dexamethasone demonstrated superior PFS and ORR versus daratumumab in RRMM and a safety profile comparable to previously published melflufen studies.
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Affiliation(s)
- Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Babak Myeloma Group, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Monika Szarejko
- University Clinical Centre, Department of Hematology and Transplantology, Gdansk
| | - Jelena Bila
- Clinic of Hematology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade
| | - Fredrik H Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital and KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo
| | - Ivan Spicka
- 1 Department of Medicine - Department of Hematology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Vladimir Maisnar
- 4 Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Artur Jurczyszyn
- Plasma Cell Dyscrasias Center, Department of Hematology, Jagiellonian University Faculty of Medicine, Krakow
| | - Zhanet Grudeva-Popova
- Department of Clinical Oncology, Medical Faculty, Medical University of Plovdiv, Plovdic, Bulgaria
| | - Roman Hájek
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ganna Usenko
- City Clinical Hospital No. 4 of Dnipro City Council, Dnipro, Ukraine
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Schjesvold FH, Ludwig H, Mateos MV, Larocca A, Abdulhaq H, Norin S, Thuresson M, Bakker NA, Richardson PG, Sonneveld P. Melflufen in relapsed/refractory multiple myeloma refractory to prior alkylators: A subgroup analysis from the OCEAN study. Eur J Haematol 2024; 112:402-411. [PMID: 37968873 DOI: 10.1111/ejh.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
Melphalan flufenamide (melflufen), a first-in-class alkylating peptide-drug conjugate, plus dexamethasone demonstrated superior progression-free survival (PFS), but not overall survival (OS), versus pomalidomide plus dexamethasone in relapsed/refractory multiple myeloma in the OCEAN study. Time to progression (TTP) <36 months after a prior autologous stem cell transplantation (ASCT) was a negative prognostic factor for OS with melflufen. This post hoc exploratory analysis evaluated patients refractory to prior alkylators (e.g., cyclophosphamide and melphalan) in OCEAN. In 153 patients refractory to prior alkylators (melflufen, n = 78; pomalidomide, n = 75), the melflufen and pomalidomide arms had similar median PFS (5.6 months [95% CI, 4.2-8.3] vs. 4.7 months [95% CI, 3.1-7.3]; hazard ratio [HR], 0.92 [95% CI, 0.63-1.33]) and OS (23.4 months [95% CI, 14.4-31.7] vs. 20.0 months [95% CI, 12.0-28.7]; HR, 0.92 [95% CI, 0.62-1.38]). Among alkylator-refractory patients with a TTP ≥ 36 months after a prior ASCT or no prior ASCT (melflufen, n = 54; pomalidomide, n = 53), the observed median PFS and OS were longer in the melflufen arm than the pomalidomide arm. The safety profile of melflufen was consistent with previous reports. These results suggest that melflufen is safe and effective in patients with alkylator-refractory disease, suggesting differentiated activity from other alkylators.
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Affiliation(s)
- Fredrik H Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - Heinz Ludwig
- Medical Department Center for Oncology, Hematology and Palliative Medicine, Wilhelminen Cancer Research Institute, Vienna, Austria
| | - Maria-Victoria Mateos
- Institute of Cancer Molecular and Cellular Biology, University Hospital of Salamanca, Salamanca, Spain
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Haifaa Abdulhaq
- Department of Hematology and Oncology, University of California, San Francisco, Fresno, California, USA
| | - Stefan Norin
- Clinical Science, Oncopeptides AB, Stockholm, Sweden
| | | | | | - Paul G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Schjesvold FH, Ludwig H, Delimpasi S, Robak P, Coriu D, Tomczak W, Pour L, Spicka I, Dimopoulos MA, Masszi T, Chernova NG, Sandberg A, Thuresson M, Norin S, Bakker NA, Mateos MV, Richardson PG, Sonneveld P. Health-related quality of life in relapsed/refractory multiple myeloma treated with melflufen and dexamethasone: analyses from the phase III OCEAN study. Haematologica 2024. [PMID: 38426292 DOI: 10.3324/haematol.2023.284635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Indexed: 03/02/2024] Open
Abstract
Not available.
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Affiliation(s)
- Fredrik H Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital and KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway.
| | - Heinz Ludwig
- Department of Medicine I, Center for Medical Oncology and Hematology with Outpatient Department and Palliative Care, Wilhelminen Cancer Research Institute, Vienna
| | - Sossana Delimpasi
- Bone Marrow Transplantation Unit and Department of Hematology, Evangelismos Hospital, Athens, Greece
| | - Pawel Robak
- Department of Hemato-Oncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Daniel Coriu
- University of Medicine and Pharmacy "Carol Davila", Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Waldemar Tomczak
- Department of Hemato-Oncology and Bone Marrow Transplantation, Medical University of Lublin
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Babak Myeloma Group, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivan Spicka
- 1st Department of Medicine - Department of Hematology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | | | - Tamas Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
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Sonneveld P, Richardson PG, Ludwig H, Dimopoulos MA, Schjesvold FH, Hájek R, Abdulhaq H, Thuresson M, Norin S, Bakker NA, Mateos MV. Benefit Versus Risk Assessment of Melflufen and Dexamethasone in Relapsed/Refractory Multiple Myeloma: Analyses From Longer Follow-up of the OCEAN and HORIZON Studies. Clin Lymphoma Myeloma Leuk 2023; 23:687-696. [PMID: 37355418 DOI: 10.1016/j.clml.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Melphalan flufenamide (melflufen), a first-in-class alkylating peptide-drug conjugate, plus dexamethasone demonstrated superior progression-free survival (PFS) but directionally different overall survival (OS) favoring pomalidomide (hazard ratio [HR], 1.10) in OCEAN. METHODS These analyses further investigated prognostic subgroups impacting survival in updated data from the randomized, phase 3 OCEAN study (NCT03151811; date: February 3, 2022) and the phase 2 HORIZON study (NCT02963493; date: February 2, 2022). RESULTS In OCEAN, subgroups prognostic for OS were age (P = .011; <65 years favored pomalidomide) and no previous autologous stem cell transplant (ASCT) or progression >36 months after ASCT (P = .001; favored melflufen). Overall, 245 of 495 (49%) patients randomized had received a previous ASCT, of which 202 (82%) had progressed within 36 months following their ASCT. When excluding patients who had progressed <36 months post-ASCT (melflufen group, n = 145; pomalidomide group, n = 148), median OS was 23.6 months with melflufen and 19.8 months with pomalidomide (HR, 0.83 [95% CI, 0.62-1.12]; P = .22). Among patients with triple-class refractory disease in HORIZON, patients who had progressed <36 months post-ASCT (n = 58) had a lower response rate and shorter duration of response and PFS than the remaining patients (n = 52). Safety was consistent with previous reports. CONCLUSION These analyses demonstrate a consistent benefit for melflufen and dexamethasone in patients with relapsed/refractory multiple myeloma who have not received an ASCT or progressed >36 months after receiving an ASCT (ClinicalTrials.gov identifier: NCT03151811).
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Affiliation(s)
- Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Paul G Richardson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA
| | - Heinz Ludwig
- Medical Department Center for Oncology, Hematology and Palliative Medicine, Wilhelminen Cancer Research Institute, Vienna, Austria
| | | | - Fredrik H Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway; KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - Roman Hájek
- Department of Hemato-oncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Haifaa Abdulhaq
- Department of Hemato-oncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; Department of Medicine, University of California, San Francisco, Fresno Campus, CA
| | | | | | | | - Maria-Victoria Mateos
- University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain; Institute of Cancer Molecular and Cellular Biology and CIBERONC, Salamanca, Spain
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Groen K, Schjesvold FH, van der Holt B, Levin MD, Seefat MR, Hansson M, Leys MB, Regelink JC, Waage A, Szatkowski D, Axelsson P, Hieu Do T, Svirskaite A, van der Spek E, Haukas E, Knut-Bojanowska D, Ypma PF, Blimark CH, Mellqvist UH, van de Donk NW, Sonneveld P, Klostergaard A, Vangsted AJ, Abildgaard N, Zweegman S. Ixazomib-Thalidomide-Dexamethasone Induction Followed by Ixazomib or Placebo Maintenance in Nontransplant Eligible Newly Diagnosed Multiple Myeloma Patients: Long-term Results of HOVON-126/NMSG 21.13. Hemasphere 2023; 7:e940. [PMID: 37663673 PMCID: PMC10470677 DOI: 10.1097/hs9.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/07/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Kazimierz Groen
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
| | - Fredrik H. Schjesvold
- Department of Hematology, Oslo Myeloma Center, Oslo University Hospital, Norway
- KG Jebsen Center for B Cell Malignancies, University of Oslo, Norway
| | - Bronno van der Holt
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Maarten R. Seefat
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital Lund, Sweden
| | - Maria B.L. Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Josien C. Regelink
- Department of Internal Medicine, Meander Medical Centre, Amersfoort, the Netherlands
| | - Anders Waage
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Damian Szatkowski
- Department of Oncology and Hematology, Førde Central Hospital, Norway
| | - Per Axelsson
- Department of Internal Medicine, Helsingborg Hospital, Sweden
| | - Trung Hieu Do
- Haematology Department H 60, Roskilde Sjaelland University, Denmark
| | - Asta Svirskaite
- Department of Hematology, Aalborg University Hospital, Denmark
| | - Ellen van der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Einar Haukas
- Department for Blood and Cancer Diseases, Stavanger University Hospital, Norway
| | | | - Paula F. Ypma
- Department of Hematology, Haga Hospital, The Hague, the Netherlands
| | - Cecilie H. Blimark
- Hematology Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Niels W.C.J. van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Niels Abildgaard
- Department of Hematology, Hematology Research Unit and Academy of Geriatric Research, Odense University Hospital and University of Southern Denmark, Denmark
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
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Schjesvold FH, Bakker NA, Sonneveld P. Authors' reply: Perspective: The approval and withdrawal of melphalan flufenamide (melflufen): Implications for the state of the FDA. Transl Oncol 2022; 25:101528. [PMID: 36087383 PMCID: PMC9468451 DOI: 10.1016/j.tranon.2022.101528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/01/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Fredrik H Schjesvold
- University of Oslo, Oslo University Hospital: Oslo Myeloma Center, Sognsvannsveien 20, Oslo, N-0372, Norway.
| | | | - Pieter Sonneveld
- Erasmus MC Cancer Institute, Rm Na 2024, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
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Schmitz A, Brøndum RF, Johnsen HE, Mellqvist UH, Waage A, Gimsing P, op Bruinink DH, van der Velden V, van der Holt B, Hansson M, Andersen NF, Frølund UC, Helleberg C, Schjesvold FH, Ahlberg L, Gulbrandsen N, Andreasson B, Lauri B, Haukas E, Bødker JS, Roug AS, Bøgsted M, Severinsen MT, Gregersen H, Abildgaard N, Sonneveld P, Dybkær K. Longitudinal minimal residual disease assessment in multiple myeloma patients in complete remission – results from the NMSG flow-MRD substudy within the EMN02/HO95 MM trial. BMC Cancer 2022; 22:147. [PMID: 35123422 PMCID: PMC8818194 DOI: 10.1186/s12885-022-09184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background Multiple myeloma remains an incurable disease with multiple relapses due to residual myeloma cells in the bone marrow of patients after therapy. Presence of small number of cancer cells in the body after cancer treatment, called minimal residual disease, has been shown to be prognostic for progression-free and overall survival. However, for multiple myeloma, it is unclear whether patients attaining minimal residual disease negativity may be candidates for treatment discontinuation. We investigated, if longitudinal flow cytometry-based monitoring of minimal residual disease (flow-MRD) may predict disease progression earlier and with higher sensitivity compared to biochemical assessments. Methods Patients from the Nordic countries with newly diagnosed multiple myeloma enrolled in the European-Myeloma-Network-02/Hovon-95 (EMN02/HO95) trial and undergoing bone marrow aspiration confirmation of complete response, were eligible for this Nordic Myeloma Study Group (NMSG) substudy. Longitdudinal flow-MRD assessment of bone marrow samples was performed to identify and enumerate residual malignant plasma cells until observed clinical progression. Results Minimal residual disease dynamics were compared to biochemically assessed changes in serum free light chain and M-component. Among 20 patients, reaching complete response or stringent complete response during the observation period, and with ≥3 sequential flow-MRD assessments analysed over time, increasing levels of minimal residual disease in the bone marrow were observed in six cases, preceding biochemically assessed disease and clinical progression by 5.5 months and 12.6 months (mean values), respectively. Mean malignant plasma cells doubling time for the six patients was 1.8 months (95% CI, 1.4–2.3 months). Minimal malignant plasma cells detection limit was 4 × 10–5. Conclusions Flow-MRD is a sensitive method for longitudinal monitoring of minimal residual disease dynamics in multiple myeloma patients in complete response. Increasing minimal residual disease levels precedes biochemically assessed changes and is an early indicator of subsequent clinical progression. Trial registration NCT01208766 Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09184-1.
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Schjesvold FH, Dimopoulos MA, Delimpasi S, Robak P, Coriu D, Legiec W, Pour L, Špička I, Masszi T, Doronin V, Minarik J, Salogub G, Alekseeva Y, Lazzaro A, Maisnar V, Mikala G, Rosiñol L, Liberati AM, Symeonidis A, Moody V, Thuresson M, Byrne C, Harmenberg J, Bakker NA, Hájek R, Mateos MV, Richardson PG, Sonneveld P, Schjesvold F, Delimpasi S, Robak P, Coriu D, Nikolayeva A, Tomczak W, Pour L, Spicka I, Dimopoulos MA, Masszi T, Doronin V, Minarik J, Salogub G, Alekseeva Y, Maisnar V, Mikala G, Rosinol L, Konstantinova T, Lazzaro A, Liberati AM, Symeonidis A, Gatt M, Illes A, Abdulhaq H, Dungarwalla M, Grosicki S, Hajek R, Leleu X, Myasnikov A, Richardson PG, Avivi I, Deeren D, Gironella M, Hernandez-Garcia MT, Martinez Lopez J, Newinger-Porte M, Ribas P, Samoilova O, Voog E, Arnao-Herraiz M, Carrillo-Cruz E, Corradini P, Dodlapati J, Granell Gorrochategui M, Huang SY, Jenner M, Karlin L, Kim JS, Kopacz A, Medvedeva N, Min CK, Mina R, Palk K, Shin HJ, Sohn SK, Sonneveld P, Tache J, Anagnostopoulos A, Arguiñano JM, Cavo M, Filicko J, Garnes M, Halka J, Herzog-Tzarfati K, Ipatova N, Kim K, Krauth MT, Kryuchkova I, Lazaroiu MC, Luppi M, Proydakov A, Rambaldi A, Rudzianskiene M, Yeh SP, Alcalá-Peña MM, Alegre Amor A, Alizadeh H, Bendandi M, Brearton G, Brown R, Cavet J, Dally N, Egyed M, Hernández-Rivas JÁ, Kaare A, Karsenti JM, Kloczko J, Kreisle W, Lee JJ, Legiec W, Machherndl-Spandl S, Manda S, Mateos MV, Moiseev I, Moreb J, Nagy Z, Nair S, Oriol-Rocafiguera A, Osswald M, Otero-Rodriguez P, Peceliunas V, Plesner T, Rey P, Rossi G, Stevens D, Suriu C, Tarella C, Verlinden A, Zannetti A. Melflufen or pomalidomide plus dexamethasone for patients with multiple myeloma refractory to lenalidomide (OCEAN): a randomised, head-to-head, open-label, phase 3 study. The Lancet Haematology 2022; 9:e98-e110. [DOI: 10.1016/s2352-3026(21)00381-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/30/2022]
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Tjønnfjord GE, Schjesvold FH, Gulbrandsen N, Kvam AK. Monoclonal gammopathy of clinical importance. Tidsskr Nor Laegeforen 2021; 141:20-0981. [PMID: 34596996 DOI: 10.4045/tidsskr.20.0981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Monoclonal gammopathy is a frequent finding and may be associated with severe cancer such as myelomatosis and other B-cell lymphoproliferative disorders. However, the monoclonal component can also be the direct cause of serious disease, namely monoclonal gammopathy of clinical significance (MGCS). MGCS is most likely significantly underdiagnosed and is consequently also undertreated. In order to achieve a good therapeutic outcome, it is crucial that the condition is recognised at an early stage, so that treatment can be initiated before the patient has developed irreversible organ damage. Increased awareness of MCGS is therefore essential.
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Schjesvold FH, Richardson PG, Facon T, Alegre A, Spencer A, Jurczyszyn A, Sunami K, Frenzel L, Min CK, Guillonneau S, Lin PL, Le-Guennec S, Campana F, van de Velde H, Bensfia S, Bringhen S. Isatuximab plus pomalidomide and dexamethasone in elderly patients with relapsed/refractory multiple myeloma: ICARIA-MM subgroup analysis. Haematologica 2021; 106:1182-1187. [PMID: 32586908 PMCID: PMC8018100 DOI: 10.3324/haematol.2020.253450] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Fredrik H Schjesvold
- Oslo University Hospital and KG Jebsen Center for B Cell Malignancies, University of Oslo, Norway
| | | | | | - Adrián Alegre
- Hospital Universitario La Princesa and Hospital Quironsalud, Madrid
| | | | | | - Kazutaka Sunami
- National Hospital Organization Okayama Medical Center, Okayama, Japan
| | | | - Chang-Ki Min
- Seoul St. Mary Hospital, The Catholic University of Korea, Seoul, Korea, Republic of (South)
| | | | | | | | | | | | | | - Sara Bringhen
- University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino
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Kaufman JL, Gasparetto C, Schjesvold FH, Moreau P, Touzeau C, Facon T, Boise LH, Jiang Y, Yang X, Dunbar F, Vishwamitra D, Unger S, Macartney T, Pesko J, Yu Y, Salem AH, Ross JA, Hong W, Maciag PC, Pauff JM, Kumar S. Targeting BCL-2 with venetoclax and dexamethasone in patients with relapsed/refractory t(11;14) multiple myeloma. Am J Hematol 2021; 96:418-427. [PMID: 33368455 PMCID: PMC7986778 DOI: 10.1002/ajh.26083] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
Venetoclax (Ven) is a selective small-molecule inhibitor of BCL-2 that exhibits antitumoral activity against MM cells with t(11;14) translocation. We evaluated the safety and efficacy of Ven and dexamethasone (VenDex) combination in patients with t(11;14) positive relapsed/refractory (R/R) multiple myeloma (MM). This open-label, multicenter study had two distinct phases (phase one [P1], phase two [P2]). Patients in both phases received VenDex (oral Ven 800 mg/day + oral Dex 40 mg [20 mg for patients ≥75 years] on days 1, 8, and 15, per 21-day cycle). The primary objective of the P1 VenDex cohort was to assess safety and pharmacokinetics. Phase two further evaluated efficacy with objective response rate (ORR) and very good partial response or better. Correlative studies explored baseline BCL2 (BCL-2) and BCL2L1 (BCL-XL ) gene expression, cytogenetics, and recurrent somatic mutations in MM. Twenty and 31 patients in P1 and P2 with t(11;14) positive translocation received VenDex. P1/P2 patients had received a median of 3/5 lines of prior therapy, and 20%/87% were refractory to daratumumab. Predominant grade 3/4 hematological adverse events (AEs) with ≥10% occurrence included lymphopenia (20%/19%), neutropenia (15%/7%), thrombocytopenia (10%/10%), and anemia (5%/16%). At a median follow-up of 12.3/9.2 months, ORR was 60%/48%. The duration of response estimate at 12 months was 50%/61%, and the median time to progression was 12.4/10.8 months. In biomarker evaluable patients, response to VenDex was independent of concurrent del(17p) or gain(1q) and mutations in key oncogenic signaling pathways, including MAPK and NF-kB. VenDex demonstrated efficacy and manageable safety in heavily-pre-treated patients with t(11;14) R/R MM.
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Affiliation(s)
| | - Cristina Gasparetto
- Duke University, Hematologic Malignancies & Cellular Therapy Durham North Carolina USA
| | - Fredrik H. Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, Oslo, Norway and K.G. Jebsen Center for B‐cell malignancies, University of Oslo Oslo Norway
| | - Philippe Moreau
- University Hospital, Nantes, France CRCINA, INSERM, Centre National de la Recherche Scientifique, University of Angers, University of Nantes Nantes France
| | - Cyrille Touzeau
- University Hospital, Nantes, France CRCINA, INSERM, Centre National de la Recherche Scientifique, University of Angers, University of Nantes Nantes France
| | - Thierry Facon
- Centre Hospitalier Regional Universitaire Lille, Hospital Huriez Lille France
| | | | - Yanwen Jiang
- Genentech Inc. South San Francisco California USA
| | | | | | | | | | | | | | - Yao Yu
- AbbVie Inc North Chicago Illinois USA
| | | | | | - Wan‐Jen Hong
- Genentech Inc. South San Francisco California USA
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12
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Zweegman S, Stege CA, Haukas E, Schjesvold FH, Levin MD, Waage A, Leys RB, Klein SK, Szatkowski D, Axelsson P, Do TH, Knut-Bojanowska D, van der Spek E, Svirskaite A, Klostergaard A, Salomo M, Blimark C, Ypma PF, Mellqvist UH, Poddighe PJ, Stevens-Kroef M, van de Donk NW, Sonneveld P, Hansson M, van der Holt B, Abildgaard N. Ixazomib-Thalidomide-low dose dexamethasone induction followed by maintenance therapy with ixazomib or placebo in newly diagnosed multiple myeloma patients not eligible for autologous stem cell transplantation; results from the randomized phase II HOVON-126/NMSG 21.13 trial. Haematologica 2020; 105:2879-2882. [PMID: 33256392 PMCID: PMC7716358 DOI: 10.3324/haematol.2019.240374] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Claudia A.M. Stege
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Einar Haukas
- Stavanger University Hospital-Rogaland Hospital, Stavanger, Norway
| | | | | | - Anders Waage
- St Olavs Hospital and Norwegian University of Science, Trondheim, Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pino J. Poddighe
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Niels W.C.J. van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Pieter Sonneveld
- Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands and
| | | | | | - Niels Abildgaard
- Hematology Research Unit and Academy of Geriatric Cancer Research, Odense University Hospital and University of Southern Denmark, Denmark
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13
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Oriol A, Larocca A, Leleu X, Hajek R, Hassoun H, Rodríguez-Otero P, Paner A, Schjesvold FH, Gullbo J, Richardson PG. Melflufen for relapsed and refractory multiple myeloma. Expert Opin Investig Drugs 2020; 29:1069-1078. [PMID: 32924646 DOI: 10.1080/13543784.2020.1808884] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The overall survival of patients with multiple myeloma has improved with the advent of novel agents; however, multiple myeloma remains incurable. Combinations of standard-of-care agents such as immunomodulators, proteasome inhibitors, and anti-CD38 monoclonal antibodies are increasingly used in earlier lines of therapy. Patients with disease that is refractory to multiple novel agents represent a population with high unmet medical need and for whom therapies with new mechanisms of action could be beneficial. Melphalan flufenamide (melflufen) has demonstrated encouraging activity in patients with relapsed and refractory multiple myeloma. AREAS COVERED This review provides an overview of the mechanism of action of melflufen, a first-in-class peptide-drug conjugate that targets aminopeptidases and rapidly delivers alkylating agents into tumor cells. It reviews key Phase I and II clinical trial data for melflufen in combination with dexamethasone as well as in triplet combinations with daratumumab or bortezomib. The safety profile of melflufen, which is characterized primarily by clinically manageable hematologic adverse events, is described. EXPERT OPINION Melflufen has potential to fill a gap in the myeloma treatment landscape by providing a new mechanism of action with clinically meaningful efficacy and a favorable safety profile in patients refractory to multiple novel agents.
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Affiliation(s)
- Albert Oriol
- Institut Josep Carreras and Institut Català d'Oncologia, Hospital Germans Trias I Pujol , Badalona, Spain
| | - Alessandra Larocca
- Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza Di Torino, University of Torino , Torino, Italy
| | - Xavier Leleu
- Department of Hematology, Hôpital De La Milétrie, CHU De Poitiers , Poitiers, France
| | - Roman Hajek
- Department of Hemato-Oncology, University of Ostrava and Faculty of Medicine, University of Ostrava , Ostrava, Czech Republic
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, NY, USA
| | | | - Agne Paner
- Division of Hematology, Oncology and Stem Cell Transplant, Rush University Medical Center , Chicago, IL, USA
| | - Fredrik H Schjesvold
- Oslo Myeloma Center, Oslo University Hospital and K.G. Jebsen Centre for B-Cell Malignancies, University of Oslo , Oslo, Norway
| | - Joachim Gullbo
- Department of Medical Sciences, Division of Clinical Pharmacology, Uppsala University , Uppsala, Sweden
| | - Paul G Richardson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School , Boston, MA, USA
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14
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Torfoss D, Fladhagen T, Holte H, Brinch L, Schjesvold FH, Fløisand Y, Nyquist E, Dalgaard J, Meyer P, Lehmann AK, Hammerstrøm J, Skjelbakken T, Høiby EA, Sandvik L, Kvaløy S. Benzylpenicillin plus an aminoglycoside versus meropenem in neutropenic lymphoma and leukaemia patients with a suspected bacterial infection: a randomized, controlled trial. Clin Microbiol Infect 2016; 23:179-187. [PMID: 27793737 DOI: 10.1016/j.cmi.2016.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/12/2016] [Accepted: 10/15/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In Norway, initial treatment of febrile neutropenia (FN) has traditionally been benzylpenicillin plus an aminoglycoside. Internationally, FN is often treated with a broad-spectrum β-lactam antibiotic. We aimed to compare these two regimens in a prospective, randomized, trial in patients with lymphoma or leukaemia with an expected period of neutropenia ≥7 days, and a suspected bacterial infection. METHODS Adult neutropenic patients with lymphoma or leukaemia, and a suspected bacterial infection, were randomized for treatment with benzylpenicillin plus an aminoglycoside or meropenem. The primary endpoint was clinical success, defined as no modification of antibiotics and clinical stability 72 h after randomization. RESULTS Among 322 randomized patients, 297 proved evaluable for analyses. Fifty-nine per cent (95% CI 51%-66%), (87/148) of the patients given benzylpenicillin plus an aminoglycoside were clinically stable, and had no antibiotic modifications 72 h after randomization, compared with 82% (95% CI 75%-87%), (122/149) of the patients given meropenem (p <0.001). When the antibiotic therapy was stopped, 24% (95% CI 18%-32%), (36/148) of the patients given benzylpenicillin plus an aminoglycoside, compared with 52% (95% CI 44%-60%), (78/149) of the patients given meropenem, had no modifications of their regimens (p <0.001). In the benzylpenicillin plus an aminoglycoside arm, the all-cause fatality within 30 days of randomization was 3.4% (95% CI 1.2%-7.9%), (5/148) of the patients, compared with 0% (95% CI 0.0%-3.0%), (0/149) of the patients in the meropenem arm (p 0.03). CONCLUSION Clinical success was more common in FN patients randomized to meropenem compared with the patients randomized to benzylpenicillin plus an aminoglycoside. The all-cause fatality was higher among the patients given benzylpenicillin plus an aminoglycoside.
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Affiliation(s)
- D Torfoss
- Department of Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
| | - T Fladhagen
- Department of Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - H Holte
- Department of Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - L Brinch
- Department of Haematology, Division of Cancer Medicine, The National Hospital, Oslo University Hospital, Oslo, Norway
| | - F H Schjesvold
- Department of Haematology, Division of Cancer Medicine, The National Hospital, Oslo University Hospital, Oslo, Norway
| | - Y Fløisand
- Department of Haematology, Division of Cancer Medicine, The National Hospital, Oslo University Hospital, Oslo, Norway
| | - E Nyquist
- Department of Haematology, Division of Cancer Medicine, Ullevål University Hospital, Oslo University Hospital, Oslo, Norway
| | - J Dalgaard
- Medical Clinic, Vestre Viken Hospital, Drammen, Norway
| | - P Meyer
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - A K Lehmann
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - J Hammerstrøm
- Department of Haematology, St Olav University Hospital, Trondheim, Norway
| | - T Skjelbakken
- Department of Haematology, University Hospital of North Norway, Tromsø, Norway
| | - E A Høiby
- National Institute of Public Health, Oslo, Norway
| | - L Sandvik
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - S Kvaløy
- Department of Oncology, Division of Cancer Medicine, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
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15
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Tveita AA, Schjesvold FH, Sundnes O, Haabeth OAW, Haraldsen G, Bogen B. Indirect CD4+ T-cell-mediated elimination of MHC II(NEG) tumor cells is spatially restricted and fails to prevent escape of antigen-negative cells. Eur J Immunol 2014; 44:2625-37. [PMID: 24846412 DOI: 10.1002/eji.201444659] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/28/2014] [Accepted: 05/16/2014] [Indexed: 11/06/2022]
Abstract
Tumor-specific Th1 cells can activate tumor-infiltrating macrophages that eliminate MHC class II negative (MHC II(NEG)) tumor cells. Activated M1-like macrophages lack antigen (Ag) receptors, and are presumably unable to discriminate and thus kill both Ag-positive (Ag(POS)) and Ag-negative (Ag(NEG)) tumor cells (bystander killing). The lack of specificity of macrophage-mediated cytotoxicity might be of clinical importance as it could provide a means of avoiding tumor escape. Here, we have tested this idea using mixed populations of Ag(POS) and Ag(NEG) tumor cells in a TCR-transgenic model in which CD4(+) T cells recognize a secreted tumor-specific antigen. Surprisingly, while Ag(POS) tumor cells were recognized and rejected, Ag(NEG) cells grew unimpeded and formed tumors. We further demonstrated that macrophage-mediated cytotoxicity was spatially restricted to areas dominated by Ag(POS) tumor cells, sparing Ag(NEG) tumor cells in the vicinity. As a consequence, macrophage tumoricidal activity did not confer bystander killing in vivo. The present results offer novel insight into the mechanisms of indirect Th1-mediated elimination of MHC II(NEG) tumor cells.
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Affiliation(s)
- Anders A Tveita
- Centre for Immune Regulation, Institute of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway
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