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DARZALEX FASPRO® (daratumumab and hyaluronidase-fihj)

Medical Information

Use of DARZALEX + DARZALEX FASPRO in Combination with Pomalidomide and Dexamethasone in Multiple Myeloma

Last Updated: 05/08/2024

SUMMARY

  • APOLLO is an ongoing phase 3, randomized, open-label, multicenter study evaluating the safety and efficacy of DARZALEX FASPRO for subcutaneous (SC) use + pomalidomide + dexamethasone (D-Pd) vs pomalidomide + dexamethasone (Pd) in patients with relapsed or refractory multiple myeloma (RRMM) who received ≥1 prior treatment with both lenalidomide and a proteasome inhibitor (PI).1
    • Dimopoulos et al (2021)1 reported the primary analysis of this ongoing study with a median follow-up of 16.9 months. The primary endpoint of improved progressionfree survival (PFS) yielded a 37% reduction in the risk of progression or death with D-Pd arm (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.470.85; P=0.0018). The most common serious treatment-emergent adverse events (TEAEs) were pneumonia (D-Pd, 15%; Pd, 8%) and lower respiratory tract infection (D-Pd, 12%; Pd, 9%).
    • Dimopoulos et al (2023)2 reported the final overall survival (OS) results and updated safety analysis of the APOLLO study at a median follow-up of 39.6 months. Median OS in the intent-to-treat (ITT) population was 34.4 months (95% CI, 23.740.3) vs 23.7 months (95% CI, 19.629.4) in the D-Pd vs Pd arm, respectively (HR, 0.82; 95% CI, 0.61-1.11; P=0.20). The most common grade 3 TEAEs (>10%) in the D-Pd arm were neutropenia (25%), anemia (17%), and leukopenia (11%), while those in the Pd arm were neutropenia (32%), anemia (21%), and thrombocytopenia (13%). The most common serious TEAE was pneumonia (D-Pd, 15%; Pd, 9%).
    • Other relevant literature related to the APOLLO study has been identified in addition to the data summarized above.3-5
  • EQUULEUS is an ongoing, phase 1b, open-label, multicenter study evaluating the safety and tolerability of DARZALEX for intravenous (IV) use when administered in combination with various treatment regimens, including Pd, for the treatment of multiple myeloma (MM).6,7
    • The overall response rate (ORR; stringent complete response [sCR] + complete response [CR] + very good partial response [VGPR] + partial response [PR]) for patients who received D-Pd (N=103) was 66% (n=94; 95% CI, 55.5%-75.4%). TEAEs that occurred in ≥25% of patients treated with D-Pd included neutropenia, anemia, fatigue, diarrhea, thrombocytopenia, cough, leukopenia, constipation, nausea, dyspnea, pyrexia, back pain, upper respiratory tract infection, muscle spasms, vomiting, and arthralgia.
  • MM-014 is an ongoing, phase 2, nonrandomized, multicenter, open-label clinical study evaluating the safety and efficacy of D-Pd and Pd in patients with RRMM who have received 1 or 2 prior lines of therapy (LOTs) including lenalidomide (N=112).
    • Bahlis et al (2023)8 reported the updated results of the D-Pd arm. Results from the other arms have not yet been presented. After a median follow-up duration of 41.9 months (0.4-73.1), the ORR for patients in the D-Pd arm was 78.6% (95% CI, 69.8-85.8). The median OS was 56.7 months (95% CI, 46.5-not reached [NR]). The median PFS was 23.7 months (95% CI, 15.836.1). The most common grade 3/4 hematologic and nonhematologic TEAEs were neutropenia (64.3%) and pneumonia (17.9%).
  • Other relevant literature has been identified in addition to the data summarized above.9-16

PRODUCT LABELING

CLINICAL DATA

DARZALEX FASPRO in Combination With Pomalidomide and Dexamethasone

APOLLO (MMY3013; clinicaltrials.gov identifier: NCT03180736) is an ongoing study evaluating the safety and efficacy of D-Pd vs Pd in patients with RRMM who received ≥1 prior LOT with both lenalidomide and a PI. Dimopoulos et al (2021)1 reported the primary analysis of this ongoing study. Sonneveld et al (2021)17 presented updated efficacy and safety results at a median follow-up of 30.7 months. Dimopoulos et al (2023)2 reported the final OS and updated safety analysis of D-Pd vs Pd alone in patients with RRMM in the APOLLO study with a median follow-up of 39.6 months. Dimopoulos et al (2023)2 presented the final OS and updated safety analysis of D-Pd vs Pd alone in patients with RRMM in the APOLLO study with a median follow-up of 39.6 months.

Study Design/Methods

APOLLO (MMY3013): Study Design1,2,18-20

Abbreviations: CR, complete response; CrCl, creatinine clearance; d, dexamethasone; D, daratumumab; D-Pd, daratumumab + pomalidomide + dexamethasone; ECOG PS, Eastern Cooperative Oncology Group performance status; HRQoL, health-related quality of life; Ig, immunoglobulin; IgA, immunoglobulin A; IgD, immunoglobulin D; IgE, immunoglobulin E; IgG, immunoglobulin G; IgM, immunoglobulin M; ISS, International Staging System; MM, multiple myeloma; MRD, minimal residual disease; ORR, overall response rate; OS, overall survival; P, pomalidomide; Pd, pomalidomide + dexamethasone; PD, progressive disease; PFS, progression-free survival; PI, proteasome inhibitor; PO, oral; QW, every week; Q2W, every 2 weeks; Q4W, every 4 weeks; RRMM, relapsed/refractory multiple myeloma; sCR, stringent complete response; VGPR, very good partial response.
aMeasurable disease was defined as: IgG MM, serum M-protein level ≥1.0 g/dL or urine M-protein level ≥200 mg/24 hours; IgA, IgD, IgE, IgM MM, serum M-protein level ≥0.5 g/dL or urine M-protein level ≥200 mg/24 hours; light chain MM for patients without measurable disease in the serum or urine, serum Ig free light chain ≥10 mg/dL and abnormal serum Ig kappa lambda free light chain ratio.
bPre-infusion medications to be administered are acetaminophen, dexamethasone, diphenhydramine, and a leukotriene inhibitor (optional). Patients with a higher risk of respiratory complications will receive post-infusion medications, including diphenhydramine, a short-acting β2 adrenergic receptor agonist, and lung disease control medications.
cPatients initially were given DARZALEX 16 mg/kg; following a protocol amendment, new patients in the D-Pd arm received DARZALEX FASPRO. Patients who had already received DARZALEX prior to this amendment may switch to DARZALEX FASPRO on day 1 of cycle 3+.
dPatients aged ≥75 years received 20 mg QW.
eFollow-up is for patients who discontinued treatment for reasons other than PD, death, loss to follow-up, or withdrawal of consent.
fMRD was assessed by next-generation sequencing using bone marrow aspirate samples obtained at screening; at the time of suspected CR or sCR; and at 6, 12, 18, 24, and Q12W after achieving CR or sCR until disease progression.
gDisease assessments were collected by a central laboratory every cycle for the first 14 months and every other month thereafter.

Results

Patient Characteristics
  • Of the 353 patients assessed for eligibility, 304 were randomized (D-Pd, n=151; Pd, n=153) and included in the ITT analysis.
  • Baseline characteristics are summarized in Table: Demographics and Baseline Characteristics.
  • A total of 98% of patients in the D-Pd arm received DARZALEX FASPRO.
  • A total of 142 of 149 (95%) of patients in the D-Pd arm started treatment with DARZALEX FASPRO.
  • Seven of 149 (5%) patients had initiated treatment with DARZALEX; of these, 4 (3%) patients switched to DARZALEX FASPRO, and 3 (2%) patients progressed on DARZALEX before switching was permitted per the protocol amendment.
  • Median duration of study treatment was 11.5 months (interquartile range [IQR], 4.617.1) in the D-Pd arm vs 6.6 months (IQR, 3.2-14.3) in the Pd arm.
  • The most common reason for treatment discontinuation was progressive disease, as presented in Table: Treatment Disposition

Demographics and Baseline Characteristicsa,1
Characteristic
D-Pd
(n=151)

Pd
(n=153)

Age, years
   Median (range)
67 (42-86)
68 (35-90)
   Distribution, n (%)
      <65
63 (42)
60 (39)
      65-<75
63 (42)
62 (41)
      ≥75
25 (17)
31 (20)
ECOG PS score, n (%)
   0
91 (60)
77 (50)
   1
54 (36)
57 (37)
   2
6 (4)
19 (12)
ISS disease stage, n (%)b
   I
68 (45)
69 (45)
   II
50 (33)
51 (33)
   III
33 (22)
33 (22)
Type of MM, n (%)
   IgG
62 (41)
63 (41)
   IgA
24 (16)
20 (13)
   Light chain
24 (16)
25 (16)
Cytogenetic profilec
   N
103
108
   Standard risk, n (%)
64 (62)
73 (68)
   High risk, n (%)
39 (38)
35 (32)
Time since MM diagnosis, years
   Median (range)
4.4 (0.5-20.0)
4.5 (0.6-19.0)
Prior LOTs
   Median (range)
2 (1-5)
2 (1-5)
   Distribution, n (%)
      1
16 (11)
18 (12)
      2-3
114 (75)
113 (74)
      ≥4
21 (14)
22 (14)
Prior PI or IMiD, n (%)
151 (100)
153 (100)
Prior ASCT, n (%)
90 (60)
81 (53)
Disease refractory to last LOT, n (%)
122 (81)
123 (80)
Disease refractory to, n (%)
   Lenalidomide
120 (79)
122 (80)
   PI
71 (47)
75 (49)
   PI + lenalidomide
64 (42)
65 (42)
Abbreviations: ASCT, autologous stem cell transplantation; D-Pd, daratumumab + pomalidomide + dexamethasone; ECOG PS, Eastern Cooperative Oncology Group performance status; IgA, immunoglobulin A; IgG, immunoglobulin G; IMiD, immunomodulatory drug; ISS, International Staging System; ITT, intention-to-treat; LOT, line of therapy; MM, multiple myeloma; Pd, pomalidomide + dexamethasone; PI, proteasome inhibitor.
aITT population (N=304).
bDerived from the combination of serum β2-microglobulin and albumin concentrations; higher stages indicate more severe disease.
cCytogenetic risk based on fluorescence in-situ hybridization; patients with high-risk cytogenetic profile had ≥1 high-risk abnormality (del17p, t[4;14], or t[14;16]).


Treatment Disposition1
Parameter
D-Pd
(n=151)

Pd
(n=153)

Patients treated, n (%)
149 (99)
150 (98)
Ongoing at clinical cutoff, n (%)a
60 (40)
33 (22)
Discontinued, n (%)a
89 (60)
117 (78)
   Progressive disease
66 (44)
87 (58)
   Death
10 (7)
7 (5)
   Adverse event
3 (2)
4 (3)
   Physician decision
4 (3)
7 (5)
   Lost to follow-up
1 (1)
0
   Noncompliance with study drug
5 (3)
12 (8)
Abbreviations: D-Pd, daratumumab + pomalidomide + dexamethasone; Pd, pomalidomide + dexamethasone.
aPercentages calculated using patients treated as denominator (D-Pd, n=149; Pd, n=150).

Efficacy
  • After a median follow-up of 16.9 months, median PFS was 12.4 months with D-Pd vs 6.9 months with Pd (HR, 0.63; 95% CI, 0.47-0.85; P=0.0018).
  • Disease progression or death occurred in 84 (56%) patients in the D-Pd arm vs 106 (69%) patients in the Pd arm.
  • A PFS benefit of D-Pd vs Pd was generally observed in all prespecified subgroups (Table: PFS in Prespecified Subgroups).
  • ORR (ITT population): 69% D-Pd vs 46% Pd (odds ratio [OR], 2.7; 95% CI, 1.7-4.4; P<0.0001).
    • sCR: 9% D-Pd vs 1% Pd
    • CR: 15% D-Pd vs 3% Pd
    • ≥CR: 25% D-Pd vs 4% Pd (P<0.0001)
    • VGPR: 26% D-Pd vs 16% Pd
    • ≥VGPR: 51% D-Pd vs 20% Pd (P<0.0001)
    • PR: 18% D-Pd vs 27% Pd
  • The minimal residual disease-negativity (MRD-negativity) rate was significantly higher in the D-Pd arm vs the Pd arm (9% vs 2%, respectively; P=0.010).
  • The median time to first response was 1 month (95% CI, 1.0-1.1) in the D-Pd arm and 1.9 months (95% CI, 1.0-2.0) in the Pd arm.
  • The median duration of response (DOR) was NR (95% CI, 15.2-NR) in the D-Pd arm vs 15.9 months (95% CI, 8.3-24.8) in the Pd arm.
  • There were 48 vs 51 deaths reported in the D-Pd vs Pd arm, respectively.

PFS in Prespecified Subgroups1
Number of Progression Events or Deaths/Total Number
D-Pd
Pd
HR (95% CI)
Overall
84/151
106/153
0.63 (0.47-0.85)
Sex
   Male
46/79
54/82
0.69 (0.44-1.09)
   Female
38/72
52/71
0.55 (0.38-0.81)
Age
   <65 years
36/63
41/60
0.69 (0.44-1.09)
   ≥65 years
48/88
65/93
0.55 (0.38-0.81)
Race
   White
75/135
93/137
0.66 (0.48-0.89)
   Non-white
9/16
13/16
0.34 (0.14-0.82)
ISS disease staging
   1
31/68
43/69
0.62 (0.39-0.98)
   2
32/50
36/51
0.54 (0.33-0.87)
   3
21/33
27/33
0.75 (0.42-1.32)
Revised ISS disease staging
   1
11/26
17/25
0.51 (0.24-1.10)
   2
45/74
64/88
0.58 (0.39-0.85)
   3
15/19
11/14
1.38 (0.62-3.11)
Number of prior LOTs
   1
9/16
12/18
0.70 (0.30-1.67)
   2-3
65/114
79/113
0.66 (0.48-0.92)
   ≥4
10/21
15/22
0.40 (0.18-0.90)
Baseline creatinine clearance
   ≤60 mL/min
23/40
36/47
0.59 (0.35-0.99)
   >60 mL/min
61/111
70/106
0.64 (0.45-0.90)
Type of MM
   IgG
43/76
52/79
0.67 (0.45-1.01)
   Non-IgG
20/34
25/32
0.44 (0.24-0.81)
Cytogenetic profile
   High risk
28/39
26/35
0.85 (0.49-1.44)
   Standard risk
30/64
50/73
0.51 (0.32-0.81)
Baseline hepatic function
   Normal
69/136
88/127
0.56 (0.41-0.77)
   Impaired
15/15
18/26
1.72 (0.84-3.50)
ECOG PS
   0
49/91
53/77
0.61 (0.41-0.90)
   ≥1
35/60
53/76
0.65 (0.42-1.00)
Refractory to lenalidomide
   No
8/31
17/31
0.36 (0.15-0.83)
   Yes
76/120
89/122
0.66 (0.49-0.90)
Refractory to PIs
   No
38/80
52/78
0.53 (0.35-0.80)
   Yes
46/71
54/75
0.73 (0.49-1.08)
Refractory to last LOT
   No
9/29
16/30
0.45 (0.20-1.02)
   Yes
75/122
90/123
0.64 (0.47-0.87)
Abbreviations: CI, confidence interval; D-Pd, daratumumab + pomalidomide + dexamethasone; ECOG PS, Eastern Cooperative Oncology Group performance status; HR, hazard ratio; IgG, immunoglobulin G; ISS, International Staging System; LOT, line of therapy; MM, multiple myeloma; Pd, pomalidomide + dexamethasone; PFS, progression-free survival; PI, proteasome inhibitor.
Safety
  • The most common grade 3/4 adverse events (AEs) were neutropenia (68% vs 51%), anemia (17% vs 21%), and thrombocytopenia (17% vs 18%) in the D-Pd vs Pd arm, respectively.
  • Serious AEs occurred in 75 (50%) patients in the D-Pd arm vs 59 (39%) patients in the Pd arm.
    • The most common serious AEs were pneumonia (15% vs 8%) and lower respiratory tract infection (12% vs 9%) in the D-Pd arm vs Pd arm, respectively.
  • TEAEs leading to treatment discontinuation and TEAEs leading to death were similar in both arms (D-Pd, 2% and 7%; Pd, 3% and 7%, respectively).
  • Incidence of second primary malignancy was 2% in each arm.
  • Infusion-related reactions were reported in 5% of D-Pd patients; all were grade 1/2 and occurred only in those receiving DARZALEX FASPRO.
  • Local injection-site reactions were reported in 2% of patients who received DARZALEX FASPRO; all were grade 1.
  • Safety data from the primary analysis are presented in Table: Most Common AEs During Treatment in the Safety Population.

Most Common AEs During Treatment in the Safety Populationa,1
n (%)
D-Pd (n=149)
Pd (n=150)
Grade 1/2
Grade 3
Grade 4
Grade 1/2
Grade 3
Grade 4
Hematologic
   Neutropenia
4 (3)
37 (25)
64 (43)
4 (3)
49 (33)
27 (18)
   Anemia
30 (20)
24 (16)
1 (1)
34 (23)
31 (21)
1 (1)
   Thrombocytopenia
22 (15)
13 (9)
13 (9)
23 (15)
19 (13)
8 (5)
   Leukopenia
14 (9)
16 (11)
9 (6)
11 (7)
6 (4)
1 (1)
   Lymphopenia
4 (3)
10 (7)
8 (5)
7 (5)
3 (2)
2 (1)
   Febrile neutropenia
0
10 (7)
3 (2)
0
3 (2)
1 (1)
Nonhematologic
   Infections
61 (41)
32 (21)
4 (3)
48 (32)
29 (19)
1 (1)
      Upper respiratory tract infection
34 (23)
0
0
21 (14)
3 (2)
0
      Pneumonia
10 (7)
14 (9)
3 (2)
8 (5)
8 (5)
1 (1)
      Lower respiratory tract infection
12 (8)
14 (9)
2 (1)
10 (7)
11 (7)
2 (1)
   Fatigue
26 (17)
12 (8)
0
31 (21)
7 (5)
0
   Asthenia
25 (17)
7 (5)
1 (1)
23 (15)
1 (1)
0
   Diarrhea
25 (17)
8 (5)
0
20 (13)
1 (1)
0
   Pyrexia
29 (20)
0
0
21 (14)
0
0
   Hyperglycemia
7 (5)
7 (5)
1 (1)
12 (8)
7 (5)
0
Second primary malignancy
3 (2)
NA
NA
3 (2)
NA
NA
Any infusion-related reaction
8 (5)
0
0
NA
NA
NA
Abbreviations: AE, adverse event; D-Pd, daratumumab + pomalidomide + dexamethasone; NA, not applicable; Pd, pomalidomide + dexamethasone.
aAEs of any grade that were reported in ≥15% of patients in either treatment group or grade 3/4 AEs that were reported in ≥5% of patients in either treatment group are listed.

Updated Analysis of the APOLLO Study

Dimopoulos et al (2023)presented the final OS and updated safety analysis of D-Pd vs Pd alone in patients with RRMM in the APOLLO study with a median follow-up of 39.6 months.2

Study Design/Methods

  • OS was defined as the number of months from the date of randomization to the date of death from any cause). Patients were censored at the last date of contact.2
  • Patients in the safety population were included if they received ≥1 administration of any study treatment.2

Results

Patient Disposition and Treatment Characteristics
  • A total of 304 patients were randomized to receive either D-Pd (n=151) or Pd (n=153) and constituted the ITT population.
  • Patients included in this study were refractory to lenalidomide (D-Pd, 79% [n=120]; Pd, 80% [n=122]), a PI (D-Pd, 47% [n=71]; Pd, 49% [n=75]), or both (DPd, 42% [n=64]; Pd, 42% [n=65]).
  • Median duration of exposure to study treatment was 11.5 (interquartile range [IQR], 4.6-36.1) months vs 6.6 (IQR, 3.2-15.0) months in the D-Pd vs Pd arm, respectively.
  • The median duration of follow-up was 39.6 (IQR, 37.1-43.7) months.
  • In the safety population (D-Pd, n=149; Pd, n=150), the median relative dose intensity of DARZALEX and DARZALEX FASPRO was 86% (IQR, 80-94) and 95% (IQR, 86-100), respectively. In the D-Pd vs Pd arm, the median relative dose intensity of pomalidomide and dexamethasone was 74% (IQR, 55‑94) vs 91% (IQR, 77‑98; P<0.0001) and 78% (IQR, 49-95) vs 87% (IQR, 64-97; P=0.0278), respectively.
Efficacy
  • Median PFS on the next LOT (PFS2) was 24.4 months (95% CI, 17.1-35.7) vs 17.6 months (95% CI, 13.622.0) in the D-Pd vs Pd arm, respectively (HR, 0.73; 95% CI, 0.55-0.98; P=0.034).
    • The 3-year PFS2 rate was 41.4% (95% CI, 33.1-49.4) vs 27% (95% CI, 19.834.8) in the D-Pd vs Pd arm, respectively.
  • Median OS was 34.4 months (95% CI, 23.7-40.3) vs 23.7 months (95% CI, 19.6-29.4) in the D-Pd vs Pd arm, respectively (HR, 0.82; 95% CI, 0.61-1.11; P=0.20).
  • Median time to subsequent therapy was 20.0 months (95% CI, 13.8-27.1) vs 11.8 months (95% CI, 8.9-15.4) in the D-Pd vs Pd arm, respectively (HR, 0.61; 95% CI, 0.45-0.82; P=0.0008).
  • In the safety population, a total of 48% (n=72) of patients in the D-Pd arm and 68% (n=102) of patients in the Pd arm received subsequent therapy in any line as presented in Table: Most Common (>10%) subsequent antimyeloma therapies.

Most Common (>10%) Subsequent Antimyeloma Therapiesa,2
Total Receiving Subsequent Therapy, n (%)
Any Subsequent LOT
Next Subsequent LOT
D-Pdb
(n=72)

Pd
(n=102)

D-Pdb
(n=72)

Pd
(n=102)

Dexamethasone
57 (79)
83 (81)
51 (71)
72 (71)
Carfilzomib
31 (43)
34 (33)
24 (33)
24 (24)
Cyclophosphamide
26 (36)
36 (35)
13 (18)
19 (19)
Bortezomib
20 (28)
37 (36)
10 (14)
26 (25)
Pomalidomide
14 (19)
23 (23)
7 (10)
14 (14)
Lenalidomide
11 (15)
19 (19)
10 (14)
11 (11)
Selinexor
11 (15)
2 (2)
5 (7)
0
Thalidomide
8 (11)
3 (3)
4 (6)
1 (1)
DARZALEX
5 (7)
66 (65)
4 (6)
47 (46)
Abbreviations: D-Pd, daratumumab + pomalidomide + dexamethasone; LOT, line of therapy; Pd, pomalidomide + dexamethasone.
aSubsequent systemic antimyeloma therapy was reported based on therapeutic class, pharmacological class, and preferred term.
bD-Pd arm included all patients who received DARZALEX, regardless of the route of administration, with Pd.
Note: Percentages have been rounded and therefore might not add up to 100%.

Safety
  • No new safety concerns were reported with longer follow-up.
  • The most common any grade and grade 3/4 TEAEs are presented in Table: Summary of Most Common TEAEs in the Safety Population.
  • Serious TEAEs were reported in 54% (n=80) vs 40% (n=60) of patients in the D-Pd vs Pd arm, respectively.
    • The most common serious TEAE was pneumonia (D-Pd, 15% [n=23]; Pd, 9% [n=13]).
  • Treatment modification occurred in 87% (n=130) vs 75% (n=112) of patients in the DPd vs Pd arm, respectively.
  • Treatment discontinuation due to TEAEs was low among both treatment arms (D-Pd, 2% [n=3]; Pd, 4% [n=6]).
    • Treatment discontinuation due to infection was reported in 1 (1%) patient each in both arms (D-Pd, meningoencephalitis bacterial infection; Pd, Coronavirus Disease 2019 [COVID-19]).
  • A total of 55% (n=83) vs 59% (n=91) of patients in the D-Pd vs Pd arm, respectively, died primarily due to disease progression, AEs unrelated to the study treatment, or COVID-19.
  • Second primary malignancies (cutaneous, invasive, and hematological) were reported in 3% (n=4) vs 4% (n=6) of patients in the D-Pd vs Pd arm, respectively.
    • In the D-Pd arm, cholangiocarcinoma, malignant melanoma, and squamous cell carcinoma were each reported in 1% (n=1) of patients.
    • In the Pd arm, malignant melanoma, acute myeloid leukemia, metastatic renal cell carcinoma, and thyroid neoplasm were each reported in 1% (n=1) of patients.
  • TEAEs leading to death were reported in 9% (n=13) of patients each in both arms.
    • The most common TEAEs leading to death were pneumonia (D-Pd, 2% [n=3]; Pd, 1% [n=2]) and COVID-19 (D-Pd, 1% [n=2]; Pd, 1% [n=1]).

Summary of Most Common TEAEs in the Safety Populationa,2
TEAE, n (%)
D-Pd (n=149)
Pd (n=150)
Grade
1/2

Grade
3

Grade
4

Grade
5

Total
Grade
1/2

Grade
3

Grade
4

Grade
5

Total
Any AEs
12 (8)
45 (30)
75 (50)
13 (9)
145 (97)
23 (15)
79 (53)
31 (21)
13 (9)
146 (97)
Hematologic
   Anemia
30 (20)
26 (17)
1 (1)
0
57 (38)
35 (23)
31 (21)
1 (1)
0
67 (45)
   Thrombocytopenia
23 (15)
14 (9)
13 (9)
0
50 (34)
23 (15)
20 (13)
8 (5)
0
51 (34)
   Leukopenia
14 (9)
16 (11)
9 (6)
0
39 (26)
11 (7)
6 (4)
1 (1)
0
18 (12)
   Neutropenia
4 (3)
37 (25)
66 (44)
0
107 (72)
4 (3)
48 (32)
28 (19)
0
80 (53)
   Lymphopenia
3 (2)
11 (7)
8 (5)
0
22 (15)
7 (5)
3 (2)
2 (1)
0
12 (8)
   Bone marrow
   failure

0
0
0
1 (1)
1 (1)
0
0
0
0
0
   Febrile
   neutropenia

0
10 (7)
3 (2)
0
13 (9)
0
4 (3)
1 (1)
0
5 (3)
Nonhematologic
   Upper respiratory
   tract infection

37 (25)
0
0
0
37 (25)
21 (14)
3 (2)
0
0
24 (16)
   Pyrexia
31 (21)
0
0
0
31 (21)
26 (17)
0
0
0
26 (17)
   Diarrhea
28 (19)
8 (5)
0
0
36 (24)
22 (15)
1 (1)
0
0
23 (15)
   Fatigue
28 (19)
15 (10)
0
0
43 (29)
31 (21)
7 (5)
0
0
38 (25)
   Asthenia
25 (17)
7 (5)
1 (1)
0
33 (22)
23 (15)
2 (1)
0
0
25 (17)
   Peripheral edema
25 (17)
0
0
0
25 (17)
14 (9)
0
0
0
14 (9)
   Bronchitis
22 (15)
0
0
0
22 (15)
15 (10)
3 (2)
0
0
18 (12)
   Dyspnea
12 (8)
3 (2)
1 (1)
1 (1)
17 (11)
12 (8)
1 (1)
0
0
13 (9)
   Lower respiratory
   tract infection

12 (8)
14 (9)
2 (1)
1 (1)
29 (19)
10 (7)
11 (7)
2 (1)
1 (1)
24 (16)
   COVID-19
10 (7)
5 (3)
1 (1)
2 (1)
18 (12)
2 (1)
0
0
1 (1)
3 (2)
   Hyperglycemia
9 (6)
8 (5)
1 (1)
0
18 (12)
13 (9)
7 (5)
0
0
20 (13)
   Muscular
   weakness

9 (6)
0
1 (1)
0
10 (7)
5 (3)
0
0
0
5 (3)
   Pneumonia
9 (6)
14 (9)
4 (3)
3 (2)
30 (20)
9 (6)
9 (6)
1 (1)
2 (1)
21 (14)
   Hypokalemia
6 (4)
6 (4)
1 (1)
0
13 (9)
8 (5)
1 (1)
0
0
9 (6)
   Hyperuricemia
3 (2)
1 (1)
1 (1)
0
5 (3)
3 (2)
0
1 (1)
0
4 (3)
   Myocardial
   ischemia

2 (1)
0
0
0
2 (1)
0
0
1 (1)
0
1 (1)
   Acute myocardial
   infarction

1 (1)
1 (1)
0
0
2 (1)
0
0
0
1 (1)
1 (1)
   General physical
   health
   deterioration

1 (1)
1 (1)
0
0
2 (1)
0
2 (1)
0
2 (1)
4 (3)
      Hyperbilirubinemia
1 (1)
0
1 (1)
0
2 (1)
1 (1)
0
0
0
1 (1)
   Lumbar vertebral
   fracture

1 (1)
0
1 (1)
0
2 (1)
0
2 (1)
0
0
2 (1)
   Acute pulmonary
   edema

0
0
1 (1)
0
1 (1)
0
0
0
0
0
   Campylobacter
   infection

0
0
0
1 (1)
1 (1)
0
0
0
0
0
   Cardiac arrest
0
0
0
0
0
0
0
0
1 (1)
1 (1)
   Cerebral
   hemorrhage

0
0
0
0
0
0
0
0
1 (1)
1 (1)
   Embolism
0
0
1 (1)
0
1 (1)
0
0
0
0
0
   Hypertensive
   hydrocephalus

0
0
0
0
0
0
0
0
1 (1)
1 (1)
   Liver disorder
0
0
0
1 (1)
1 (1)
0
0
0
0
0
   Pneumonia
   aspiration

0
0
0
1 (1)
1 (1)
0
0
0
1 (1)
1 (1)
   Respiratory failure
0
1 (1)
0
1 (1)
2 (1)
1 (1)
1 (1)
1 (1)
0
3 (2)
   Sepsis
0
1 (1)
0
1 (1)
2 (1)
0
0
1 (1)
0
1 (1)
   Septic shock
0
0
0
1 (1)
1 (1)
0
0
0
2 (1)
2 (1)
   Sudden death
0
0
0
1 (1)
1 (1)
0
0
0
0
0
   Systemic candida
0
0
0
1 (1)
1 (1)
0
0
0
0
0
   Viral pneumonia
0
0
1 (1)
0
1 (1)
0
0
0
0
0
Abbreviations: AE, adverse event; COVID-19, Coronavirus Disease 2019; D-Pd, daratumumab + pomalidomide + dexamethasone; MedDRA, Medical Dictionary for Regulatory Activities; NCI-CTCAE, National Cancer Institute Common Terminology Criteria for Adverse Events; Pd, pomalidomide + dexamethasone; TEAE, treatment-emergent adverse event.
aTEAEs are listed for all grade 4 or 5 events and any grade 3 event occurring in ≥15% of patients in either treatment group (corresponding grade 1 or 2 events are listed). Each patient could have >1 event, and multiple occurrences of each event but were only counted once for each row.

DARZALEX Studies

EQUULEUS-Phase 1b Study

EQUULEUS (MMY1001; clinicaltrials.gov identifier: NCT01998971)6,7 is an ongoing study evaluating the safety and tolerability of DARZALEX when administered in combination with various treatment regimens, including Pd, for the treatment of MM. Subgroup analyses and data specific to patients who received D-Pd are summarized.

Study Design/Methods
  • Phase 1b, open-label, multicenter study.
  • The trial is expected to enroll approximately 250 patients from about 24 sites in 3 countries, including the United States.
  • The trial includes 6 arms, one of which is D-Pd (N=103 patients).
  • Patients in the D-Pd arm received 28-day cycles of DARZALEX 16 mg/kg IV in combination with pomalidomide 4 mg (Days 1-21) and dexamethasone 40 mg weekly.
  • DARZALEX was administered weekly for cycles 1-2, every 2 weeks for cycles 3-6, and every 4 weeks thereafter.
  • Eligibility criteria for the D-Pd arm: ≥18 years of age and documented myeloma; Eastern Cooperative Oncology Group performance status (ECOG PS ≤2); ≥2 prior lines of antimyeloma therapy, including at least 2 consecutive cycles of prior treatment that included lenalidomide and bortezomib; progressed on a combination regimen of lenalidomide and bortezomib, or consecutive regimens that contained lenalidomide and bortezomib separately; lenalidomide refractory; for patients with immunoglobulin G (IgG) disease, serum Mprotein level ≥1.0 g/dL or urine M-protein ≥200 mg/24h; for patients with light chain MM, serum immunoglobulin free light chain ≥10 mg/dL and an abnormal serum Ig kappa/gamma free light chain ratio; hemoglobin ≥8 g/dL; absolute neutrophil count (ANC) ≥1.0 x 109/L; aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 x upper limit of normal (ULN); total bilirubin ≤2.0 mg/dL; calculated creatinine clearance ≥45 mL/min/1.73 m2; corrected serum calcium <14 mg/dL; free ionized calcium <6.5 mg/dL; platelet count ≥75 x 109/L in patients for whom <50% of bone marrow nucleated cells were plasma cells.
  • Exclusion criteria: previous treatment with daratumumab or pomalidomide; allogeneic stem cell transplantation (SCT) at any time; autologous SCT within 12 weeks of treatment start; antimyeloma therapy within 2 weeks of treatment start; monoclonal gammopathy of undetermined significance, smoldering MM, amyloidosis, or Waldenström disease; peripheral neuropathy (grade ≥2); chronic obstructive pulmonary disease; meningeal involvement of myeloma; moderate, severe or uncontrolled asthma, or significant heart disease; known hypersensitivity to thalidomide or lenalidomide.
  • Primary safety endpoint: maximum tolerated dose of DARZALEX, defined as the highest dose level at which ≤1 patient out of an initial 6 patients experienced a dose limiting toxicity.
  • Secondary endpoints included: ORR, CR rate, cytogenic risk, disease progression, MRD in patients who achieved ≥CR.
Results

Baseline Characteristics

Disposition and Drug Exposure

  • Among patients who received D-Pd regimen (N=103)7:
    • 85% of patients discontinued treatment with D-Pd:
      • 53% due to progressive disease
      • 17% due to AEs
      • 4% due to physician’s decision
      • 4% due to death
      • 4% due to other reasons
      • 3% due to patient withdrawal

Baseline Characteristics for the D-Pd Regimen6,7
Characteristic
D-Pd
(N=103)

Median (range) age, years
64 (35-86)
Age category, n (%)
   <65 years
52 (51)
   ≥75 years
8 (8)
Male, %
55
Race, n (%)
   White
79 (77)
   Other
24 (23)
High-risk cytogenetic profilea
22/87 (25)
   del17p
16 (18)
   t(4;14)
6 (7)
   t(14;16)
1 (1)
Baseline ECOG PS score, n (%)
   0
28 (27)
   1
63 (61)
   2
12 (12)
   >2
0 (0)
Type of myeloma, n (%)
   IgG
63 (61)
   IgA
18 (18)
   IgD
2 (2)
   Light chain
20 (19)
Median (range) time from diagnosis, years
5.1 (0.4-16.0)
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; ECOG PS, Eastern Cooperative Oncology Group performance status; Ig, immunoglobulin.
aThe presence of high-risk cytogenetic abnormalities was adjudicated locally per individual center practices.


Prior Therapy Status for the D-Pd Regimen6,7
Characteristic
D-Pd
(N=103)

Median (range) prior LOTs, n (%)
4 (1-13)
Prior LOTs, n (%)
   1a
3 (3)
   2
22 (21)
   3
25 (24)
   >3
53 (52)
Autologous stem cell transplant
76 (74)
Prior therapy with, n (%)
   PI
102 (99)
      Carfilzomib
34 (33)
      Bortezomib
101 (98)
      Ixazomib
2 (2)
   Lenalidomide
103 (100)
   Thalidomide
29 (28)
   Bortezomib + lenalidomide
101 (98)
   Bortezomib + lenalidomide + carfilzomib
34 (33)
   Steroids
103 (100)
   Chemotherapy
103 (100)
   PI and immunomodulatory drug
102 (99)
Refractory to, n (%)
   PI
9 (9)
   IMiD
21 (20)
   PI and IMiD
73 (71)
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; IMiD, immunomodulatory drug; LOT, line of therapy; PI, proteasome inhibitor.
aThree patients were identified by investigators as having ≥2 prior LOTs but per International Myeloma Working Group criteria, they were later determined to have received only 1 prior LOT that included both bortezomib and lenalidomide.

Safety

  • Among patients who received the D-Pd regimen (N=103)6:
    • The most common (≥25%) TEAEs are presented in Table: TEAEs Occurring in ≥25% of Patients Who Received the D-Pd Regimen.
    • The most common grade 3 or 4 AEs were neutropenia (79% [febrile neutropenia 8%]), anemia (28%), and leukopenia (24%).
    • Other than neutropenia, rates of grade ≥3 AEs were similar to those observed historically with Pd alone.
    • A total of 44% of patients had preexisting grade 1/2 neutropenia at enrollment.
    • Serious AEs occurred in 57% of patients.
      • 19%, 22%, and 19% were related to DARZALEX, pomalidomide, and dexamethasone, respectively.
    • A total of 19% of patients discontinued treatment (any components) due to a TEAE; 4% were reasonably related to DARZALEX.
    • TEAEs leading to death occurred in 9% of patients.
    • Overall, no deaths were considered related to DARZALEX.
    • One patient reported a secondary primary malignancy.

TEAEs Occurring in ≥25% of Patients Who Received the D-Pd Regimen6
Event, n (%)
D-Pd
(N=103)

Any Grade
Grade ≥3
Neutropenia
83 (80.6)
81 (78.6)
Anemia
57 (55.3)
29 (28.2)
Fatigue
54 (52.4)
13 (12.6)
Diarrhea
51 (49.5)
5 (4.9)
Thrombocytopenia
44 (42.7)
20 (19.4)
Cough
42 (40.8)
0 (0)
Leukopenia
40 (38.8)
25 (24.3)
Constipation
37 (35.9)
0 (0)
Nausea
36 (35.0)
0 (0)
Dyspnea
34 (33.0)
8 (7.8)
Pyrexia
34 (33.0)
2 (1.9)
Back pain
33 (32.0)
6 (5.8)
Upper respiratory tract infection
33 (32.0)
3 (2.9)
Muscle spasms
30 (29.1)
1 (1.0)
Vomiting
29 (28.2)
2 (1.9)
Arthralgia
28 (27.2)
2 (1.9)
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; TEAE, treatment-emergent adverse event.

Efficacy

  • Among patients who received ≥1 dose of study drug D-Pd regimen (N=103)6:
    • ORR was 66% (n=94; 95% CI, 55.5%-75.4%).
    • Best responses:
      • sCR: 13% (n=12)
      • CR: 10% (n=9)
      • VGPR: 26%
      • PR: 18%
    • Among responders, the median DOR was 21.5 months (95% CI, 13.6-not estimable [NE]).
    • 8%, 7%, and 2% of patients became negative for MRD at thresholds of 10-4, 10-5, and 10-6, respectively.
    • ORR data from a subgroup analysis of patients who received D-Pd are presented in Table: ORR Subgroup Analysis: D-Pd.
    • PFS:
      • Median PFS: 9.9 months (95% CI, 5.4-15.4).
      • 24-month PFS rate: 30.8% (95% CI, 21.3%-40.8%).
    • At a median follow-up of 28.1 months:
      • Median OS was 25.1 months (95% CI, 15.6-NE)
      • Estimated OS rate at 24 months was 52.4% (95% CI, 41.9%-61.8%).
    • The median OS was NR (95% CI, NE-NE) in ≥PR patients, 8.0 months (95% CI, 5.2-13.5) in stable disease/minimal response patients, and 2.3 months (95% CI, 0.6-4.4) in progressive disease/NE patients.

ORR Subgroup Analysis: D-Pd6,7
Subgroups
N
ORR
95% CI
All patients
103
60.2
(50.1-69.7)
Sex
   Male
57
54.4
(40.7-67.6)
   Female
46
67.4
(52.0-80.5)
Age, years
   <65
52
57.7
(43.2-71.3)
   ≥65
51
62.7
(48.1-75.9)
Renal function (baseline creatinine clearance)
   <60 mL/min
31
58.1
(39.1-75.5)
   ≥60 mL/min
72
61.1
(48.9-72.4)
Baseline hepatic function
   Normal
84
65.5
(54.3-75.5)
   Impaireda
19
36.8
(16.3-61.6)
Number of prior LOTs
   2 lines
22
63.6
(40.7-82.8)
   3 lines
26b
65.4
(44.3-82.8)
   >3 lines
53
54.7
(40.4-68.4)
Refractoriness
   PI and immunomodulatory drug
73
57.5
(45.4-69.0)
Measurable type of MM
   IgG
56
53.6
(39.7-67.0)
   Non-IgG
17
58.8
(32.9-81.6)
Cytogenic risk
   Standard risk
65
58.5
(45.6-70.6)
   High risk
22
59.1
(36.4-79.3)
Abbreviations: CI, confidence interval; D-Pd, DARZALEX + pomalidomide + dexamethasone; IgG, immunoglobulin G; LOT, line of therapy; MM, multiple myeloma; ORR, overall response rate; PI, proteasome inhibitor.
aClassified as mild, moderate or severe; 17% mild impairment, 1% moderate impairment, 0% severe impairment. Patients with impaired hepatic function received few doses of DARZALEX vs patients with normal hepatic function.
bDiscrepancy from demographics table due to update of concomitant medication data.

Phase 2 Study

MM-014 (clinicaltrials.gov identifier: NCT01946477) is an ongoing study evaluating the safety and efficacy of D-Pd and Pd in RRMM patients who have received 1 or 2 prior LOTs including lenalidomide.21,22 Siegel et al (2020)22 reported results of the DPd arm with a median follow-up of 17.2 months. Bahlis et al (2022)21 reported the results of the D-Pd arm with a median follow-up of 28.4 months. Bahlis et al (2023)8 reported the final OS of the D-Pd arm and updated results with a median follow-up duration of 41.9 months (range, 0.4-73.1). Data specific to patients who received D-Pd are summarized.

Study Design/Methods
  • Phase 2, nonrandomized, open-label, multicenter study.
  • The trial is expected to enroll 156 participants from about 49 sites in 3 countries, including the United States.
  • Patients in the D-Pd arm will receive 28-day cycles of DARZALEX 16 mg/kg IV in combination with pomalidomide 4 mg PO daily (Days 1-21) and dexamethasone 40 mg/day (20 mg for patients > 75 years) on Days 1, 8, 15 and 22 of a 28-day cycle weekly.
  • DARZALEX was administered weekly for cycles 1-2, every 2 weeks for cycles 3-6, and every 4 weeks thereafter.21
  • Thromboprophylaxis was mandatory for all patients and included low-dose aspirin, lowmolecular-weight heparin, or other equivalent antithrombotic agents.
  • Key inclusion criteria for the D-Pd arm: ≥18 years of age with documented MM diagnosis, measurable disease (serum M-protein ≥0.5 g/dL or urine M-protein ≥200 mg/24 h), and ECOG PS ≤2, 1-2 prior lines of antimyeloma therapy, documented progressive disease during or after their last LOT, treatment with a lenalidomidecontaining regimen for ≥2 consecutive cycles as their most recent regimen.22
  • Key exclusion criteria for the D-Pd arm: prior treatment with pomalidomide or daratumumab or hypersensitivity to thalidomide, lenalidomide, dexamethasone, or monoclonal antibodies, ANC <1 × 109/L, platelet count <75 × 109/L (<30 × 109/L for patients in whom ≥50% of bone marrow nucleated cells were plasma cells), corrected serum calcium >2.875 mmol/L (11.5 mg/dL), hemoglobin <8 g/dL, AST or ALT >3.0 × ULN, serum total bilirubin level >2.0 mg/dL, and severe renal impairment (creatinine clearance <30 mL/min or requiring dialysis).
  • Primary endpoint: ORR per the modified International Myeloma Working Group (IMWG) criteria modified to include minimal response (MR).
  • Secondary endpoints: PFS, OS, DOR, time to response, time to progression, and safety.
  • Key exploratory endpoints for cohort B: pharmacodynamic and mechanistic biomarkers of D-Pd; quality of life by EuroQoL 5 dimensions (EQ-5D).
Results

Patient Characteristics


Baseline Demographics and Disease Characteristics of the D-Pd ITT Population8
Characteristic
D-Pd ITT Population
(n=112)

Age, median (range), years
66.5 (39-83)
   Age category, n (%)
      ≤65 years
50 (44.6)
      >65 to ≤75 years
50 (44.6)
      >75 years
12 (10.7)
Male/female, n (%)
76 (67.9)/36 (32.1)
Race, n (%)
   White
91 (81.3)
   Black or African American
10 (8.9)
   Asian
6 (5.4)
   Others
5 (4.5)
ECOG PSa, n (%)
   0
44 (39.3)
   1
67 (59.8)
R-ISS stage, n (%)
   I
31 (27.7)
   II
52 (46.4)
   III
8 (7.1)
   NE
21 (18.8)
Time from first diagnosis, median (range), years
3.4 (0.5-11.5)
Status of most recent prior LEN-containing treatment, n (%)
   LEN-relapsed
27 (24.1)
   LEN-refractory
85 (75.9)
Prior lines of therapy, n (%)
   1
69 (61.6)
   2
43 (38.4)
Prior stem cell transplant, n (%)
78 (69.6)
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; ECOG PS, Eastern Cooperative Oncology Group performance status; ITT, intention-to-treat; LEN, lenalidomide; NE, not evaluable; R-ISS, Revised International Staging System.
a1 patient had an ECOG PS of 2.

Patient Disposition

  • A total of 97 (86.6%) patients discontinued treatment at a median follow up of 41.9 (range, 0.4–73.1) months with the most common reason being progressive disease, as presented in Table: Patient Disposition.
  • A total of 75 (67%) patients discontinued the study at a median follow up of 41.9 (range, 0.4–73.1) months with the most common reason being death (n=50); 47/50 patients died off treatment during the long-term follow-up.

Patient Disposition8
Reason, n (%)
D-Pd (N=112)
Continuing treatment
15 (13.4)
Discontinued treatment
97 (86.6)
   Disease progression
54 (48.2)
   Withdrawal by patient
23 (20.5)
   Adverse event
10 (8.9)
   Death
3 (2.7)
   Transition to commercially available treatment
2 (1.8)
   Other
3 (2.7)
   Unknown
2 (1.8)
Patients continuing in follow-up
22 (19.6)
Discontinued study
75 (67)
   Death
50 (44.6)
   Withdrawal by patient
19 (17.0)
   Lost to follow-up
2 (1.8)
   Other
4 (3.6)
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone.

Drug Exposure

  • The median treatment duration for pomalidomide, dexamethasone, and DARZALEX was 15.7 months (range, 0.3-73.1), 13.7 months (range, <0.1 to 72.5), and 15.2 months (range, <0.1 to 72.7), respectively.
  • The median number of treatment cycles for pomalidomide, dexamethasone, and DARZALEX was 17 (range, 1-77), 15 (range, 1-77), and 17 (range, 1-78), respectively.

Efficacy

  • In the ITT population (n=112), ORR was 78.6% (95% CI, 69.8-85.8), CR was 26.8%, VGPR was 25.9%, and PR was 25.9% as presented in Table: Response Rates in the ITT Population and LEN-Relapsed and -Refractory Subgroups.
  • The median PFS in the ITT population was 23.7 months (95% CI, 15.8-36.1) at the data cutoff.
  • The median OS was 56.7 months (95% CI, 46.5-NR).
    • The median OS for the lenalidomide-relapsed and lenalidomide-refractory groups was NR (95% CI, 47.6-NR) months and 53.6 months (95% CI, 28.6-NR), respectively.
    • The median OS was similar in the prespecified patient subgroups as presented in Table: OS by Subgroup.
    • The median OS was also similar in patients with different LOTs of the number of prior LOTs.
      • In patients who received 1 and 2 prior LOTs, respectively, the median OS was 56.6 (95% CI, 41.3-NR) and NR (95% CI, 22.8-NR), and death occurred in 33 (47.8%) and 17 (39.5%) patients.
  • Sixty-four (57.1%) patients received subsequent therapy, most commonly bortezomib/cyclophosphamide/dexamethasone (n=7, 6.3%).
    • Only 1 patient each received chimeric antigen receptor T-cell therapy and T cell engager therapy (elranatamab; data not shown) in the regimen.

OS by Subgroup8
Baseline Characteristics
OS, Median Months
95% CI
Overall
56.7
(46.5-NR)
Age, years
   ≤65
NR
(43.6-NR)
   >65
54.4
(24.1-NR)
ECOG PS score
   <1
59.8
(47.6-NR)
   ≥1
56.6
(28.5-NR)
Creatinine clearance
   <30 mL/min
NA
NA
   ≥30 and <45 mL/min
NA
NA
   ≥45 and <60 mL/min
NR
(28.6-NR)
   ≥60 mL/min
49.1
(34.9-NR)
Missing
NR
(20.5-NR)
Prior stem cell transplant
   Yes
60.3
(43.6-NR)
   No
56.6
(24.1-NR)
Duration of the most recent LEN
   ≤24 months
41.3
(21.2-56.7)
   >24 months
NR
(54.4-NR)
Immediately prior LEN dose
   >10 mg
53.6
(28.6-NR)
   ≤10 mg
NR
(38.4-NR)
   Missing
NA
NA
Number of prior antimyeloma lines
   1
56.6
(41.3-NR)
   2
NR
NR (22.8-NR)
Status after most recent prior LEN
   Refractory
53.6
(28.6-NR)
   Relapsed
NR
(47.6-NR)
Baseline β-2 microglobulin
   <3.5 mg/L
NR
(49.1-NR)
   ≥3.5 mg/L and <5.5 mg/L
54.4
(21.3-NR)
   ≥5.5 mg/L
21.2
(13.3-NR)
   Missing
NR
(25.5-NR)
Prior LEN+proteasome inhibitor
   Yes
54.4
(42.5-NR)
   No
56.7
(28.6-NR)
Triplet induction
   <3 agents
NR
(24.1-NR)
   ≥3 agents
54.4
(42.5-NR)
Calculated R-ISS stage
   I
NR
(53.6-NR)
   II
35
(21.3-56.6)
   III
34.4
(6.1-NR)
   NE
NR
(41.3-NR)
Cytogenetic abnormality
   High risk
35
(18.7-NR)
   Standard risk
56.7
(38.4-NR)
   NE
NR
(41.3-NR)
Abbreviations: CI, confidence interval; ECOG PS, Eastern Cooperative Oncology Group performance status; LEN, lenalidomide; NA, not applicable; NE, not evaluable; NR, not reached; OS, overall survival; R-ISS, Revised International Staging System.

Response Rate in the ITT Population and LEN-Relapsed and -Refractory Subgroups8
Response, n
D-Pd ITTb Population
(N=112)

LEN-Relapsedc
(n=27)

LEN-Refractoryd
(n=85)

ORRa (95% CI)
78.6 (69.8-85.8)
81.5 (61.9-93.7)
77.6 (67.3-86)
   CR%
26.8
40.7
22.4
   VGPR%
25.9
25.9
25.9
   PR%
25.9
14.8
29.4
MR
8
7.4
8.2
SD
6.3
3.7
7.1
PD
3.6
3.7
3.5
Abbreviations: CI, confidence interval; CR, complete response, D-Pd, DARZALEX + pomalidomide + dexamethasone; ITT, intention-to-treat; LEN, lenalidomide; MR, minimal response; ORR, overall response rate; PD, progressive disease; PR, partial response; SD, stable disease; VGPR, very good partial response.
aDue to rounding, the sum of individual response rates (CR + VGPR+ PR) may not exactly equal the ORR.
b
Patients were NE/missing.
cPatient was NE/missing.
dPatients were NE/missing.

Safety

  • Among patients who received the D-Pd regimen (N=112):
    • The TEAEs are presented in Table: Grade 3/4 TEAEs for the D-Pd Regimen
    • Discontinuation of pomalidomide, dexamethasone and DARZALEX occurred in 7 (6.3%), 9 (8%), and 6 (5.4%) patients, respectively, as presented in Table: Discontinuation or Modification of Dose Due to TEAEs.
    • The most common hematologic TEAE was neutropenia 72 (64.3%) resulting in dose modification of pomalidomide (reduction, n=17 [15.2%]; interruption, n=38 [33.9%]), and DARZALEX (interruption, n=30 [26.8%]).
    • The most common nonhematologic-related TEAE was pneumonia 20 (17.9%) resulting in dose modification of pomalidomide (interruption, n=7 [6.3%]) and DARZALEX (interruption, n=5 [4.5%]).

Grade 3/4 TEAEs for the D-Pd Regimen8
TEAEs Observed in ≥5% of Patients, n (%)
D-Pd (N=112)
Hematologic TEAEs
   Neutropenia
72 (64.3)
   Anemia
22 (19.6)
   Thrombocytopenia
16 (14.3)
   Febrile neutropenia
11 (9.8)
   Leukopenia
11 (9.8)
Nonhematologic TEAEs
   Pneumonia
20 (17.9)
   Decreased neutrophil count
10 (8.9)
   Hypertension
10 (8.9)
   Dyspnea
8 (7.1)
   Back pain
7 (6.3)
   Fatigue
7 (6.3)
   Decreased WBC
6 (5.4)
   Sepsis
6 (5.4)
   Chronic obstructive pulmonary disease
6 (5.4)
   Hyperglycemia
6 (5.4)
   Hypokalemia
6 (5.4)
   Atrial fibrillation
6 (5.4)
   Insomnia
6 (5.4)
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; TEAE, treatment-emergent adverse event; WBC, white blood cells.

Discontinuation or Modification of Dose Due to TEAEs8
Patients With TEAEs, n (%)
D-Pd (N=112)
Pomalidomide
Dexamethasone
DARZALEX
Discontinuation of and related to study drug
7 (6.3)a
9 (8.0)a
6 (5.4)b
Dose reduction of and related to study drug (≥5% of patients for any drug)
31 (27.7)
38 (33.9)
0
   Neutropenia
17 (15.2)
0
0
   Insomnia
0
10 (8.9)
0
   Peripheral edema
0
6 (5.4)
0
Dose interruption of and related to study drug (≥5% of patients for any drug)
55 (49.1)
17 (15.2)
65 (58)
   Neutropenia
38 (33.9)
3 (2.7)
30 (26.8)
   Pneumonia
7 (6.3)
5 (4.5)
5 (4.5)
   Leukopenia
4 (3.6)
0
6 (5.4)
   Infusion-related reaction
0
0
26 (23.2)
Abbreviations: D-Pd, DARZALEX + pomalidomide + dexamethasone; TEAE, treatment-emergent adverse event.
aIncluded 1 case each of leukopenia and thrombocytopenia.
bIncluded 1 case each of leukopenia, thrombocytopenia, and febrile neutropenia.

Literature Search

A literature search of MEDLINE®, Embase®, BIOSIS Previews®, and Derwent Drug File databases (and/or other resources, including internal/external databases) was conducted on 20 March 2024.

 

References

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