Triple Regimen for Relapsed/Refractory Multiple Myeloma Feasible in Frail Patients

Frail patients with relapsed/refractory multiple myeloma treated with isatuximab plus pomalidomide and dexamethasone (Isa-Pd) demonstrated response and benefit consistent with older adult patients as well as the overall study population, according to study findings published in the American Journal of Hematology.

“To our knowledge, this is the first post-hoc analysis to show the benefit of a triplet regimen compared with a doublet therapy in frail patients with relapsed/refractory multiple myeloma in the later-line setting,” researchers wrote.

The post-hoc analysis focused on frail patients and fit/intermediate patients in the phase 3 ICARIA-MM study, which demonstrated the efficacy and safety of Isa-Pd, compared with pomalidomide and dexamethasone (Pd), in adults with relapsed/refractory multiple myeloma who had received two or more prior therapies, including lenalidomide and a proteasome inhibitor.

Clinical outcomes tended to improve for frail patients with Isa-Pd compared with Pd alone, researchers reported. Median progression-free survival was 9 months for frail patients on Isa-Pd compared with 4.5 months for those on Pd. The 4.5-month gain was consistent with a nearly 7-month gain with Isa-Pd in participants 75 years and older and with the 5-month improvement for the overall study population.

Toxicities in study participants with frailty treated with Isa-Pd were manageable, the analysis found, and similar to those in participants deemed fit/intermediate. Discontinuation rates, treatment duration, and rates of hematologic treatment-emergent adverse events with the triple regimen were also comparable among participants with and without frailty.

Findings from the analysis suggest the feasibility of Isa-Pd in patients with frailty, researchers noted.

“Fewer frail patients discontinued Isa-Pd than Pd treatment due to treatment-emergent adverse events, further supporting the benefit of Isa-Pd in both frail and fit/intermediate patients with relapsed/refractory multiple myeloma, and the translation of this triplet regimen to real-world practice,” they advised.

Reference:
Schjesvold F, Bringhen S, G Richardson P, et al. Isatuximab plus pomalidomide and dexamethasone in frail patients with relapsed/refractory multiple myeloma: ICARIA-MM subgroup analysis. Am J Hematol. 2021;96(11):E423-E427. doi:10.1002/ajh.26319