Safety, Efficacy of Dara-KRd in Treatment of Patients With Newly Diagnosed Multiple Myeloma

Pharmacy Times interviewed Luciano Costa, MD, PhD, associate director for clinical research at the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, on his recent presentation at the American Society of Hematology Annual Meeting and Exposition 2021 on the trial assessing daratumumab, carfilzomib, lenalidomide, and dexamethasone (Dara-KRd), autologous transplantation, and minimal residual disease (MRD) response-adapted consolidation and treatment cessation.

Luciano Costa: The idea behind developing Dara-KRd is really to leverage some of the best drugs available in the treatment of multiple myeloma. We take lenalidomide, which is an established immunomodulatory agent that is approved and almost ubiquitously used in the newly diagnosed setting; carfilzomib, which is a second generation proteasome inhibitor that has been shown to be superior to bortezomib in the relapse setting, but not or not yet in the newly diagnosed setting, but it also has a different profile of toxicity with much less neurotoxic neuropathy, for example; daratumumab, which is a CD38 monoclonal antibody; and dexamethasone.

All those agents have shown to be combinable with one another and in very active regimens in the relapse setting. The idea was to bring it to the newly diagnosed setting, ideally before the disease becomes kind of out of control and try to drive patients in as deep a response as possible, so that we can experiment with the cessation of therapy on patients with sustained deep response.

As many of you know, carfilzomib has been used in a variety of doses, and for this trial, we chose to go with carfilzomib at a dose of 56 mg/m2 given once a week, and we find that dose to be quite active and also very convenient for patients, avoiding the twice a week administration from the early carfilzomib regimens.