Multiple Myeloma

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Adding Daratumumab to Front-line Therapy in Multiple Myeloma

Dr. Robert Orlowski MD Anderson Cancer Center

Another Front-Line Drug Available for Multiple Myeloma

  • Daratumumab, which traditionally has been used in later stages of treatment for multiple myeloma, is now believed to be effective when added to upfront treatments
  • Using daratumumab right away can be helpful for those with standard-risk disease whether or not they’re able to receive stem cell transplants
  • The drug can be added to existing drug combinations without increasing what’s called the “toxicity” of the treatment regimen — that is, its side effects

After a diagnosis of multiple myeloma, the first type of treatment you receive — also called “upfront” or “front-line” therapy — now includes a promising new option.

Research has shown that the drug daratumumab, which traditionally has been used in later stages of treatment for multiple myeloma, can now be effective as an upfront treatment. Also known by its brand name, Darzalex, daratumumab is a “monoclonal antibody,” which works by binding to a specific protein on the surface of multiple myeloma cells called CD38. In doing so, the drug essentially summons the body’s own immune system to attack the cancerous cells.

“Upfront therapy for multiple myeloma has really been evolving very quickly,” says Dr. Robert Orlowski, the director of myeloma at the MD Anderson Cancer Center. “And we now have actually three trials where daratumumab was incorporated as part of front-line therapy and found to show increased activity compared with regimens without daratumumab.”

The Benefits

Using daratumumab right away can be helpful for those with standard-risk disease whether or not they’re able to receive stem cell transplants, says Dr. Orlowski.

RELATED: Standard Risk vs. High Risk Multiple Myeloma

For patients not eligible to receive stem cell transplants as part of their multiple myeloma treatment, Dr. Orlowski cites two recent clinical trials showing the benefit of adding daratumumab to several combinations of drugs.

“The addition of daratumumab made a large difference in the overall response rate, the quality of response — meaning how many patients achieved complete remission — as well as MRD, or ‘minimal disease negativity,’ and showed an improvement in progression-free survival,” Dr. Orlowski explains.

And for patients eligible to receive a stem cell transplant as part of their treatment regimen, another recent trial showed the benefit of adding daratumumab to a combination of drugs before and after the transplant.

Dr. Orlowski points out however, that for patients with a type of multiple myeloma that’s considered “high-risk,” the research into the benefits of daratumumab is still ongoing.

‘Daratumumab Is Like Bacon’

Overall, though, the growing body of research seems to indicate that adding daratumumab to other drug regimens for multiple myeloma has a lot of potential.

“Everything is better with bacon,” Dr. Orlowski says, comparing the promising drug to the popular breakfast side dish. “It seems the same is true for daratumumab. Whatever combination you add it to makes it work better.”

One of the reasons, says Dr. Orlowski, is that daratumumab can be added to existing drug combinations without increasing what’s called the “toxicity” of the treatment regimen — that is, its side effects.

“It’s an antibody, so it has a relatively low toxicity profile,” Dr. Orlowski explains. “Dara doesn’t usually add too many side effects, and that makes it easier for patients to tolerate 3- and 4-drug combinations … so that that’s why you’re seeing so many daratumumab-based combinations.”

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Dr. Orlowski is a Professor of Medicine in the Departments of Lymphoma/Myeloma and Experimental Therapeutics, Division of Cancer Medicine, where he is board-certified in medical oncology.   Read More