Joseph Mikhael, MD

Joseph Mikhael, MD, chief medical officer of the International Myeloma Foundation and professor in the applied cancer research and drug discovery division at the Translational Genomics Research Institute, an affiliate of City of Hope Cancer Center, discusses the ongoing impact of daratumumab (Darzalex) as treatment in patients with multiple myeloma.

Daratumumab’s main impact has been on patients in the early relapse setting who are transplant ineligible, usually given in combination with lenalidomide and dexamethasone. However, daratumumab continues to show its effectiveness for patients with multiple myeloma in the frontline setting and now for patients who are transplant eligible. Mikhael discusses the role daratumumab is now playing in this patient population and what the future may hold for it.

Recently, real-world outcomes of daratumumab as a monotherapy for patients with relapsed/refractory multiple myeloma are starting to show favorable efficacy outcomes. In a multicenter study that looked at 107 patients with relapsed/refractory multiple myeloma on daratumumab monotherapy, the overall response rate was 42.1%, the median first and second progression-free survival was 3.6 and 8.1 months, respectively, with an overall survival of 11.9 months in this group. However, certain risk factors have impacted the use of daratumumab as a monotherapy, meaning the use of this treatment in combination with other therapies remains the standard of care.

 Daratumumab has really had an impact on myeloma, of course, primarily early in the more relapse setting, but now more so in the frontline setting. One, because in transplant-ineligible patients, it really has become the standard of care to give patients daratumumab, lenalidomide, and dexamethasone. With time we continue both the daratumumab and the lenalidomide indefinitely, which has now given us the best outcomes we've ever seen in transplant-ineligible patients with respect to progression-free survival, and indeed overall survival.

But similarly, now we're starting to see an impact of daratumumab in the transplant-eligible population also. In that, we are seeing more and more movement towards quadruplets where we add daratumumab to the usual baseline of bortezomib, lenalidomide, and dexamethasone or, in some patients, carfilzomib, lenalidomide, and dexamethasone. So, we are seeing this continued evolution of daratumumab going from the most relapse setting to the early relapse setting, now even to the frontline setting, whether a patient is going to transplant or not.

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Joseph Mikhael, MD, discusses the ongoing impact of daratumumab in the treatment landscape of patients with multiple myeloma. 

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Discussing Daratumumab’s Ongoing Impact on Multiple Myeloma Treatment