Sagar Lonial, MD

Sagar Lonial, MD, chief medical officer, Winship Cancer Institute of Emory University, discusses how phase III trials should be designed in the United States for patients with multiple myeloma in the early-relapse setting.

One of the most important pieces of information that separates practice in the United States and the way phase III clinical trials are designed is that most of these trials use lenalidomide (Revlimid) and dexamethasone as the control arm. However, Lonial argues that much of the data cannot be used because most patients progress on lenalidomide-based maintenance. Most of these data are irrelevant, except for in the case of a patient refusing or becoming intolerant to some form of lenalidomide maintenance.

Lonial suggests phase III trials look at using a proteasome inhibitor or pomalidomide (Pomalyst)based salvage therapy for the control arm in these patients. These approaches are important because they are most relevant to the patient, he says. Currently, many physicians are using daratumumab (Darzalex) as a backbone and trying to figure out what would be the best agent to add, such as pomalidomide, bortezomib (Velcade), or carfilzomib (Kyprolis).

Videos

Sagar Lonial, MD, discusses how phase III trials should be designed in the United States for patients with multiple myeloma in the early-relapse setting.

Evaluating Control Regimens in Phase III Clinical Trials for Early-Relapsed Multiple Myeloma

Sagar Lonial, MD, professor and chair, Department of Hematology & Medical Oncology, Emory University School of Medicine, chief medical officer, Winship Cancer Institute of Emory University, discusses the results from 2 large phase III trials presented earlier this year for triplet regimens including pomalidomide (Pomalyst) in multiple myeloma.

First, in the phase III randomized OPTIMISMM trial, the 3-drug regimen of pomalidomide with bortezomib (Velcade) and dexamethasone (PVd) was compared to the combination of bortezomib/dexamethasone. An 11-month progression-free survival (PFS) was found with the triplet regimen, versus 7.9 months in the control arm, according to Lonial.

These results are significant for these patients with early relapse. Lonial also notes that in the first patients to relapse, the PFS was at almost 20 months for the triplet regimen.

In the ELOQUENT-3 trial, patients with multiple myeloma were treated with either the triplet combination of elotuzumab (Empliciti) with pomalidomide and dexamethasone or pomalidomide/dexamethasone. The addition of elotuzumab improved PFS from about 3 months to over 10 months.

Sagar Lonial, MD, professor and chair, Department of Hematology &amp; Medical Oncology, Emory University School of Medicine, chief medical officer, Winship Cancer Institute of Emory University, discusses the results from 2 large phase III trials presented earlier this year for triplet regimens including pomalidomide in multiple myeloma.

Triplet Regimens With Pomalidomide in Patients With Multiple Myeloma

Sagar Lonial, MD, professor and chair, Department of Hematology &amp; Medical Oncology, Emory University School of Medicine, chief medical officer, Winship Cancer Institute of Emory University, discusses the importance of partnering with a myeloma center when managing multiple myeloma.

Dr. Lonial Discusses the Importance of Partnering With a Myeloma Center

Sagar Lonial, MD, professor and chair, Department of Hematology &amp; Medical Oncology, Emory University School of Medicine, chief medical officer, Winship Cancer Institute of Emory University, discusses CAR T-cell therapy for myeloma and other hematologic malignancies.

Sagar Lonial, MD | Authors

Articles

Evaluating Control Regimens in Phase III Clinical Trials for Early-Relapsed Multiple Myeloma

Triplet Regimens With Pomalidomide in Patients With Multiple Myeloma

Dr. Lonial Discusses the Importance of Partnering With a Myeloma Center

CAR T-Cell Therapy for Myeloma and Other Hematologic Malignancies