Review of the key primary outcome data from this trial of subcutaneous daratumumab with bortezomib, lenalidomide and dexamethasone for newly diagnosed transplant eligible multiple myeloma patients.
Case: A 54-Year-Old Woman with Newly Diagnosed Multiple Myeloma (NDMM)
Clinical Presentation:
Initial Clinical Workup and Diagnosis:
Treatment:
This is a video synopsis/summary of a Case-Based Peer Perspectives featuring Douglas Sborov, MD.
The phase 3 PERSEUStrial compared subcutaneous daratumumab plus lenalidomide, bortezomib, and dexamethasone (Dara-RVD) with RVD alone in patients with transplant-eligible newly diagnosed multiple myeloma. Data were first presented at the 2023 American Society of Hematology Annual Meeting and Exposition. The design mirrored the Griffin trial, except for maintenance therapy. The Dara-RVD arm had 2 years of Dara-lenalidomide maintenance, with those patients with minimal residual disease (MRD) positive continuing Dara-lenalidomide and those who were MRD negative continuing lenalidomide alone. Primary end point was progression-free survival (PFS); key secondary end points included response rates, MRD negativity, safety, and overall survival.
PERSEUS solidified quadruplet over triplet therapy in this population based on the significantly improved PFS. As in Griffin, Dara-RVD improved response rates, complete response, and MRD negativity vs RVD consistently across subgroups. Complete response or better rate was 87.9% with Dara-RVD; MRD-negativity rate (10-5 threshold) was 75.2%. At 47.5-month median follow-up, PFS was significantly improved with Dara-RVD (4-year PFS, 84.3%). Whereas Griffin was underpowered for PFS, PERSEUS resolved prior doubts, cementing quadruplet therapy as standard of care for patients with transplant-eligible newly diagnosed multiple myeloma. However, there is debate over the optimal proteasome inhibitor and anti-CD38 antibody in quad regimens.
Video synopsis is AI-generated and reviewed by Targeted Oncology® editorial staff.
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