On June 12, 2021 The Janssen Pharmaceutical Companies of Johnson & Johnson reported overall survival (OS) results from the Phase 3 MAIA (NCT02252172) study showing the addition of DARZALEX ▼(daratumumab) to lenalidomide and dexamethasone (D-Rd) resulted in a statistically significant survival benefit over lenalidomide and dexamethasone (Rd) alone in patients with newly diagnosed multiple myeloma (NDMM) who were ineligible for autologous stem cell transplant (ASCT) and were treated to progression (Press release, Johnson & Johnson, JUN 12, 2021, View Source [SID1234583933]).1 These data were featured in the European Hematology Association (EHA) (Free EHA Whitepaper) 2021 Virtual Press Briefing and will be presented as a late-breaking abstract during the EHA (Free EHA Whitepaper) Virtual Congress (Abstract #LB1901).
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The prespecified interim analysis for OS found that after a median follow-up of nearly five years (56.2 months), a 32 percent reduction in the risk of death was observed in the D-Rd treatment arm vs. Rd arm.1 Median OS was not reached in either arm [hazard ratio (HR): 0.68, 95 percent confidence interval (CI), 0.53-0.86; p=0.0013].1 Median progression-free survival (PFS) was not reached after nearly five years and the PFS benefit observed with D-Rd was maintained, with a 47 percent reduction in risk of disease progression or death [HR: 0.53; 95 percent CI, 0.43-0.66; p<0.0001].1 These data are expected to form the basis of future regulatory submissions.
"The treatment of multiple myeloma becomes more complex with each relapse. Therefore, it is critical to achieve deep treatment responses and improved survival with frontline therapy," said Thierry Facon*, M.D., Professor of Haematology at Lille University Hospital, Lille, France and study investigator. "These results strongly support the use of daratumumab, lenalidomide and dexamethasone as a new standard of care to extend survival and improve clinical outcomes in transplant ineligible patients with newly diagnosed multiple myeloma."
All patients enrolled in the MAIA study (n=737) were diagnosed with NDMM, were ineligible for high-dose chemotherapy and ASCT, and received 28-day cycles of D-Rd (n=368) or Rd (n=369). Patients were treated until disease progression or unacceptable toxicity.1 The median age of patients was 73 years (range, 45-90 years). Median PFS was not reached with D-Rd vs. 34.4 months with Rd [HR, 0.53; 95 percent CI, 0.43-0.66; p<0.0001]. Of the 186 patients in the Rd arm who received subsequent therapy, 46 percent received daratumumab.1
Additional New Findings from the MAIA Longer-Term Follow-Up Analysis:
Estimated five-year OS rate of 66 percent with D-Rd vs. 53 percent with Rd (HR: 0.68; 95 percent CI, 0.53-0.86; p=0.0013).1
Estimated five-year PFS rate of 53 percent with D-Rd vs. 29 percent with Rd [HR: 0.53; 95 percent CI, 0.43-0.66; p<0.0001].1
Median time to next treatment was not reached with D-Rd vs. 42.4 months with Rd [HR, 0.47; 95 percent CI, 0.37-0.59 p<0.0001].1
Updated overall response rate (ORR) of 93 percent with D-Rd vs. 82 percent with Rd.1
No new safety concerns were identified in the D-Rd arm. The most common Grade 3 or 4 treatment-emergent adverse events were neutropenia (D-Rd: 54 percent; Rd: 37 percent); pneumonia (D-Rd: 19 percent; Rd: 11 percent); anaemia (D-Rd: 17 percent; Rd: 22 percent); and lymphopenia (D-Rd: 16 percent; Rd: 11 percent).1
"These latest findings from the MAIA study demonstrate the impact of this daratumumab combination regimen on long-term survival in the frontline setting, further establishing the importance of daratumumab as a backbone therapy in the treatment of multiple myeloma," said Craig Tendler, M.D., Vice President, Late Development and Global Medical Affairs, Oncology, Janssen Research & Development, LLC. "These results provide hope and confidence for newly diagnosed patients with multiple myeloma seeking effective treatment regimens that improve long term outcomes and reflect our commitment to continuing to explore the full potential of daratumumab in multiple myeloma."
"Despite multiple myeloma being a difficult to treat, incurable blood cancer, we are pleased to see this daratumumab-based regimen in combination with lenalidomide and dexamethasone continue to deliver positive overall survival and progression-free results to patients with newly diagnosed multiple myeloma within this extended follow-up" said Edmond Chan, EMEA Therapeutic Area Lead Haematology, Janssen-Cilag Ltd. "The new findings from the MAIA study reinforce the transformative role of daratumumab in multiple myeloma and highlight our ongoing commitment to changing what a multiple myeloma diagnosis means to patients".
#ENDS#
About the MAIA Trial2
The randomised, open-label, multicentre Phase 3 study included 737 newly diagnosed patients with multiple myeloma ineligible for high-dose chemotherapy and ASCT, aged 45-90 years (median age of 73).1 Patients were randomised to receive either daratumumab-Rd (D-Rd) or Rd alone in 28-day cycles. In the D-Rd arm, patients received daratumumab 16 milligrams per kilogram (mg/kg) IV weekly for Cycles 1 – 2, every two weeks for Cycles 3 – 6 and every 4 weeks for Cycle 7 and thereafter.1 Patients in the D-Rd and Rd treatment arms received 25 mg of lenalidomide on Days 1 – 21 of each 28-day cycle, and dexamethasone at 40 mg once a week for each cycle. Patients in both treatment arms continued until disease progression or unacceptable toxicity.1
Earlier results from the MAIA study supported the European Commission (EC) approval of daratumumab in combination with Rd, marking the first approval of a CD-38 monoclonal antibody for patients with transplant ineligible NDMM. These data were also published in The New England Journal of Medicine in 2019.
About daratumumab
In August 2012, Janssen Biotech, Inc. and Genmab A/S entered a worldwide agreement, which granted Janssen an exclusive license to develop, manufacture and commercialise daratumumab. Since launch, it is estimated that nearly 190,000 patients have been treated with daratumumab worldwide.3 Daratumumab is also the only CD38-directed antibody approved to be given subcutaneously to treat patients with multiple myeloma (MM). Daratumumab SC is co-formulated with recombinant human hyaluronidase PH20 (rHuPH20), Halozyme’s ENHANZE drug delivery technology.4
CD38 is a surface protein that is highly expressed across MM cells, regardless of the stage of disease. Daratumumab binds to CD38 and induces myeloma cell death through multiple immune-mediated mechanisms of action, including complement-dependent cytotoxicity (CDC), antibody-dependent cell-mediated cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP), as well as through apoptosis, in which a series of molecular steps in a cell lead to its death.5
Data across nine Phase 3 clinical trials in the frontline and relapsed settings for MM and newly diagnosed light chain (AL) amyloidosis, have shown that daratumumab-based regimens resulted in significant improvement in progression-free survival and/or overall survival.6,7,8,9,10,11,12,13,14 Additional studies have been designed to assess the efficacy and safety of daratumumab in the treatment of other malignant and pre-malignant haematologic diseases in which CD38 is expressed.15
For further information on daratumumab, please see the Summary of Product Characteristics at View Source
About Multiple Myeloma
Multiple myeloma (MM) is an incurable blood cancer that starts in the bone marrow and is characterised by an excessive proliferation of plasma cells.16 In Europe, more than 50,900 people were diagnosed with MM in 2020, and more than 32,500 patients died.17 Around 50 percent of newly diagnosed patients do not reach five-year survival,18,19 and almost 29 percent of patients with MM will die within one year of diagnosis.20
Although treatment may result in remission, unfortunately, patients will most likely relapse as there is currently no cure.21 Relapsed and refractory MM is defined as disease that is nonresponsive while on salvage therapy, or progresses within 60 days of last therapy in patients who have achieved minimal response (MR) or better at some point previously before then progressing in their disease course.22 While some patients with MM have no symptoms at all, others are diagnosed due to symptoms that can include bone problems, low blood counts, calcium elevation, kidney problems or infections.23 Patients who relapse after treatment with standard therapies, including proteasome inhibitors and immunomodulatory agents, have poor prognoses and require new therapies for continued disease control.24