On March 25, 2019 Janssen Pharmaceutical Companies of Johnson & Johnson reported the submission of a Type II Variant Application to the European Medicines Agency (EMA) for DARZALEX ▼ (daratumumab) in combination with lenalidomide and dexamethasone (Rd) for the treatment of newly diagnosed patients with multiple myeloma who are not eligible for autologous stem cell transplantation (GATS) (Press release, Johnson & Johnson, MAR 25, 2019, View Source [SID1234534607]).
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"Today’s submission brings us a little closer to our goal of improving treatment outcomes for people newly diagnosed with multiple myeloma," said José Antonio Burón Vidal, vice president of medical affairs, Europe, Middle East and Africa (EMEA) region, Janssen-Cilag Limited. "We are extremely grateful to the patients and researchers who have participated in the MAIA clinical trial program and look forward to working closely with regulatory authorities to gain approval for this new association."
The application is supported by data from the MAIA Phase 3 Study (MMY3008), which was presented at the 60th Annual Meeting of the American Society of Hematology (ASH) (Free ASH Whitepaper). 1 The study showed that at a median follow-up of 28 months, daratumumab-Rd significantly reduced the risk of disease progression or death by 44 percent in patients with newly diagnosed multiple myeloma who were not not eligible for transplant compared to treatment with Rd alone (risk ratio [HR] = 0.56, 95% confidence interval [CI]: 0.43-0.73, p <0.0001). 1Median progression-free survival with daratumumab-Rd has not yet been reached, compared to 31.9 months for patients who received Rd alone. 1 The addition of daratumumab resulted in more pronounced responses compared to Rd alone, including increased rates of complete response (CR) or better (48% vs. 25%) and very good partial response (VGPR) or better ( 79% vs. 53%). 1As part of the study, patient health, functional capacity, symptoms, psychosocial well-being and life satisfaction were assessed through measures to assess changes in quality of life related to health using the questionnaire of the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) on the quality of life and the study EQ-5D-5L on the health profile of EuroQol. 2
The most common adverse events during treatment grade 3/4 for daratumumab-Rd (≥10 percent) included neutropenia (50%), lymphopenia (15%), pneumonia (14%), and anemia (12%). 1 Infusion-related reactions occurred in 41% of patients receiving daratumumab-Rd, of whom 3% were grade 3/4. 1 The incidence of the second primary invasive malignancy was 3% in the daratumumab-Rd group compared to 4% in the Rd group alone. 1 EISTs leading to death were 7% in the daratumumab-Rd group, compared to 6% in the Rd group. 1The safety profile of daratumumab was consistent with previous studies. 1,3,4,5,6,7
Daratumumab-Rd is being reviewed by the US Food and Drug Administration (FDA) as part of the Real-Time Oncology Review (RTOR) pilot program.
In Europe, daratumumab is indicated: 8
in combination with bortezomib, melphalan and prednisone for the treatment of adult patients with newly diagnosed multiple myeloma who are not eligible for autologous stem cell transplantation
as monotherapy for the treatment of adult patients with recurrent and refractory multiple myeloma whose previous treatment included a proteasome inhibitor and an immunomodulatory agent and who have demonstrated progression of the disease during the last treatment
in combination with lenalidomide and dexamethasone, or bortezomib and dexamethasone, for the treatment of adult patients with multiple myeloma who have received at least one prior therapy
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About the MAIA 2 study
The randomized, open-label, multi-center Phase 3 study included 737 newly diagnosed patients with multiple myeloma eligible for high-dose chemotherapy and GATS, aged 45 to 90 years (median age 73). Patients were randomized to receive the combination of daratumumab-Rd or Rd alone in 28-day cycles. In the patients treated with daratumumab-Rd combination, patients received weekly 16 milligrams of daratumumab per kilogram (mg / kg) intravenously during cycles 1 and 2, every other week during cycles 3 to 6, and every 4 weeks from cycle 7. Patients in the daratumumab-Rd and Rd alone arm received lenalidomide 25 mg on days 1 to 21 of each 28-day cycle, and a weekly dose of 40 mg dexamethasone in each cycle. Patients from both treatment arms continued until disease progression or an unacceptable degree of toxicity.
About Daratumumab
Daratumumab is a novel genus that targets the CD38 gene, a surface protein that is highly expressed in multiple myeloma cells, regardless of the stage of the disease. 9,10 Daratumumab is thought to induce rapid tumor cell death through numerous immune-mediated mechanisms of action, including complement-dependent cytotoxicity and antibody-dependent cellular phagocytosis, as well as apoptosis in the course of time. which a series of cell steps inside the cell result in the death of the cell. 11A subset of suppressor cells derived from myeloid cells (CD38 + MDSCs), CD38 + regulatory T cells, and CD38 + B cells decreased with daratumumab treatment. 11 Daratumumab is being evaluated in a comprehensive clinical development program across a range of multiple myeloma therapies, including first-line and post-relapse therapies. 2,12,13,14,15,16,17,18 Ongoing or planned studies are being conducted to evaluate its potential in the treatment of other hematologic malignant and pre-malignant diseases in which CD38 is expressed, such as indolent myeloma . 19,20 For more information, please consultwww.clinicaltrials.gov .
For more information about daratumumab, please see the Summary of Product Characteristics at View Source .
In August 2012 , Janssen Biotech, Inc. and Genmab A / S entered into a worldwide agreement that granted Janssen an exclusive license to develop, manufacture and market daratumumab. 21
About Multiple Myeloma Multiple
myeloma (MM) is an incurable blood cancer that starts in the bone marrow and is characterized by excessive proliferation of plasma cells. 22 More than 48,200 people have been diagnosed with multiple myeloma in Europe in 2018, and more than 30,800 patients have died. 23 Nearly half of newly diagnosed patients do not achieve five-year survival, 24 and nearly 29% of multiple myeloma patients die within one year of diagnosis. 25
Although the treatment may lead to a remission, unfortunately, patients will most likely experience a relapse because there is currently no cure. 26 The refractory multiple myeloma is a disease which progresses within 60 days following the last treatment of the patient. 27,28 Recurrent cancer refers to the return of the disease after a period of initial, partial or complete remission. 29While some patients with multiple myeloma have absolutely no symptoms, the majority of them are diagnosed because of symptoms that may include bone problems, low blood counts, elevated calcium levels, kidney problems, or infections. . 30 Patients who relapse after treatment with standard therapies, including IP and immunomodulatory agents have a poor prognosis and have few treatment options available. 31