The following article features coverage from the 2021 Annual Meeting of the Society of Hematologic Oncology (SOHO). Click here to read more of Cancer Therapy Advisor’s conference coverage.

Adding isatuximab (isa) to carfilzomib and dexamethasone (Kd) can improve progression-free survival (PFS) in elderly patients with relapsed multiple myeloma, according to a subanalysis of the IKEMA study.

Thierry Facon, MD, of Lille University Hospital in France, presented the analysis at the Annual Meeting of the Society of Hematologic Oncology (SOHO).1

The phase 3 IKEMA trial (ClinicalTrials.gov Identifier: NCT03275285) was designed to compare isa-Kd with Kd in patients with relapsed MM who had received 1 to 3 prior lines of therapy. 


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The interim analysis included 302 patients who were randomized to isa-Kd (n=179) or Kd (n=123), and results showed superior PFS with isa-Kd.2 

The current subgroup analysis was designed to compare the regimens in older and younger patients. Among patients age 70 and older, 52 received isa-Kd, and 34 received Kd. Among patients younger than 70 years, 127 received isa-Kd, and 89 received Kd.

Isa-Kd was associated with improved PFS in both older and younger patients. 

The median PFS in patients age 70 or older was not reached for those assigned to isa-Kd and was 16.2 months for those assigned to Kd (hazard ratio [HR], 0.36; 95% CI, 0.18-0.75). 

The median PFS was not reached for either treatment arm in patients younger than 70 years (HR, 0.61; 95% CI, 0.38-0.97).

In addition to improved PFS, the depth of response was better with isa-Kd, regardless of age group.

Among patients age 70 and older, the complete response rate was 38.5% with isa-Kd and 23.5% with Kd. Among patients younger than 70 years, the complete response rate was 40.2% and 29.2%, respectively.

Among patients age 70 and older, the rate of minimal residual disease (MRD) negativity was 23.1% with isa-Kd and 11.8% with Kd. Among patients younger than 70 years, the rate of MRD negativity was 32.3% and 13.5%, respectively. 

In both treatment arms, grade 3 or higher treatment-emergent adverse events (TEAEs) and serious TEAEs were more common among elderly patients. 

Among patients age 70 or older, grade 3 or higher TEAEs were more common in the isa-Kd arm than in the Kd arm (90.2% vs 76.5%). However, rates of serious TEAEs were similar between the treatment arms (72.5% vs 70.6%).

Among patients age 70 or older, the most common any-grade TEAEs (in the isa-Kd and Kd arms, respectively) were diarrhea (43.1% vs 29.4%), dyspnea (43.1% vs 26.5%), upper respiratory infection (39.2% vs 23.5%), fatigue (39.2% vs 23.5%), and hypertension (37.3% vs 29.4%). 

“Isa-Kd provides a consistent benefit versus Kd in elderly patients and represents a new treatment option for patients with relapsed multiple myeloma,” Dr Facon concluded. 

Disclosures: This research was supported by Sanofi. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Read more of Cancer Therapy Advisor’s coverage of SOHO 2021 by visiting the conference page.

References

1. Facon T, Moreau P, Martin TG, et al. Isatuximab plus carfilzomib and dexamethasone versus carfilzomib and dexamethasone in elderly patients with relapsed multiple myeloma: IKEMA subgroup analysis. Paper presented at: Annual Meeting of the Society of Hematologic Oncology (SOHO); September 8-11, 2021.

2. Moreau P, Dimopoulos M-A, Mikhael J et al. Isatuximab, carfilzomib, and dexamethasone in relapsed multiple myeloma (IKEMA): A multicentre, open-label, randomised phase 3 trial. Lancet. 2021;397(10292):2361-2371. doi:10.1016/S0140-6736(21)00592-4.