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Triplet combinations with pomalidomide improve response vs. doublet combinations in myeloma
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SAN DIEGO — Triplet combination regimens containing pomalidomide nearly doubled response rates compared with doublet combination regimens of pomalidomide in patients with relapsed or refractory multiple myeloma, according to results of a systematic review and meta-analysis.
Adeela Mushtaq, MD, physician and medical resident at the University of Pittsburgh Medical Center, and colleagues found that pomalidomide (Pomalyst, Celgene) and low-dose dexamethasone plus bortezomib (Velcade, Millennium/Takeda) or carfilzomib (Kyprolis, Amgen) were associated with the highest overall response rates among the triplet combination regimens analyzed.
“Pomalidomide has distinct anticancer, antiangiogenic and immunomodulatory properties and has demonstrated synergistic antiproliferative activity in combination regimens,” the researchers wrote. “Our study provides useful insight into relative efficacy of various pomalidomide regimens for the treatment of [relapsed or refractory multiple myeloma] patients.”
Mushtaq and colleagues conducted a comprehensive literature search of phase 2 and 3 studies evaluating the efficacy of various pomalidomide-based therapies to identify the optimal regimen in relapsed and refractory multiple myeloma. Their analysis included 35 studies involving 4,623 patients who received at least two prior treatment regimens. Most patients were refractory to lenalidomide (Revlimid, Celgene). The most common regimen studied was pomalidomide plus low-dose dexamethasone, which was examined in 16 studies.
A pooled analysis of data revealed an ORR of 47.1% with both triplet and doublet pomalidomide-containing regimens. In separate analyses, the ORR of the pomalidomide plus low-dose dexamethasone doublet regimen was 35.7% vs. 61.9% with triplet regimens.
The triplet combinations with the highest ORR included pomalidomide and low-dose dexamethasone plus bortezomib (ORR = 83.5%) or carfilzomib (ORR = 77.1%), followed by:
- pomalidomide and low-dose dexamethasone plus bendamustine (ORR = 74.2%);
- pomalidomide and dexamethasone plus daratumumab (Darzalex; Janssen Oncology; ORR = 64.5%);
- pomalidomide and low-dose dexamethasone plus cyclophosphamide (ORR = 59.4%); and
- pomalidomide and low-dose dexamethasone plus doxorubicin (ORR = 32%).
Pomalidomide had an “acceptable safety profile,” according to the researchers. The most common treatment-emergent adverse event was myelosuppression. Grade 3 or higher hematologic adverse events included neutropenia (47.6%), anemia (26.5%) and thrombocytopenia (20.8%). Non-hematologic adverse events included infections (29.1%), pneumonia (13.8%) and fatigue (10%). – by Stephanie Viguers
Reference:
Mushtaq A, et al. Abstract 2022. Presented at: ASH Annual Meeting and Exposition; Dec. 1-4, 2018; San Diego.
Disclosure: The researchers report no relevant financial disclosures.