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达雷妥尤单抗为基础的治疗方案在复发或难治性多发性骨髓瘤患者中具有高度疗效和良好耐受性,与患者年龄无关:III 期 CASTOR 和 POLLUX 研究的亚组分析。

Daratumumab-based regimens are highly effective and well tolerated in relapsed or refractory multiple myeloma regardless of patient age: subgroup analysis of the phase 3 CASTOR and POLLUX studies.

机构信息

University Hospital of Salamanca/IBSAL, Salamanca, Spain

Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, Australia.

出版信息

Haematologica. 2020 Jan 31;105(2):468-477. doi: 10.3324/haematol.2019.217448. Print 2020.

Abstract

The phase 3 POLLUX and CASTOR studies demonstrated superior benefit of daratumumab plus lenalidomide/dexamethasone or bortezomib/dexamethasone in relapsed/refractory multiple myeloma. Efficacy and safety of daratumumab was analyzed according to age groups of 65 to 74 years and ≥75 years. Patients received ≥1 prior line of therapy. In POLLUX, patients received lenalidomide/dexamethasone ± daratumumab (16 mg/kg weekly, cycles 1-2; every two weeks, cycles 3-6; monthly until progression). In CASTOR, patients received eight cycles of bortezomib/dexamethasone ± daratumumab (16 mg/kg weekly, cycles 1-3; every three weeks, cycles 4-8; monthly until progression). Patients aged >75 years received dexamethasone 20 mg weekly. For patients aged ≥75 years in POLLUX (median follow-up: 25.4 months), daratumumab/lenalido-mide/dexamethasone prolonged progression-free survival lenalido-mide/dexamethasone (median: 28.9 11.4 months; hazard ratio, 0.27; 95% confidence interval, 0.10-0.69; =0.0042) and increased overall response rate (93.1% 76.5%; =0.0740). Neutropenia was the most common grade 3/4 treatment-emergent adverse event (daratumumab: 44.8%; control: 31.4%). Infusion-related reactions occurred in 12 (41.4%) patients. For patients aged ≥75 years in CASTOR (median follow-up: 19.4 months), daratumumab/bortezomib/dexamethasone prolonged progression-free survival versus bortezomib/dexamethasone (median: 17.9 8.1 months; hazard ratio, 0.26; 95% confidence interval, 0.10-0.65; =0.0022) and increased overall response rate (95.0% 78.8%; =0.1134). Thrombocytopenia was the most common grade 3/4 treatment-emergent adverse event (daratumumab: 45.0%; control: 37.1%). Infusion-related reactions occurred in 13 (65.0%) patients. Similar findings were reported for patients aged 65 to 74 years in both studies. Taken together, this subgroup analysis of efficacy and safety of daratumumab was largely consistent with the overall populations.

摘要

POLLUX 和 CASTOR 这两项 3 期研究证实,达雷妥尤单抗联合来那度胺/地塞米松或硼替佐米/地塞米松在复发性/难治性多发性骨髓瘤患者中的获益优于安慰剂联合来那度胺/地塞米松或硼替佐米/地塞米松。本研究根据患者年龄分为 65-74 岁和≥75 岁两个亚组,评估了达雷妥尤单抗的疗效和安全性。患者均接受过至少一线治疗。在 POLLUX 研究中,患者接受来那度胺/地塞米松±达雷妥尤单抗(16mg/kg,每周 1 次,第 1-2 周期;每两周 1 次,第 3-6 周期;每月 1 次,直至疾病进展);在 CASTOR 研究中,患者接受 8 周期硼替佐米/地塞米松±达雷妥尤单抗(16mg/kg,每周 1 次,第 1-3 周期;每三周 1 次,第 4-8 周期;每月 1 次,直至疾病进展)。年龄>75 岁的患者接受地塞米松 20mg/ 周。POLLUX 研究中年龄≥75 岁的患者(中位随访时间:25.4 个月),达雷妥尤单抗/来那度胺/地塞米松组的无进展生存期长于来那度胺/地塞米松组(中位:28.9 个月比 11.4 个月;风险比,0.27;95%置信区间,0.10-0.69;P=0.0042),总缓解率更高(93.1%比 76.5%;P=0.0740)。中性粒细胞减少是最常见的 3/4 级治疗相关不良事件(达雷妥尤单抗组:44.8%;对照组:31.4%)。达雷妥尤单抗组有 12 例(41.4%)患者发生输注相关反应。在 CASTOR 研究中年龄≥75 岁的患者(中位随访时间:19.4 个月),达雷妥尤单抗/硼替佐米/地塞米松组的无进展生存期长于硼替佐米/地塞米松组(中位:17.9 个月比 8.1 个月;风险比,0.26;95%置信区间,0.10-0.65;P=0.0022),总缓解率更高(95.0%比 78.8%;P=0.1134)。血小板减少是最常见的 3/4 级治疗相关不良事件(达雷妥尤单抗组:45.0%;对照组:37.1%)。达雷妥尤单抗组有 13 例(65.0%)患者发生输注相关反应。在两项研究的 65-74 岁年龄亚组中也观察到了类似的疗效和安全性结果。综上所述,该亚组分析结果与总体人群结果基本一致。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/708c/7012498/50b8f7ffd577/105468.fig1.jpg

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