2016 Clinical Trial Highlight of CASTOR and POLLUX Trials

Highlighted Trials 2016 published on July 25, 2016
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Sagar Lonial, MD, FACP
Chair and Professor
Department of Hematology and Medical Oncology
Chief Medical Officer
Winship Cancer Institute
Emory University School of Medicine
Atlanta, Georgia

I am Dr. Sagar Lonial from the Winship Cancer Institute of Emory University in Atlanta, Georgia, and I am live at the EHA meeting in Copenhagen, Denmark. This last week has been really eventful for myeloma. We have seen lots of new data presented on a number of different topics, and what we saw presented that was really new at the EHA meeting was the POLLUX clinical trial, and POLLUX is a randomized phase 3 trial of daratumumab in combination with lenalidomide and dexamethasone versus lenalidomide and dexamethasone in one to three prior lines of therapy. What Dr. Dimopoulos showed today was really impressive data with a much higher overall response rate favoring the triplet over the doublet and a hazard ratio in terms of progression-free survival that was 0.37, now the lowest hazard ratio we have ever seen in a myeloma trial to date.

If you add this to the more recent CASTOR study that was presented at ASCO last week and re-presented at EHA this week, which also had a very low hazard ratio, CASTOR trial was a randomized phase 3 trial of bortezomib-dexamethasone with or without daratumumab, significantly favoring the three-drug, daratumumab-bortezomib-dexamethasone, combination with a hazard ratio of 0.39. Again, what you see is a pretty amazing synergy when daratumumab is combined with two of our most active drugs in the context of myeloma, the IMiD lenalidomide, and the proteasome inhibitor bortezomib. What I think this means is that we will rapidly see movement of daratumumab to earlier lines of therapy. It will no longer be relegated to the refractory relapse, which is its current FDA label, and I think this data really begins to set up the platform for long-term disease control with a monoclonal being sort of the rituximab, if you will, of multiple myeloma. There are obviously upfront trials that are ongoing combining daratumumab with lenalidomide-dexamethasone as well as daratumumab with a proteasome inhibitor and IMiD combination such as RVD or KRD, and I think we just have to see over time how these all play out together. But the response, the depth of response, and the durability is really some of the most impressive data we have seen in myeloma in a long time. Thank you very much for your attention.

Reviewed on January 17, 2017 for clinical relevance.

Last modified: February 8, 2017