Oral presentation by Dr. Marc S. Raab
Treatment for patients with relapsed/refractory (R/R) multiple myeloma (MM) is highly variable across Canada and depends on a variety of patient, disease-type, and funding factors. The present management paradigm is to generally treat these patients with a triplet, which could include an alkylating agent, an immunomodulatory drug (IMiD), a protease inhibitor, and a steroid. Recent developments have made available an entirely new class of therapy, the monoclonal antibodies, of which daratumumab is presently the only clinically available agent. Daratumumab would be a good standard of care option in this patient group, but access to this drug is highly variable primarily because of funding restrictions. Another difficulty with daratumumab in its present formulation is the long intravenous infusion time, and there is also the significant issue of infusion-related reactions.
MOR202, a human IgG1 CD38 monoclonal antibody, has demonstrated activity as monotherapy and synergy in combination with the IMiDs lenalidomide and pomalidomide in preclinical models of MM. This phase II dose-escalation study of MOR202 shows reasonable activity in combination with dexamethasone with or without an IMiD. As this is a phase II study, it cannot be practice changing but does show a potentially exciting future option for therapy.
A possible benefit for this drug is that it seems to cause less infusion-related reactions than daratumumab. This may be related to a different mechanism of action as this antibody does not fix complement, which is at least partially implicated in daratumumab infusion-related reactions.
Finally, larger phase III studies will need to be conducted with MOR202 to further clarify its efficacy and toxicities.