Article
Author: Nooka, Ajay K. ; Abrahamsen, Ingerid Weum ; Chen, Christine ; Rodríguez-Otero, Paula ; Cavo, Michele ; Pabst, Thomas ; Iida, Shinsuke ; Arnulf, Bertrand ; Eliason, Laurie ; Truppel-Hartmann, Anna ; Felten, Jasper ; Patel, Krina ; Jagannath, Sundar ; Benjamin, Reuben ; Baz, Rachid ; Zhong, Xiaobo ; Bahlis, Nizar J. ; Popa McKiver, Mihaela ; Ailawadhi, Sikander ; Raje, Noopur ; Giralt, Sergio ; Solomon, Scott ; Wu, Fan ; Dhanda, Devender ; Berdeja, Jesús ; Manier, Salomon ; Cook, Mark ; Costa, Luciano J. ; Piasecki, Julia ; Vij, Ravi ; Moreau, Philippe ; Caia, Andrea ; Chen, Yanping ; Delforge, Michel ; Callander, Natalie ; Scheid, Christof ; Broijl, Annemiek
Abstract:Outcomes are poor in triple-class–exposed (TCE) relapsed and refractory multiple myeloma (R/RMM). In the phase 3 KarMMa-3 trial, patients with TCE R/RMM and 2 to 4 prior regimens were randomized 2:1 to idecabtagene vicleucel (ide-cel) or standard regimens (SRs). An interim analysis (IA) demonstrated significantly longer median progression-free survival (PFS; primary end point; 13.3 vs 4.4 months; P < .0001) and higher overall response rate (ORR) with ide-cel vs SRs. At final PFS analysis (median follow-up, 30.9 months), ide-cel further improved median PFS vs SRs (13.8 vs 4.4 months; hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.38-0.63). PFS benefit with ide-cel vs SRs was observed regardless of number of prior lines of therapy, with greatest benefit after 2 prior lines (16.2 vs 4.8 months, respectively). ORR benefit was maintained with ide-cel vs SRs (71% vs 42%; complete response, 44% vs 5%). Patient-centric design allowed crossover from SRs (56%) to ide-cel upon progressive disease, confounding overall survival (OS) interpretation. At IA of OS, median was 41.4 (95% CI, 30.9 to not reached [NR]) vs 37.9 (95% CI, 23.4 to NR) months with ide-cel and SRs, respectively (HR, 1.01; 95% CI, 0.73-1.40); median OS in both arms was longer than historical data (9-22 months). Two prespecified analyses adjusting for crossover showed OS favoring ide-cel. This trial highlighted the importance of individualized bridging therapy to ensure adequate disease control during ide-cel manufacturing. Ide-cel improved patient-reported outcomes vs SRs. No new safety signals were reported. These results demonstrate the continued favorable benefit-risk profile of ide-cel in early-line and TCE R/RMM. This trial was registered at www.ClinicalTrials.gov as #NCT03651128.