DARZALEX® (daratumumab) Clinical Studies: CASSIOPEIA Efficacy

Adding DARZALEX^® (daratumumab) to VTd resulted in significantly more patients with sCR vs VTd alone after consolidation^1,2

sCR was assessed in the ITT population.

Primary endpoint: sCR assessed 100 days after transplant, or immediately following consolidation if greater than 100 days.

DARZALEX^® + VTd post-consolidation responses^1,2

CR=complete response; HR=hazard ratio; ITT=intent-to-treat; MM=multiple myeloma; OR=odds ratio; ORR=overall response rate; PR=partial response; sCR=stringent complete response; VGPR=very good partial response; VTd=bortezomib (V) + thalidomide (T) + dexamethasone (d).

*Based on interim analysis and the boundary for PFS was crossed.

ASCT=autologous stem cell transplant; HR=hazard ratio; ITT=intent-to-treat; MM=multiple myeloma; PFS=progression-free survival; sCR=stringent complete response; VTd=bortezomib (V) + thalidomide (T) + dexamethasone (d).

† In the ITT analysis, patients who did not receive ASCT were considered nonresponders for post-transplant analyses.
^‡Neutrophils >0.5 × 109/L, leukocytes >1.0 × 109/L, and platelets >50 × 109/L (without transfusion).

DARZALEX^® (daratumumab) + VTd consistently improved depth of response

Responses assessed 100 days after transplant, or immediately following consolidation if greater than 100 days^1,3

93% ORR for DARZALEX^® + VTd includes patients in the ITT population:

With a PR or better at the prespecified time point

Response rates over time^3,4

Post-induction, post-ASCT, and best response analyses were not adjusted for multiplicity.
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Median duration of follow-up was 18.8 months (0.0–32.2)

^†Best response of stringent complete response (sCR), complete response (CR), sCR + CR, very good partial response (VGPR), VGPR or better (sCR + CR + VGPR), partial response (PR), overall response (sCR + CR + VGPR + PR), stable disease (SD), progressive disease (PD), and not evaluable (NE) were derived based on the computerized algorithm, according to IMWG response criteria, during the study treatment period.

ASCT=autologous stem cell transplant; IMWG=International Myeloma Working Group; ITT=intent-to-treat; ORR=overall response rate; VTd=bortezomib (V) + thalidomide (T) + dexamethasone (d).

CONTRAINDICATIONS

DARZALEX^® is contraindicated in patients with a history of severe hypersensitivity (eg, anaphylactic reactions) to daratumumab or any of the components of the formulation.

WARNINGS AND PRECAUTIONS

Infusion-Related Reactions

DARZALEX^® can cause severe and/or serious infusion-related reactions including anaphylactic reactions. In clinical trials (monotherapy and combination: N=2066), infusion-related reactions occurred in 37% of patients with the Week 1 (16 mg/kg) infusion, 2% with the Week 2 infusion, and cumulatively 6% with subsequent infusions. Less than 1% of patients had a Grade 3/4 infusion-related reaction at Week 2 or subsequent infusions. The median time to onset was 1.5 hours (range: 0 to 73 hours). Nearly all reactions occurred during infusion or within 4 hours of completing DARZALEX^®. Severe reactions have occurred, including bronchospasm, hypoxia, dyspnea, hypertension, laryngeal edema, and pulmonary edema. Signs and symptoms may include respiratory symptoms, such as nasal congestion, cough, throat irritation, as well as chills, vomiting, and nausea. Less common symptoms were wheezing, allergic rhinitis, pyrexia, chest discomfort, pruritus, and hypotension.

When DARZALEX^® dosing was interrupted in the setting of ASCT (CASSIOPEIA) for a median of 3.75 months (range: 2.4 to 6.9 months), upon re-initiation of DARZALEX^®, the incidence of infusion-related reactions was 11% for the first infusion following ASCT. Infusion-related reactions occurring at re-initiation of DARZALEX^® following ASCT were consistent in terms of symptoms and severity (Grade 3 or 4: <1%) with those reported in previous studies at Week 2 or subsequent infusions. In EQUULEUS, patients receiving combination treatment (n=97) were administered the first 16 mg/kg dose at Week 1 split over two days, ie, 8 mg/kg on Day 1 and Day 2, respectively. The incidence of any grade infusion-related reactions was 42%, with 36% of patients experiencing infusion-related reactions on Day 1 of Week 1, 4% on Day 2 of Week 1, and 8% with subsequent infusions.

Pre-medicate patients with antihistamines, antipyretics, and corticosteroids. Frequently monitor patients during the entire infusion. Interrupt DARZALEX^® infusion for reactions of any severity and institute medical management as needed. Permanently discontinue DARZALEX^® therapy if an anaphylactic reaction or life-threatening (Grade 4) reaction occurs and institute appropriate emergency care. For patients with Grade 1, 2, or 3 reactions, reduce the infusion rate when re-starting the infusion.

To reduce the risk of delayed infusion-related reactions, administer oral corticosteroids to all patients following DARZALEX^® infusions. Patients with a history of chronic obstructive pulmonary disease may require additional post-infusion medications to manage respiratory complications. Consider prescribing short- and long-acting bronchodilators and inhaled corticosteroids for patients with chronic obstructive pulmonary disease.

Interference With Serological Testing

Daratumumab binds to CD38 on red blood cells (RBCs) and results in a positive Indirect Antiglobulin Test (Indirect Coombs test). Daratumumab-mediated positive Indirect Antiglobulin Test may persist for up to 6 months after the last daratumumab infusion. Daratumumab bound to RBCs masks detection of antibodies to minor antigens in the patient’s serum. The determination of a patient’s ABO and Rh blood type is not impacted. Notify blood transfusion centers of this interference with serological testing and inform blood banks that a patient has received DARZALEX^®. Type and screen patients prior to starting DARZALEX^®.

Neutropenia and Thrombocytopenia

DARZALEX^® may increase neutropenia and thrombocytopenia induced by background therapy. Monitor complete blood cell counts periodically during treatment according to manufacturer’s prescribing information for background therapies. Monitor patients with neutropenia for signs of infection. Consider withholding DARZALEX^® until recovery of neutrophils or for recovery of platelets.

Interference With Determination of Complete Response

Daratumumab is a human IgG kappa monoclonal antibody that can be detected on both the serum protein electrophoresis (SPE) and immunofixation (IFE) assays used for the clinical monitoring of endogenous M-protein. This interference can impact the determination of complete response and of disease progression in some patients with IgG kappa myeloma protein.

Embryo-Fetal Toxicity

Based on the mechanism of action, DARZALEX^® can cause fetal harm when administered to a pregnant woman. DARZALEX^® may cause depletion of fetal immune cells and decreased bone density. Advise pregnant women of the potential risk to a fetus. Advise females with reproductive potential to use effective contraception during treatment with DARZALEX^® and for 3 months after the last dose.

The combination of DARZALEX^® with lenalidomide, pomalidomide, or thalidomide is contraindicated in pregnant women, because lenalidomide, pomalidomide, and thalidomide may cause birth defects and death of the unborn child. Refer to the lenalidomide, pomalidomide, or thalidomide prescribing information on use during pregnancy.

ADVERSE REACTIONS

The most frequently reported adverse reactions (incidence ≥20%) were: upper respiratory infection, neutropenia, infusion-related reactions, thrombocytopenia, diarrhea, constipation, anemia, peripheral sensory neuropathy, fatigue, peripheral edema, nausea, cough, pyrexia, dyspnea, and asthenia. The most common hematologic laboratory abnormalities (≥40%) with DARZALEX^® are: neutropenia, lymphopenia, thrombocytopenia, leukopenia, and anemia.

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Efficacy Demonstrated with DARZALEX^® + VTd

Adding DARZALEX^® (daratumumab) to VTd resulted in significantly more patients with sCR vs VTd alone after consolidation^1,2

DARZALEX^® + VTd post-consolidation responses^1,2

53% reduction in the risk of disease progression or death with DARZALEX^® + VTd vs VTd alone^1,2*

DARZALEX^® (daratumumab) + VTd consistently improved depth of response

Efficacy Demonstrated with DARZALEX® + VTd

Adding DARZALEX® (daratumumab) to VTd resulted in significantly more patients with sCR vs VTd alone after consolidation1,2

DARZALEX® + VTd post-consolidation responses1,2

53% reduction in the risk of disease progression or death with DARZALEX® + VTd vs VTd alone1,2*

DARZALEX® (daratumumab) + VTd consistently improved depth of response

Efficacy Demonstrated with DARZALEX^® + VTd

Adding DARZALEX^® (daratumumab) to VTd resulted in significantly more patients with sCR vs VTd alone after consolidation^1,2

DARZALEX^® + VTd post-consolidation responses^1,2

53% reduction in the risk of disease progression or death with DARZALEX^® + VTd vs VTd alone^1,2*

DARZALEX^® (daratumumab) + VTd consistently improved depth of response