Trial identifies a better way to treat ultra-high risk myeloma patients

Research news // 16th December 2021

This month results from the OPTIMUM/MUK nine clinical trial were presented at the American Society of Hematology Annual Meeting.

The results showed that a new intensive treatment regimen is more effective than standard treatments delivering longer remission times in ultra-high risk (UHR) myeloma patients.

This shows there is a better way to treat high-risk patients and is a significant step towards tailored myeloma treatments.

A step towards patient-tailored myeloma treatment

Myeloma is a very complex, individual cancer. Although treatable in the majority of cases, current treatments do not work well for everyone, and new treatment approaches are urgently needed.

Research has identified several genetic changes associated with myeloma that is more aggressive, less responsive to treatment and more likely to relapse quickly. As a result, we can identify patients with more aggressive, high-risk myeloma using cytogenetic tests and gene expression profiling.

MUK nine is building on this research aiming to find a better way to treat high-risk patients. It is one of the first trials testing treatments specifically for UHR myeloma patients and the first to use state-of-the-art diagnostics and genetic profiling to screen for patients in this hard-to-treat group.

A better way to treat ultra-high risk myeloma patients

The 107 UHR myeloma patients included in the trial received a five-drug induction treatment, Dara-CVRd (daratumumab (Darzalex®), cyclophosphamide, bortezomib (Velcade®), lenalidomide (Revlimid®) and dexamethasone), high-dose therapy and a stem cell transplant. This was followed by two sets of consolidation treatment and maintenance.

The overall benefit of the new treatment regimen was determined by comparing the results from MUK nine to the results from a matched group of patients who received standard treatment as part of the Myeloma XI trial.

The new treatment regimen was effective with 95% of patients responding to treatment by the end of the first set of consolidation treatments. 68% of patients achieved a complete response.

At 18 months, 82% of patients in the MUK nine group (intensive treatment) were still in remission compared with 66% of patients in the Myeloma XI group (standard treatment).

The analysis showed that patients who received the new intensive treatment had a 99.5% higher chance of having a longer remission time than those who received the standard treatment.

The shows that the new intensive treatment regimen for ultra-high risk (UHR) myeloma patients is more effective than the standard treatment.

It is hoped these results will support the delivery of the first personalised treatment approach for high-risk myeloma patients.

Sarah McDonald, Director of Research at Myeloma UK said:

“Myeloma is a very variable cancer, and we want to ensure every patient has access to effective treatment. To do this we need to move towards a more individual approach to treatment. These results are a significant advance for high-risk myeloma patients and clearly shows there are superior ways to treat them. We are getting closer to delivering treatments tailored to patients’ risk status”

Dr Martin Kaiser, the clinical lead for the MUK nine said:

“Our study shows the benefit of genetic testing in patients with myeloma to identify those at highest risk since we now have a new and better treatment option for these people.

“All these drugs are already individually licensed and available so we know they are safe, and that means the new combination could potentially be made available for patients quickly. I hope the NHS will consider our data as soon as possible.”

The trial was supported by the pharmaceutical companies that manufacture the drugs tested, the David Forbes-Nixon Foundation, Myeloma UK and the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London.

Watch our video with Dr Martin Kaiser.