Subgroup analysis of ICARIA-MM study in relapsed/refractory multiple myeloma patients with high-risk cytogenetics

Treatment benefit in multiple myeloma (MM) patients with high-risk cytogenetics remains suboptimal. The phase 3 ICARIA-MM trial (NCT02990338) showed that isatuximab plus pomalidomide-dexamethasone prolongs median progression-free survival (mPFS) in patients with relapsed/refractory MM (RRMM). This subgroup analysis of ICARIA-MM compared the benefit of isatuximab in high-risk [defined by the presence of del(17p), t(4;14) or t(14;16)] versus standard-risk patients. The efficacy of isatuximab in patients with gain(1q21) abnormality was also assessed in a retrospective subgroup analysis. In ICARIA-MM, 307 patients received isatuximab-pomalidomide-dexamethasone (n = 154) or pomalidomide-dexamethasone (n = 153). Isatuximab (10 mg/kg intravenously) was given weekly in the first 28-day cycle, and every other week thereafter. Standard pomalidomide-dexamethasone doses were given. Isatuximab-pomalidomide-dexamethasone improved mPFS (7 center dot 5 vs 3 center dot 7 months; HR, 0 center dot 66; 95% CI, 0 center dot 33-1 center dot 28) and overall response rate (ORR, 50 center dot 0% vs 16 center dot 7%) in high-risk patients. In patients with isolated gain(1q21), isatuximab addition improved mPFS (11 center dot 2 vs 4 center dot 6 months; HR, 0 center dot 50; 95% CI, 0 center dot 28-0 center dot 88) and ORR (53 center dot 6% vs 27 center dot 6%). More grade >= 3 adverse events occurred in high-risk patients receiving isatuximab (95 center dot 7%) versus the control group (67 center dot 6%); however, isatuximab did not increase events leading to discontinuation or treatment-related mortality. Isatuximab-pomalidomide-dexamethasone provides a consistent benefit over pomalidomide-dexamethasone treatment in RRMM patients regardless of cytogenetic risk.