On July 9, 2021, the FDA accelerated the approval of a new indication for daratumumab and hyaluronidase-fihj (Darzalex Faspro; Janssen Biotech), in combination with pomalidomide (Pomalyst; Bristol Myers Squibb) and dexamethasone, for the treatment of adults with multiple myeloma who have received ≥1 previous lines of therapy, including lenalidomide (Revlimid) or a proteasome inhibitor. Daratumumab and hyaluronidase, as well as pomalidomide, are each already approved for the treatment of patients with multiple myeloma, alone or in combination with other drugs.
This new indication was based on the results of the APOLLO study, an open-label, active-controlled clinical trial of 304 patients who were randomized in a 1:1 ratio to daratumumab and hyaluronidase plus pomalidomide and dexamethasone or to pomalidomide and dexamethasone alone.
“With this approval, we are now able to combine pomalidomide and dexamethasone with a daratumumab subcutaneous option that can be administered in minutes rather than the hours needed for intravenous administration,” said Meletios A. Dimopoulos, MD, Professor and Chairman of the Department of Clinical Therapeutics at the National and Kapodistrian University of Athens School of Medicine, Athens, Greece, and the study’s principal investigator.
The primary end point was progression-free survival. The median progression-free survival was 12.4 months in the daratumumab and hyaluronidase plus pomalidomide and dexamethasone arm versus 6.9 months with pomalidomide and dexamethasone alone (hazard ratio, 0.63; 95% CI, 0.47-0.85; P = .0018), a 37% risk reduction for disease progression or death with the 3-drug versus the 2-drug combination.
The most common (≥20%) adverse reactions with the 3-drug combination were fatigue, pneumonia, upper respiratory tract infection, and diarrhea.