In a small case series, the investigators identified five patients who had an initial response to standard daratumumab (weekly for 2 cycles, every other week for 4 cycles, then monthly thereafter) either as mono- or combination therapy, who then had daratumumab frequency escalated when early biochemical progression was noted, an investigational endeavor. In this series, patients received a median of 5 additional cycles of daratumumab at an escalated frequency (range: 2-8). Additionally, the median change in involved paraprotein after one cycle of weekly-escalated dara was -40% (range: -67% to +5%), with most achieving prior partial response or stable disease. In patients who initially have at least a partial response (PR) to daratumumab, who then have biochemical progression following de-escalation, it is conceivable that CD38 saturation is not optimized at the every 4 weeks dosing interval. The investigators believe that escalating the frequency of daratumumab in patients with biochemical progression, in this investigational setting, may recapture the initial response, delay clinical progression, and/or delay treatment changes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
-Subcutaneous daratumumab and hyaluronidase-fihj
-Cycle 1 Day 1, Cycle 3 Day 1, and at progression or end of study (whichever is first)
-Cycle 1 Day 1, Cycle 3 Day 1, and at progression or end of study (whichever is first)
Progression-free survival (PFS)
-Defined as the length of time between Cycle 1 Day 1 and progressive disease or death. Patients who are alive and progression-free or were lost to follow-up at the time of data analyses will be censored on the last known alive date.
Time frame: Up to 3 years following initiation of treatment (estimated to 3 years and 8 months)
Overall response rate (ORR)
-Defined as the proportion of patients with a partial response (PR) or better following first treatment with daratumumab following randomization, as defined by IMWG criteria
Time frame: Up to 6 months following initiation of treatment
Proportion of patients on treatment following 3 cycles
Time frame: Completion of cycle 3 by all enrolled patients (estimated to be 12 weeks)
Paraprotein change between Cycle 1 and Cycle 2 of treatment
Time frame: From cycle 1 through cycle 2 (estimated to be 8 weeks)
Overall survival
-Overall survival (OS) will be defined as time from Cycle 1 Day 1 to death due to any causes. Patients who are alive or were lost to follow-up at the time of data analyses will be censored on the last known alive date.
Time frame: Up to 2 years following treatment removal (estimated to be 2 years and 8 months)
Duration of response (DOR)
-Defined as the length of time between initial response with daratumumab following randomization and progressive disease (in responders).
Time frame: Up to 3 years following initiation of treatment (estimated to be 3 years and 8 months)
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