Comparing Three Monoclonal Antibodies With Combined Drugs in Multiple Myeloma

A meta-analysis, published in BMC Cancer, compared the safety and effectiveness of three monoclonal antibodies (MAbs) with different targets, when combined with proteasome inhibitors or immunomodulators and dexamethasone/prednisone, in treatment of patients with multiple myeloma (MM).

According to lead author Wu Ye and colleagues, MAbs that targeted CD38 or SLAMF7 displayed the best results, while those targeting PD-1/PD-L1 performed worse.

Investigators searched for randomized controlled trials containing at least one of the three MAbs in several study databases until February 26, 2020. The final meta-analysis included eleven eligible RCTs encompassing a total of 5,367 patients. StataMP14 and Indirect Treatment Comparisons software were used for statistical analysis.

The authors calculated hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS). Relative risk (RR) for overall response rate, complete response (CR) or better, very good partial response (VGPR) or better, VGPR, partial response, stable disease, and grade III or higher adverse events among the three groups were also calculated.

Comparisons of HRs for PFS were as follows:

  • CD38 group versus SLAMF7 group: 0.662 (95% CI 0.543-0.806)
  • CD38 group versus PD-1/PD-L1 group: 0.317 (95% CI 0.221-0.454)
  • SLAMF7 group versus PD-1/PD-L1 group: 0.479 (95% CI 0.328-0.699)

Additional results included the following:

  • The HR for OS of the CD38 group versus the SLAMF7 group was 0.812 (95% CI 0.584-1.127).
  • The RR for CR or better in the CD38 group versus the SLAMF7 group was 2.253 (95% CI 1.284-3.955).
  • The RR for neutropenia of the CD38 group versus the SLAMF7 group was 1.818 (95% CI 1.41-2.344).

From their findings, authors concluded that the MAbs targeting CD38 produced longer PFS and better treatment response than those targeting SLAMF7 or PD-1/PD-L1. However, the SLAMF7 MAbs prolonged PFS when compared with the PD-1/PD-L1 MAbs and were also associated with a lower incidence of grade III or higher neutropenia than either the CD38 and PD-1/PD-L1 MAbs.