Older Patients with Refractory Myeloma Benefitted from Oral Panobinostat Combination

A subgroup analysis of the PANORAMA 3 study showed that patients with relapsed/refractory multiple myeloma (MM) aged ≥75 years had similar benefits from oral panobinostat in combination with subcutaneous (SC) bortezomib and oral dexamethasone as their younger counterparts.

Data from the subgroup analysis were presented at the European Hematology Association 2021 Virtual Meeting. According to the study poster, PANORAMA 1 trial showed panobinostat plus IV bortezomib and dexamethasone (FVd) significantly improved progression-free survival compared with placebo plus Vd. However, there were some concerns about adverse events.

The phase-2 PANORAMA 3 study was designed to optimize FVd by comparing three varying regimens and incorporating SC bortezomib.

Included patients were aged ≥18 years with one to four prior lines of therapy and prior exposure to an immunomodulatory agent.

Previously reported data showed that 20 mg (2 weeks on, 1 week off; TIW) arm provided favorable outcomes and durable responses with a favorable adverse event profile. In this subgroup analysis, the researchers looked at safety and outcomes in patients aged ≥75 years (30 of 241 patients).

Overall, the efficacy outcomes seen in this subset of patients were similar to those of the general study population and to patients aged <75 years.

Across the three arms studied, the overall response rate after 8 cycles was 62.2% with a median duration of response for 20 mg TIW was 22 months. In patients aged ≥75 years, the overall response rate for 20 mg TIW was 60.0%.

The researchers noted that a median duration of response in older patients has not been reached yet.

Serious adverse events of all grades occurred in 53.6% of younger patients compared with 55.6% of older patients assigned to the 20 mg TIW arm. Serious adverse events of grade 3 or worse occurred in 49.3% and 44%, respectively.

According to the poster, the SC administration of bortezomib improved the tolerability of FVd compared with that of IV bortezomib, and older patients had similar efficacy and safety outcomes as younger patients.