Shrimp Options

John DeFlice |
John Deflice, myeloma patient, with backdrop of ASH conference in Orlando 2019

“Anyway, like I was sayin’, shrimp is the fruit of the sea. You can barbecue it, boil It, broil it, bake it, sauté it. Dey’s un, shrimp-kabobs, shrimp creole, shrimp gumbo, pan fried, deep fried, stir-fried. There’s pineapple shrimp, lemon shrimp, coconut shrimp, pepper shrimp, shrimp soup, shrimp stew, shrimp salad, shrimp and potatoes, shrimp burger, shrimp sandwich. That-that’s about it.” – Bubba

Daratumumab is a monoclonal antibody (mab), with a tumor antibody target (tu), derived from a human antibody source (mu). It targets the CD38 site which is a glycoprotein that is highly and uniformly expressed on the surface of the myeloma cell. This provides the strategy for immunotherapy.

Options for the use of daratumumab include: 1. the Alcyone trial-treatment for newly diagnosed, transplant ineligible patients with daratumumab, bortezomib, melphalan, and prednisone, 2. the Pollux trial- treatment after one prior failed therapy using daratumumab, lenalidomide, and dexamethasone, 3. the Castor trial-treatment after one failed prior therapy, using daratumumab, bortezomib, and dexamethasone, 4. the Equuleus trial- treatment after becoming refractory to prior therapies, using daratumumab, pomalidomide, and dexamethasone, 5. the Sirius trial-treatment using daratumumab monotherapy in patients with refractory multiple myeloma, 6. the Candor trial-treatment for relapsed refractory MM patients using daratumumab, carfilzomib, and dexamethasone, 7. the Cassiopeia/Cassiopeia Companion trial-treatment for newly diagnosed multiple myeloma patients who are transplant eligible using daratumumab, bortezomib, thalidomide, and dexamethasone. Cassiopeia is the first study showing clinical benefit of daratumumab in transplant eligible patients with newly diagnosed multiple myeloma, 8. The Griffin phase II study has been added to the options as a frontline therapy with daratumumab, bortezomib, lenalidomide, and dexamethasone for newly diagnosed multiple myeloma patients who are transplant eligible.

The phase I portion of the Griffin study was presented at ASH 2018 which demonstrated a good safety profile. The phase II study presented at ASH 2019 by Peter Voorhees, M.D. clinically has demonstrated a high response rate and significant depth of response. The end point of the study was a stringent complete response and MRD negativity. These results were very favorable when compared to the control arm of the study. The side effects of quadruplet therapy using daratumumab include cytopenia and upper respiratory infections. The overall survival at 2 years was 96% in the daratumumab arm of the study. Long term follow-up of this study will determine the progression free survival and if MRD negative status will remain with maintenance therapy.

Just as Bubba reminds us, there are plenty of great ways to cook and serve shrimp. The Griffin study suggests that a quadruple frontline therapy may be on the menu for treating newly diagnosed multiple myeloma followed by ASCT, consolidation, and maintenance therapy.

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