Manni Mohyuddin: Six key take-aways regarding the IMROZ trial while we wait for ASCO 24
Manni Mohyuddin shared on X:
“The IMROZ trial (Isa-VRd versus VRd for transplant-ineligible myeloma) just dropped. .
Although the trial is successful, numerous caveats exist. Six key take-aways regarding this trial, while we await the formal presentation at ASCO.
The primary endpoint of PFS was met, not reached for Isa-VRd vs 54 months for VRd For VRd (without transplant) to get median PFS of 54 months is a lot.
Context= VRd in ENDURANCE: 35 months and SWOG0777 43 months PFS. Needs more details, but speaks to fitness/biology of enrolled patients.
We do not have patient characteristics, but I suspect that patients enrolled were actually fit and transplant eligible by US standards.
This is mostly NOT a frail patient population, and will probably be a younger cohort than MAIA trial (median age was 73 for MAIA).
Using quads doubled the treatment related deaths. More than 1 in every 10 people (11%!) receiving Isa-VRd died due to a Grade V adverse event as opposed to 5.5% for VRd. This is similar to what was seen in the Spanish GEMFIT study (best MRD with Dara-KRd, but most deaths).
This trial tells us how to use quads, and what to expect in people for whom transplant is deferred (or not done), not necessarily a population whom is clearly transplant ineligible. It tells us that quads are providing great outcomes even without transplant.
This regimen is best avoided in a clearly frail patient population, until we get further data. The doubling of deaths may very well lead to a PFS/OS disconnect, and you may get more mileage by sequencing things and starting gently for frailer patients (KM Curve needed!)
By allowing isatuximab upon cross-over (the compassionate/ethical thing to do), we learn more insights about sequencing of CD38 monoclonal antibodies, which may be very relevant in LMIC’s (in the US, CD38 already upfront).
Thanks for reading-will update when I review slides!”
Source: Manni Mohyuddin/X
Dr. Manni Mohyuddin is an Assistant Professor at the Huntsman Cancer Institute, University of Utah, specializing in oncology. He is mainly interested in myeloma, supportive care, end-of-life management, and implementing cost-effective, evidence-based treatment strategies.