The purpose of this study is to compare the efficacy (rate of very good partial response
[VGPR] or better as best response as defined by the International Myeloma Working Group
[IMWG] criteria) of daratumumab subcutaneous (Dara-SC) in combination with carfilzomib and
dexamethasone (Kd) with the efficacy of Kd in participants with relapsed refractory multiple
myeloma who were previously exposed to daratumumab to evaluate daratumumab retreatment.
For relapsed or refractory multiple myeloma, the treatment is determined on an individual
basis. Common standard of care regimens use either a proteasome inhibitor (PI) or an
immunomodulatory agent (IMiD) in combination with dexamethasone with or without a monoclonal
antibody (mAb) such as daratumumab. After relapse from PIs or IMiDs, patients are often
retreated with drugs that have same mechanism of action to which they have been sensitive.
The disease becomes refractory and all effective treatment options are exhausted. Daratumumab
is a human IgG1 mAb that binds with high affinity to unique epitope on cluster of
differentiation 38 (CD38) and attacks tumor cells that overexpress CD38. Study is to
determine the efficacy of Dara-SC in combination with carfilzomib and dexamethasone (DKd) in
adult participants with relapsed refractory MM who had 1 to 3 prior line(s) of treatment
including a line containing daratumumab to evaluate daratumumab retreatment. The MM treatment
is determined on an individual basis where patient's age, prior therapy, bone marrow
function, co-morbidities, patient preference and time to relapse are considered. Common
standard of care regimens use either PI or an IMiD in combination with dexamethasone with or
without a mAb. It is a targeted immunotherapy that attacks tumor cells that overexpress CD38,
a transmembrane glycoprotein, in a variety of hematological malignancies including multiple
myeloma. The study will be conducted in 3 phases: Screening (28 days), Treatment, and
Follow-Up. Assessments like chest X-ray, spirometry test, electrocardiogram (ECG), will be
performed during Screening phase. During the Treatment Phase, participants will be randomized
to receive Kd or DKd. Efficacy assessments like bone marrow examination will be performed.
Follow-up will continue until the end of study.
Inclusion Criteria:
- Evidence of a response (partial response or better based on investigator's
determination of response by International Myeloma Working Group [IMWG] criteria) to
daratumumab-containing therapy with response duration of at least 4 months
- Participants must have progressed from or be refractory to their last line of
treatment. Relapsed or refractory disease as defined as: a) Relapsed disease is
defined as an initial response to previous treatment, followed by confirmed
progressive disease (PD) by IMWG criteria greater than (>) 60 days after cessation of
treatment. b) Refractory disease is defined as less than (<) 25 percent (%) reduction
in M-protein or confirmed PD by IMWG criteria during previous treatment or >60 days
after cessation of treatment
- Received 1 to 3 prior line(s) of treatment of which one contained daratumumab, and
completed daratumumab at least 3 months prior to randomization. A single line of
therapy may consist of 1 or more agents, and may include induction, hematopoietic stem
cell transplantation, and maintenance therapy. Radiotherapy, bisphosphonate, or a
single short course of corticosteroids (no more than the equivalent of dexamethasone
40 milligram per day [mg/day] for 4 days) would not be considered prior lines of
therapy
- Eastern Cooperative Oncology Group (ECOG) Performance Status score of 0, 1, or 2
- Women of childbearing potential must have a negative urine or serum pregnancy test at
screening within 14 days prior to randomization
Exclusion Criteria:
- Previous treatment with daratumumab within the last 3 months prior to randomization
- Discontinuation of daratumumab due to a daratumumab-related adverse event (AE)
- History of malignancy (other than multiple myeloma) unless all treatment of that
malignancy was completed at least 2 years before consent and the patient has no
evidence of disease. Further exceptions are squamous and basal cell carcinomas of the
skin and carcinoma in situ of the cervix, or breast, or other non-invasive lesion,
that in the opinion of the investigator, with concurrence with the sponsor's medical
monitor, is considered cured with minimal risk of recurrence within 3 years
- Allergies, hypersensitivity, or intolerance to daratumumab, hyaluronidase, monoclonal
antibodies (mAbs), human proteins, or their excipients, or known sensitivity to
mammalian-derived products. Known history of allergy to Captisol (a cyclodextrin
derivative used to solubilize carfilzomib)
- Participant is: a) Known to be seropositive for human immunodeficiency virus (HIV)
with one or more of the following: not receiving highly active antiretroviral therapy
(ART), had a change in ART within 6 months of the start of screening, receiving ART
that may interfere with study treatment, cluster of differentiation (CD)4 count <350
(unit: cells per cubic millimeter of blood) at screening, acquired immunodeficiency
syndrome (AIDS)-defining opportunistic infection within 6 months of start of
screening, and not agreeing to start ART and be on ART >4 weeks plus having HIV viral
load <400 copies/milliliters (mL) at end of 4-week period (to ensure ART is tolerated
and HIV controlled. b) Seropositive for hepatitis B (defined by a positive test for
hepatitis B surface antigen [HBsAg]). Participants with resolved infection (example:
participants who are HBsAg negative but positive for antibodies to hepatitis B core
antigen [anti-HBc] and/or antibodies to hepatitis B surface antigen [anti-HBs]) must
be screened using real-time polymerase chain reaction (PCR) measurement of hepatitis B
virus (HBV) deoxyribonucleic acid (DNA) levels. Those who are PCR positive will be
excluded. c) Known to be seropositive for hepatitis C (except in the setting of a
sustained virologic response [SVR], defined as aviremia at least 12 weeks after
completion of antiviral therapy)