Thread by @ManniMD1

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



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🧵meetings.asco.org/abstracts-pres…

1. The primary endpoint of PFS was met, not reached for Isa-VRd vs 54 mo for VRd

For VRd (without transplant) to get median PFS of 54 months is alot

Context= VRd in ENDURANCE:35 mo and SWOG0777 43 mo PFS

Needs more details, but speaks to fitness/biology of enrolled pts

2. 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)

3. 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)

4. This trial tells us how to use quads, and what to expect in ppl 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 in such a pop

5. 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!)

6. 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!