Pereus Update D-VRd vs VRd Newly Diagnosed Transplant Eligible | Pieter Sonneveld, MD | EHA 2024

Hello, my name is Pieter Sonderveld. I'm a professor of Hematology in Rotterdam, the Netherlands. And here we are at the EHA meeting in Madrid, where there is a lot of people coming together talking about Hematology. So my expertise is in multiple myeloma. And here in Madrid, I had the privilege to present new updated information about the so-called Perseus trial. We presented Perseus before at ASH in San Diego, 2023. And briefly, the first analysis that was presented there, provide a lot of data. The main data being that in a schedule of data to add it to VRD for induction, for consolidation in transplant eligible patients, and also during maintenance compared to VRD alone without data. We observed four years progression free survival of 84%, which was really very high. And it compared to 70% with VRD alone. In that analysis, we also observed that looking at MRD, minimal residual disease data, the level and the quantity of MRD negativity was much higher with data VRD, again, for induction, for consolidation, and during the maintenance treatment. So we did a planned MRD updated analysis to be presented at EHA, where we are right now. And now we can say that the overall MRD negativity at 10 minus 5 level, which is quite sensitive, is around 75% compared with much lower levels, 47 in the standard arm. So we are able to achieve a very deep response with data VRD. But there's more. Also, we observed that we could assess a much even much deeper level of response at 10 minus 6, which was extremely superior in the data treated patients, twice as high as with the treatment without data tumor map. And very importantly, the majority of MRD patients did very well over the course of the treatment and thereafter. So if I may focus in a little bit, 30% of the MRD negativity was obtained during the maintenance phase. So patients had already MRD with induction and consolidation, but others did not. And so 30% of patients that did not achieve MRD negativity before the maintenance phase did achieve it during the maintenance phase, indicating the relevance of giving data tumor map during the maintenance as well. So combined with lenalidomide. A next important and very intriguing observation was that in patients that had MRD negativity for one year during the treatment and also two years of complete response, we stopped data tumor map and this was in two thirds of the patients. So two thirds of the patients had two years of complete response and also one year of sustained MRD negativity. So ongoing MRD negativity. And this is a very high number. So these patients have stopped, they continue with lenalidomide, the standard alone right now, and only very few, less than 20 patients turned MRD positive again out of more than 200 and to be precise 207. So only 5% of the patients that were MRD negative became MRD positive again, indicating that with this approach, we probably can use data tumor map for the early phase of treatment, then continue for some time in maintenance, and then we can stop data and continue with lenalidomide, which is easy on the patient, less administration, so no sub-q data anymore, only when they turn MRD positive again. So this is MRD guided treatment, which I think is very good. And it's one way to avoid overtreatment, but we are very confident that the long-term results will be very good, because the projected PFS, so not the PFS that we have measured right now, but the PFS for the future on this treatment will be more than 15 years. And this is very good news for the patients, because that means they have, let's say, a lot of time ahead of them with only limited treatment or no treatment, good quality of life, and even, although it's not nice to talk about, they may die from other causes than multiple myeloma. And this is what we may almost, let's say, call cure. So we are getting close to that, and this per se trial certainly is a next step to reaching that goal. For this reason, we consider the PESAEUS trial, the results, as the next standard of care in the general population of myeloma patients outside clinical trials. So we will continue to follow these patients and see what happens over the next few years, but for now I think the results are very promising. Thank you. you