Expert Evaluates Evolving Options in Newly Diagnosed Myeloma

Transplant remains the standard of care for eligible patients with newly diagnosed multiple myeloma, although the optimal induction regimen and value of consolidation is still debated, explained Ravi Vij, MD.

However, in patients who are ineligible for transplant, Vij noted that proteasome inhibitors and monoclonal antibodies are showing promise in the frontline setting and may obviate the need for melphalan altogether.

Although bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone (VRd) is the preferred induction regimen, according to Vij, the combination of carfilzomib (Kyprolis), lenalidomide, and dexamethasone (KRd) has already entered the pipeline, following multiple studies that have demonstrated a deeper depth of response. The head-to-head trial comparing the 2 competing strategies has completed accrual and will likely read out within the next 2 years (NCT01863550).

In patients ineligible for transplant, a recent news release announced that results of the phase III MAIA trial showed that the addition of daratumumab (Darzalex) to lenalidomide and dexamethasone (DRd) decreased the risk of disease progression or death by 45% compared with lenalidomide/dexamethasone (Rd) alone. In the interim analysis of the MAIA study, the median progression-free survival (PFS) had not been reached with the triplet versus 31.9 months in the Rd arm (HR, 0.55; 95% CI, 0.43-0.72; P <.0001).

This follows the May 2018 FDA approval of daratumumab in combination with bortezomib, melphalan, and prednisone for the treatment of patients with newly diagnosed disease who are ineligible for autologous stem cell transplant.

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