Is the treatment landscape expanding for the front-line setting in multiple myeloma?

FAQ Library published on August 20, 2018
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Noopur Raje, MD
Professor of Medicine
Harvard Medical School
Director, Center for Multiple Myeloma
Massachusetts General Hospital
Boston, Massachusetts

The landscape of multiple myeloma treatment keeps increasing and it was only a few years back when we had approximately five drugs approved within a frame of a few weeks which was very interesting. What’s happened now is that these same drugs are being used more in the upfront setting. Most recently, we saw approval of a drug which we have used quite a lot, daratumumab, in the upfront setting based on data which was presented at last year's ASH, the ALCYONE data. This was daratumumab in combination with melphalan, prednisone, and bortezomib (MPV) which showed a progression-free survival benefit in these patients and deep minimal residual disease (MRD). This is one of the first few trials in a randomized fashion comparing four drugs to three drugs. This is certainly widening the landscape of treatments available to us. Having said that, I do not think this regimen is that relevant to what we do in the United States, being an MPV-based dara regimen. But it opens the door for approval in the upfront setting, which is a good thing. We are obviously eagerly awaiting the data from the MAIA trial which is more applicable to patients in the United States where lenalidomide-dexamethasone has been combined with daratumumab, and that is being compared to len-dex. Our hope is that we hear some of this data either later this year or early next year. All of those drugs which actually got approved in the relapsed setting – daratumumab, ixazomib, carfilzomib, elotuzumab – are all being studied more in the upfront setting. That is going to allow us to expand our horizon of what we have available for treatment. With that, I think the future for myeloma will be typically a quadruplet combination in the context of a clinical trial and that would be to drive down deep, deep responses. The depth of response hopefully is going to translate into survival benefit, which then is going to cure a subset of patients. Just having these drugs moved to the upfront setting is going to allow us a lot more flexibility, and our remission durations hopefully are going to continue to keep increasing to way beyond what they are today.

Last modified: July 30, 2018
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