Should Frontline Myeloma Treatment Include a 3- or 4-Drug Regimen?

Shaji K. Kumar, MD, professor of medicine, Mayo Clinic, addresses an important unanswered question that remains in the treatment landscape of newly diagnosed multiple myeloma, which is whether 3- or 4-drug regimens should be used in the frontline setting.

This is the biggest question that is being explored in phase 3 studies at this time, Kumar says. There are now 3 effective classes of drugs available in multiple myeloma, which include proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies.

The standard of care for newly diagnosed patients is a proteasome inhibitor with a monoclonal antibody and bortezomib with lenalidomide (Revlimid) and dexamethasone, and this is the standard for both patients who are eligible and ineligible stem cell transplant. However, Kumar says this is being challenged with the introduction of daratumumab (Darzalex) to the clinic. The phase 3 MAYA study demonstrated that bortezomib could be replaced with daratumumab, and this is an effective strategy for the treatment of patients who are ineligible for stem cell transplant.