Standard of Care in Multiple Myeloma Shifts With Advent of Monoclonal Antibodies

Ruben Niesvizky, MD, director of the Multiple Myeloma Center at New York Presbyterian Hospital-Cornell Medical Center, discusses the shift in standard of care treatment for multiple myeloma.

According to Niesvizky, the standard of care in multiple myeloma has shifted significantly since the advent of monoclonal antibodies. Prior to the widespread use of monoclonal antibodies, a combination of immunomodulatory drugs and a proteasome inhibitor (PI) triplet was used. This combination saw an overall response rate of 90% and a complete response rate of 30%.

After that came the VRd regimen [bortezomib [Velcade], lenalidomide, and dexamethasone] construct and the KRd regimen [carfilzomib, lenalidomide, and dexamethasone] construct. However, there is no evidence that KRd improves the rate of complete response.

0:08 | Well, the standard of care has shifted significantly since the advent of the monoclonal antibodies. The manuscript that we're discussing is before the era of the monoclonal antibodies, or at least when those monoclonal antibodies were going to be used only in the relapsed/refractory setting. So, during that time, the standard of care was able to achieve a complete response of about 30% and then overall response rates were about 90% in using triplets of PIs, immunomodulatory drugs, or corticosteroids. Then there was the VRd [bortezomib construct and more recently the KRd construct. But there had been no discovery that KRd had an increased number of complete responses and better minimal residual disease. And, it had been thought through all the trials that carfilzomib (Kyprolis) was superior to bortezomib (Velcade) even in certain parameters, therefore, we decided to move into this trial in which we combined carfilzomib and dexamethasone induction until maximum response followed by lenalidomide, clarithromycin, and dexamethasone.