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New Directions in Newly Diagnosed Multiple Myeloma |
Practice Community
New York, NY
Practice Niche
Multiple Myeloma
Hospital and Institutional Affiliations
Tisch Cancer Institute in the Icahn School of Medicine at The Mount Sinai Hospital
Question How has the treatment landscape for newly diagnosed multiple myeloma evolved over the years and what do you feel are the most promising approaches on the horizon in this setting? |
Answer This is a big question. The big evolution in newly diagnosed multiple myeloma really has been the establishment of triplets as the mainstay of therapy. If you look across a variety of studies in transplant-eligible and transplant-ineligible patients, triplets are really ruling the roost. The really big changes we are looking at now is not going from 2 to 3 drugs, but from going from 3 to 4 drugs. |
Question The ANDROMEDA study recently met its primary endpoint of more than 50% of patients with hematologic complete response to subcutaneous daratumumab in newly diagnosed amyloid light-chain (AL) amyloidosis. In your view, what could be the biggest advantages of subcutaneous drug delivery over other methods? |
Answer The ANDROMEDA study (ClinicalTrials.gov Identifier: NCT03201965) was really groundbreaking for amyloid. We’ve known for years that the standard for most patients with amyloid has been cyclophosphamide, bortezomib and dexamethasone (CyBorD), but still some older patients get melphalan and dexamethasone for the transplant ineligible. However, CyBorD has been really standard. Then, comes the question of giving daratumumab along with CyBorD and obviously in every regimen that we have studied, people have done better with daratumumab than not across the board when you look at the studies. |
Question Please discuss the results of the DREAMM-9 phase 3 study examining the addition of belantamab mafodotin to bortezomib, lenalidomide, and dexamethasone (VRd) compared with VRd alone in transplant-ineligible newly diagnosed multiple myeloma. What would be some likely pros and cons of treatment with this antibody-drug conjugate, in your view? |
Answer We don’t have results yet. DREAMM-9 (ClinicalTrials.gov Identifier: NCT04091126)5 is going to answer some very important questions. The biggest question is the way we give a lot of our drugs. The way we give them now is not biological, but we give them in chronological order ([lenolidomide] then pomalidomide, [bortezomib] then [carfilzomib]). Now, we have more targeted immunologic agents targeting CD38 and with belantamab mafodotin we will have BCMA (B-cell maturation antigen). The question is, [is it] CD38 then BCMA, or BCMA first? |
Question According to research presented during the ASCO20 Virtual Scientific Program (ClinicalTrials.gov Identifier: NCT01081028),6 and based on real-world results from a study on patients with newly diagnosed disease who were in the Connect MM Registry, patients with renal impairment should now be considered for inclusion in clinical trials, as well as for treatment with lenalidomide-bortezomib-dexamethasone (RVd). Do you agree with this assessment? Why or why not? |
Answer This has been one of the difficult things about clinical trials in myeloma and their applicability post approval. Many patients with myeloma in some course of their therapy either at presentation or later on will go on to develop renal insufficiency. So, those patients are excluded from key clinical trials because of the way the trials are designed. First of all, we don’t get the answer of how the drugs work in terms of efficacy and toxicity in that group, and then after the drug’s approval, we are doing [our] best guesswork to try to give these drugs to these real-life patients with renal dysfunction. |
Question Are there any other recent study results or data that you feel are of particular interest in the setting of newly diagnosed multiple myeloma? |
Answer We generally walk in with a lot of high hopes in patients with newly diagnosed myeloma because of all the drugs we have and the huge pipeline. But one of the things that has really been an issue has been high-risk myeloma patients, because we are confident we can get them into remission, but we are not confident that we can keep them in remission. |
This interview has been edited for clarity and accuracy.
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