Dr. Raje on Quadruplet Regimens in Myeloma

Noopur Raje, MD, director, Center for Multiple Myeloma, Massachusetts General Hospital, discusses the potential for quadruplet regimens in the multiple myeloma treatment paradigm.

Quadruplets are now being utilized in the frontline setting, Raje says. In May 2018, the FDA approved daratumumab (Darzalex) in combination with bortezomib (Velcade), melphalan, and prednisone for the treatment of newly diagnosed patients who are ineligible for stem cell transplant. Along with this, researchers are using minimal residual disease as an endpoint in clinical trials determining whether or not dosing should be escalated or deescalated. In addition to the advances in technology the landscape has recently seen, these trials could result in a subset of patients being cured with already available agents.

In the vast majority of patients who are incurable even with the 4-drug regimens and testing modalities, this is where chimeric antigen receptor (CAR) T-cell therapy is utilized. However, Raje says, if data show a long-term disease control with CAR T cells, it remains to be seen whether or not quadruplets would even have a role in treatment.