Dr. Raje on Treatment Approaches for Relapsed/Refractory Myeloma

Noopur Raje, MD, professor of medicine at Harvard Medical School and director of the Center for Multiple Myeloma at Massachusetts General Hospital Cancer Center, discusses treatment approaches for patients with relapsed/refractory multiple myeloma.

The field is shifting toward the use of quadruplet regimens in the frontline setting. The goal is to achieve minimal residual disease (MRD) negativity, says Raje. Maintaining MRD negativity may translate to a higher cure rate, she adds. Recent data curves now show that the time to relapse is 3.5 to 4 years from the time of diagnosis.

There are promising data with 3-drug regimens, Raje adds, and the decision for treatment at the time of relapse has a lot to do with what the patient was previously treated with. In the United States, the majority of patients are progressing after having been on lenalidomide (Revlimid) maintenance therapy. As such, the next line of therapy is typically pomalidomide (Pomalyst)-based. Whether pomalidomide should be paired with daratumumab (Darzalex), carfilzomib (Kyprolis), or other effective agents remains to be seen.