Dr. Shaji Kumar on Novel Frontline Treatment Options in Multiple Myeloma

Shaji Kumar, MD, professor of Medicine, Mayo Clinic discusses going beyond bortezomib, lenalidomide, dexamethasone for newly diagnosed multiple myeloma.

In the phase III SWOG SO77 the bortezomib triplet showed improved survival over lenalidomide and dexamethasone alone, demonstrating a median progression-free survival (PFS) with the of 43 months versus 30 months with lenalidomide and dexamethasone alone (HR, 0.712; 96% CI, 0.560-0.906; one-sided P = .0018).

The focus should not be to improve on that combination, says Kumar. One option is to consider other proteasome inhibitor (PI)-based triplet therapies. The phase III ENDURANCE trial is comparing the carfilzomib-lenalidomide-dexamethasone combination to bortezomib-lenalidomide-dexamethasone combination in the frontline setting.

Using monoclonal antibodies like daratumumab and elotuzumab in combination with lenalidomide-dexamethasone is also an option, says Kumar. Panobinostat is also being investigated in frontline multiple myeloma.