Dr Usmani on Approaching Treatment Decisions in High-Risk Multiple Myeloma

Saad Z. Usmani, MD, MBA, FACP, hematologic oncologist, chief, Myeloma Service, Memorial Sloan Kettering Cancer Center, discusses the complexity of approaching frontline treatment decisions in patients with high-risk multiple myeloma.

In a presentation during the 2023 SOHO Annual Meeting, Usmani argued that quadruplet induction regimens should be employed in the treatment of high-risk patients with multiple myeloma. Among these regimens, the combination of carfilzomib (Kyprolis), lenalidomide (Revlimid), and dexamethasone (KRd), a carfilzomib-based induction regimen, has demonstrated the most promising progression-free survival outcomes, Usmani explains. Additionally, Usmani underscores the significant benefits of incorporating daratumumab into KRd, which leads to deeper treatment responses and an enhanced likelihood of minimal residual disease negativity in this patient population, he notes.

It is also important to acknowledge that most available data supporting the addition of daratumumab to KRd are derived from nonrandomized studies, he expands. Nevertheless, when patients seek a treating oncologist’s expertise, it becomes imperative to diligently evaluate these data and select the most effective treatment strategies, Usmani emphasizes. He also highlights the importance of recognizing that patients’ initial therapies play a pivotal role in their overall disease outcomes.

Furthermore, Usmani places a strong emphasis on the necessity of avoiding undertreatment, specifically in patients with multiple myeloma who have high-risk disease profiles. Although randomized phase 3 data are not available to guide these treatment decisions, patients should still receive treatments based on the best available evidence, he emphasizes. To combat a lack of research in this area, it is important to actively engage in the planning of enrichment design clinical trials that pose novel questions and explore alternative approaches tailored specifically to the challenges presented by high-risk disease, he adds. This approach represents a departure from conventional research practices and underscores the urgency of adopting a more personalized and assertive approach in the treatment of these patients, Usmani concludes.

Clinicians referring a patient to MSK can do so by visiting msk.org/refer, emailing referapatient@mskcc.org, or by calling 833-315-2722.