Dr. Costello on Sequencing Challenges in Multiple Myeloma

Caitlin Costello, MD, an associate clinical professor of medicine at the University of California, San Diego, discusses sequencing challenges in multiple myeloma.

Sequencing has and will continue to evolve as novel agents and combinations are introduced into the multiple myeloma paradigm, says Costello.

Broadly speaking, switching classes of agents or introducing novel drug classes is preferred, explains Costello.

The phase 3 OPTIMISMM trial revealed that patients who are refractory to lenalidomide (Revlimid) can receive another immunomodulatory agent even if it is in the same drug class, says Costello.

However, Costello explains that her preferred sequencing strategy for patients who progress on lenalidomide maintenance therapy is to give monoclonal antibodies in combination with carfilzomib (Kyprolis) or pomalidomide (Pomalyst).

Daratumumab (Darzalex) is typically implemented as second-line therapy in patients who have not previously received it, concludes Costello.