Dr. Garfall on Quadruplet Regimen in Multiple Myeloma

Alfred L. Garfall, MD, assistant professor of medicine, Perelman School of Medicine, University of Pennsylvania, provides insight on the FDA approval of daratumumab (Darzalex) added to bortezomib (Velcade), thalidomide (Thalomid), and dexamethasone (VTd) for the treatment of patients with newly diagnosed multiple myeloma who are eligible for autologous stem cell transplant.

Thalidomide is not used often in the United States, but works similar to lenalidomide (Revlimid), explains Garfall. Therefore, adding daratumumab to VTd will be similar to adding daratumumab to bortezomib, lenalidomide, and dexamethasone. There is an ongoing clinical trial that will likely support that assertion, according to Garfall.

Garfall has started using the daratumumab plus VTd combination in patients who will not respond positively to a bortezomib-based therapy due to preexisting neuropathy. Likewise, Garfall uses the daratumumab plus VTd regimen in patients with aggressive disease who might have inadequate response or progress early in the course of their therapy. Adding the fourth drug of daratumumab to VTd provides extra protection against those early progressions that can be difficult to treat, concludes Garfall.