Dr. Godara on Treatment Strategies Following First Relapse in Multiple Myeloma

Amandeep Godara, MBBS, a medical oncologist, the Huntsman Cancer Institute, assistant professor, the Division of Hematology and Hematologic Malignancies, the University of Utah, discusses the current treatment strategies following first relapse for patients with multiple myeloma.

When a patient with multiple myeloma experiences their first disease relapse, it is important to determine if the relapse occurred while a patient was on treatment with lenalidomide (Revlimid) or if relapse took place when the patient was off lenalidomide, Godara begins. Lenalidomide is used in the maintenance setting for patients who have undergone autologous stem cell transplant (ASCT), as well as those who are not eligible for transplant, Godara expands. Whether a patient is sensitive or refractory to lenalidomide will help inform the next choice of treatment, Godara adds.

For patients who are sensitive to lenalidomide and have not been exposed or are not refractory to an anti-CD38 antibody, subsequent treatment can consist of a combination of daratumumab (Darzalex), lenalidomide, and dexamethasone, Godara continues. However, for patients who are sensitive to lenalidomide but are refractory to an anti-CD38 antibody, lenalidomide could be combined with another proteasome inhibitor, such as carfilzomib (Kyprolis).

For patients who progress and are refractory to lenalidomide, the combination of daratumumab with another type of proteasome inhibitor, such as carfilzomib, could be an option. Godara notes. Notably,

bortezomib (Velcade) could be combined with an anti-CD38 antibody for these patients, only if they patient are not yet refractory to bortezomib, Godara adds.

Given the number of combination therapies available in the relapse setting, it is important to understand these factors when selecting subsequent therapy after first relapse, Godara concludes.