Dr. Holstein Discusses Induction Therapy for Multiple Myeloma

Sarah Holstein, MD, PhD, associate professor, University of Nebraska Medical Center, discusses induction therapy for the treatment of patients with multiple myeloma.

Patients with high-risk disease initially do well on induction therapy, but have a much higher rate of relapse and live a shorter time progression-free, says Holstein. The current standard of care induction therapy for patients with myeloma is lenalidomide (Revlimid) plus bortezomib (Velcade) and dexamethasone (RVd). Although, Holstein says that there are ongoing studies investigating the addition of carfilzomib (Kyprolis) as a replacement for bortezomib.

There is a lot of excitement surrounding the triplet of carfilzomib, lenalidomide, and dexamethasone (KRd), but there is also interest in the triplet of lenalidomide, ixazomib (Ninlaro), and dexamethasone in the older patient population. This is an all-oral regimen, which might be well tolerated in this population, Holstein says.

Most of the interest with quadruplets has been with adding antibodies such as daratumumab to the backbone of a proteasome inhibitor plus an immunomodulatory agent. This includes daratumumab plus RVd and daratumumab plus KRd.