Dr. Larson on Potentially Practice-Changing Data in Frontline Multiple Myeloma

Sarah M. Larson, MD, assistant professor, University of California, Los Angeles, discusses potentially practice-changing studies for patients with transplant-eligible and -ineligible multiple myeloma.

Frontline therapy for transplant-eligible multiple myeloma has progressed in recent years where patients can get to a minimal residual disease (MRD) state; however, questions about how to best treat patients still remain, according to Larson. Following stem cell transplant, Larson questions whether maintenance should be lenalidomide (Revlimid) alone, ixazomib (Ninlaro) alone, or a combination of agents. Additionally, should there be MRD testing with maintenance therapy, similar to testing after stem cell transplant?

Ongoing trials have potential to answer some of these questions regarding the frontline setting in transplant-eligible multiple myeloma. For example, the phase II GRIFFIN trial, which compares lenalidomide/bortezomib (Velcade)/dexamethasone with lenalidomide/bortezomib/dexamethasone/daratumumab (Darzalex), has promising preliminary data for the daratumumab arm, but further data are necessary before determining if it is practice-changing, explains Larson. Another trial Larson is awaiting the results of examines carfilzomib (Kyprolis)/lenalidomide/dexamethasone versus bortezomib/lenalidomide/dexamethasone.

For transplant-ineligible patients with multiple myeloma, the MAIA trial, which examined daratumumab/lenalidomide/dexamethasone versus lenalidomide/dexamethasone alone, shed some light on the frontline treatment setting and led to the approval of daratumumab for that patient population, concludes Larson.