Dr Richardson on the Role of Triplet Regimens in Newly Diagnosed Myeloma

“We started with doublet therapies [approximately] 20 years ago as a standard [of care], and now we've seen triplets become new standards of care, with examples being VRd or KRd. Now, building on those 2 mainframe triplet therapies, we have the success of VRd combined with daratumumab or isatuximab.”

Paul G. Richardson, MD, the RJ Corman Professor of Medicine at Harvard Medical School and the clinical program leader and director of Clinical Research of the Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute, discusses the role of triplet regimens as the standard of care for patients with newly diagnosed multiple myeloma.

More than 20 years ago, doublet regimens were the standard of care for patients with newly diagnosed multiple myeloma, Richardson begins. However, within the past 2 decades, triplet and quadruplet regimens have emerged into the treatment landscape as the new standard of care, he notes. Two triplets of significance include bortezomib [Velcade], lenalidomide [Revlimid], and dexamethasone [VRd], and carfilzomib [Kyprolis], lenalidomide, and dexamethasone [KRd], he explains. After settling a foundation with these 2 triplet regimens, Richardson adds that triplets in combination with other agents have shown positive results. These combinations include daratumumab [Darzalex] or isatuximab [Sarclisa] plus VRd and daratumumab or isatuximab with KRd, he says.

Another significant regimen to note also includes an ixazomib [Ninlaro]-based regimen including lenalidomide and dexamethasone plus immunomodulatory treatment, which provides an oral treatment, Richardson emphasizes. This treatment option may be more approachable for patients who are frailer or aren’t able to frequently visit the infusion centers, he explains.

Furthermore, the impact of anti-CD38 monoclonal antibody therapy has provided a dramatic contribution to the quality of responses in multiple myeloma, Richardson continues. Specifically, with isatuximab, evidence has shown that it can overcome higher risk, and adding a monoclonal antibody could provide a higher depth and quality of response with prolonged response, he concludes.