Patient Case #1: A 75-Year-Old Woman With Newly Diagnosed MM

EP: 1.Challenges in Treating Transplant-Ineligible Multiple Myeloma

EP: 2.Multiple Myeloma: Transplant Ineligibility and Goals of Therapy

EP: 3.Transplant-Ineligible Multiple Myeloma: Assessing Response to Therapy

EP: 4.Transplant-Ineligible MM: Treatment After Adequate Response to Therapy

EP: 5.Treatment Options for First-Line Therapy in Transplant-Ineligible MM

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EP: 6.Patient Case #1: A 75-Year-Old Woman With Newly Diagnosed MM

EP: 7.Patient Case #2: A 77-Year-Old Man With Newly Diagnosed MM

EP: 8.Future Directions in Multiple Myeloma Care: Improvements and Unmet Needs

EP: 9.Recap: Optimizing Therapy in Frontline Multiple Myeloma Not Eligible for Transplant

Transcript:
C. Ola Landgren, MD, PhD:Patient case No. 1, a 75-year-old lady, newly diagnosed multiple myeloma, with mild or persistent low back pain and also progressive fatigue. Past medical history is stage 2 chronic kidney disease, cardiac dysrhythmia, medically controlled hypertension, diabetes controlled with diet and exercise, and anemia. There are several things going on here. The performance status is 1, so that’s pretty good, and the revised-ISS [International Staging System] is stage 2 on a scale from 1 to 3. Then, there is an 11;14 translocation. This patient is deemed transplant ineligible by the treatment team. I ask the audience here to vote. How would you treat this patient: DRd [daratumumab, lenalidomide, dexamethasone], Rd [lenalidomide, dexamethasone], Dara-CyBorD [daratumumab, cyclophosphamide, bortezomib, dexamethasone], VRd [bortezomib, lenalidomide, dexamethasone]-lite, or KRd [carfilzomib, lenalidomide, dexamethasone]? Please go ahead and vote. Let’s see here. A is DRd and D is VRd-lite.

When you initiate the triplet regimen for a newly diagnosed patient, do you continue the triple therapy, or do you switch to maintenance? Do you typically continue, do you typically switch to a single drug, or do you reduce to a doublet, or is there really no standard practice you follow? Please go ahead and vote. You typically go to a single drug. That’s what I do…. There are more votes, A, some continue, and some say here, “We have no standard practice.” But the winner is, go to a single drug. I think you could argue for all of them, and there are probably individual factors for individual patients.

Next, if you do not continue the triplet therapy, what’s the rationale for reducing to a double or single agent? Is it feasibility/patient preference, is it safety and toxicity, that you want to save drugs for later, or other reasons? The poll results show safety and toxicity, and then you want to save drugs. In my practice, I think a lot of my patients are also asking for feasibility. But safety/toxicity, obviously if there are patients who are in this older category, that probably is one of my main factors as well and that could be others’ as well.

What’s your approach to determine the duration of treatment for your patients with myeloma? Treat to progression, treat to a prespecified response, treat until the patient requests a drug holiday, treat to a predetermined fixed duration, or treat until tolerability issues arise? The winner here is A, which is treat until progression, and then B and E are treat to a prespecified criteria and treat until tolerability issues arise.

Transcript edited for clarity.