Discussing the latest advances in multiple myeloma from IMW2017, Prof Philippe Moreau (University Hospital of Nantes, Nantes, France) chairs a roundtable discussion with Prof Phillip McCarthy (Roswell Park Cancer Institute, New York, USA), Prof Meletios Dimopoulos (University of Athens, Athens, Greece) and Dr Jens Hillengass (University of Heidelberg, Heidelberg, Germany).
The discussion is introduced by looking at SCT-ineligible newly diagnosed multiple myeloma (NDMM) patients and the FIRST trial.
Recently updated analyses show that an OS benefit was maintained with continuous lenalidomide plus low-dose dexamethasone (Rd) and was better tolerated compared to melphalan, prednisone, and thalidomide (MPT).
Conversation then moved on to the SWOG S0777 study, recently published in The Lancet which looked at how Rd combined with bortezomib resulted in significantly improved progression-free and overall survival, leading many to suggest that this frontline triplet regimen could become a new standard of care in certain NDMM patients.
One of the LBA’s at IMW was the CLARION study, which assessed carfilzomib, melphalan and prednisone (KMP) v bortezomib, melphalan and Prednisone (VMP) in NDMM.
The panel suggested that it was “surprising” that KMP did not improve PFS compared to VMP in transplant-ineligible NDMM patients, adding that questions remain following the results.
Although these results provide great promise at first-line, as patients are going to progress it was asked to the panel how they would treat at first relapse.
General consensus was that it depends on the individual patient, however a backbone of Rd plus a novel agent is where the evidence is pointing.
Specific mention was made to the addition of daratumumab, with the POLLUX trial suggesting this is the “most effective combination”, with patients reaching MRD negativity “for the first time” in the relapsed setting.
Comparing two different proteasome inhibitors for the first time and as one of the LBAs at IMW, the ENDEAVOR trial showed that treatment with carfilzomib and dexamethasone significantly prolonged OS compared to RRMM patients receiving bortezomib and dexamethasone.
With the role of MRD becoming more apparent, imaging remains a critical component in the management of multiple myeloma.
The panel provide their thoughts on the most effective current imaging methods, as well as looking to the future of imaging techniques.
This programme has been supported by an unrestricted educational grant from Janssen Pharmaceuticals (A Johnson & Johnson Company).