The final point that people need to keep in mind is the management of the side effects from these drugs. Now, obviously, all of these drugs have toxicities, and when you use them in combination, you can see even more toxicities. It is very important to manage the toxicities appropriately, instead of rapidly decreasing the dose, because suboptimal doses of these drugs can be more harmful in the long run. There are a lot of good guidelines that have come out on how to modify drugs based on toxicities, and how to change the doses based on the initial assessment of frailty.
Looking ahead, how do you see the adoption of good early management techniques effecting the landscape of multiple myeloma?
In the best-case scenario, if people are doing all these steps and all patients get the optimal initial therapy, I think 2 things are going to happen. Duration of first remission is going to get longer and longer. Right now, we know that duration of remission is roughly 4 years in the patients who get transplant and maintenance, and in patients who are transplant ineligible, it is somewhere between 2 and 3 years, based on the current approaches.
Now, in addition to patients saying in remission longer, they are going to come into the first relapse in much better shape than they do today. In essence, what could happen is that patients who are experiencing their first relapse of myeloma could be in as good or better shape as the patients with newly-diagnosed myeloma that we see today. That opens up the option to use a more intense therapy in the second line, which could lead to a more prolonged disease response in the relapsed setting. I think each of those building blocks become bigger and bigger as more effective therapies are used upfront.