Dr. Silberman on Treatment Options in Early-Relapse Multiple Myeloma

Rebecca Silbermann, MD, MMS, assistant professor of medicine, Division of Hematology/Medical Oncology, School of Medicine, Oregon Health & Science University, discusses current treatment options for fit patients with multiple myeloma who experience early relapse.

In patients who may be sensitive to immunomodulatory drugs (IMiDs), lenalidomide (Revlimid) could be considered as part of a triplet regimen, Silbermann says. For example, lenalidomide in combination with daratumumab (Darzalex) and dexamethasone has demonstrated efficacy in this setting.

Similarly, patients who are unlikely to respond to IMiDs could be considered for triplet therapy with a proteasome inhibitor (PI) such as bortezomib (Velcade), Silbermann explains. The phase 3 CASTOR trial demonstrated significantly longer progression-free survival with bortezomib plus daratumumab and dexamethasone compared with bortezomib and dexamethasone alone.

Additionally, carfilzomib (Kyprolis), another PI, could be considered based on findings from the phase 3 ENDEAVOR trial, which showed that carfilzomib/dexamethasone significantly reduced the risk of death compared with bortezomib/dexamethasone in patients with relapsed/refractory myeloma, concludes Silbermann