There is an intergroup study comparing KRd to VRd, which should hopefully establish that maybe KRd would be the standard of care. This is because KRd is not neurotoxic; it is at least as good, if not better. That type of treatment may likely be introduced in the upfront setting pretty soon.
Anecdotally, how have you seen daratumumab impact quality of life or patient outcomes?
It has made a tremendous difference. Initially, it was approved as a single agent and we were already using it. But in combination, the POLLUX and CASTOR data are perhaps not typically what I currently use in practice. I am more likely to do a combination with pomalidomide (Pomalyst) and daratumumab; some say that data have shown that this is a considerably efficacious regimen. We have had a lot of patients with very aggressive disease refractory to other therapy and salvage them with this kind of regimen, with very impressive responses. [Daratumumab has] certainly made a big difference for patients’ lives.
Are there any clear answers with sequencing therapies yet?
I don’t think we have a problem with “too many cooks in the kitchen.” The reality is, this is one of those situations where it is not a problem—it’s a good thing to have and it’s good for patients. Where we need more guidance is where each agent fits in the sequence and sequencing, but perhaps studies will guide us [to those answers] in the future. Overall, having more active agents for patients is a good thing, considering those therapies don’t cure patients. Having more available therapies makes them live longer, better, and healthier.
What are the pivotal messages from your lecture for community oncologists?
The key thing is that there’s a lot to consider for almost any instance in myeloma. There are still a lot of very good unanswered questions. Even though upfront treatment is quite good, we can do quite better, as a community, for our patients. This is definitely the number-one thing to consider.
The second part is to look at frailty, instead of age, as a main determinant of when I use VRd or lenalidomide/dexamethasone and who the patient who can undergo transplant is. Fortunately, we have a very good relationship with community doctors in the area and they have good access to us, so we can communicate better and try to educate when we have a new trial and so forth.