Determining Frailty in Patients With Newly Diagnosed Multiple Myeloma

Transcript:

Joshua Richter, MD: Jumping off from history, and I will always say this, regardless of all the regimens at any of these congresses and all the drugs out there in the US, the No. 1 most prescribed regimen is based off of a paper you wrote. So, being honored to sit next to you as the first author on the VRd [bortezomib/lenalidomide/dexamethasone] lite version, understanding that that [INAUDIBLE] is looking at an older frailer patient, how do you define frailty in clinical practice and how do you go about looking, not for someone just chronologically old, but truly frail?

Elizabeth O’Donnell, MD: It's fantastic. More and more attention [from] the IMW [International Myeloma Society] has put into appreciating and studying, incorporating frailty into our clinical trial design. Frailty is a state of vulnerability; patients are deconditioned, have increased risk of poor outcomes, due to increased risk of infection. Often you can have associations with mood disorders, depression, anxiety, and so it's an overall state of compromise that occurs with chronologic aging, how we study that. So, there are a lot of different tests that have been evolved over time that help to do a quote, frailty assessment, the Charlson Comorbidity [Index], but that was not specific to myeloma. So now we've evolved to have more myeloma-specific that include things like the activities of daily living and come up with this frailty risk score and we can then start to stratify patients based on that risk. And frailty is something that you can assign a score to, but also in clinical practice, we would all agree it's a gestalt as well and having objective tools is what we feel is the best thing to do in terms of standard of care. But again, what we do in practice is often different. And so, what is a frail person in practice? This is someone who may have had recent weight loss, who has sarcopenia, so not a lot of muscle mass. That is one of the most important things in frailty. And it's very relevant, too, when we think about dexamethasone because when you're taking somebody who already is frail and has sarcopenia and giving them something that causes lean muscle loss, these are unintended but important side effects in a population that is at risk for falling and having the compliment complications with that. So, upfront dose modifications is an important part of therapy. And so, what was nice about RVD lite is we took the 25 mg and right off the bat dose reduced that; Velcade, we moved to once weekly dose reductions by age, going down to 20 mg once a week in patients over [the age of] 75. And what we saw was that it was overall very well tolerated, and we had excellent progression-free survival, so you can achieve great results. So, the take-home message, at least for me, for RVD lite, is don't be afraid to do upfront dose modifications. Tailor your therapy to the patient and the comorbidities that they present with.

Transcript edited for clarity.