Dr. O'Donnell on Up-front Triplets in Multiple Myeloma

Betsy O'Donnell, MD, medical oncologist in the Multiple Myeloma Disease Center and director of Lifestyle Medicine at the Massachusetts General Hospital, discusses the utility of up-front triplet regimens in multiple myeloma.

Most elderly patients with multiple myeloma who are transplant ineligible and younger patients who are transplant eligible are treated with a triplet regimen, says O'Donnell. Physicians will typically draw from the proteasome inhibitor class and immunomodulatory drugs with dexamethasone as the standard. The combination of lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone is a classic up-front regimen that is used in this space. Data with carfilzomib (Kyprolis) plus lenalidomide and dexamethasone in multiple myeloma are also available.

Now, the standard of care is being challenged with the addition of monoclonal antibodies, such as daratumumab (Darzalex) in the up-front setting, adds O'Donnell. Some recent phase 3 data were presented over the past year that are very exciting. As of this moment, triplets typically serve as the standard induction regimen in this space, concludes O'Donnell.