IMS 2023 | Novel therapeutic options and quadruplet regimens for newly diagnosed multiple myeloma

In terms of upfront options, we are seeing that space evolve very quickly. We had the original platform of doublets and triplets that were chemotherapeutically based. We have now moved into the paradigm of immunomodulatory drugs, proteasome inhibition and steroids, such as RVd. I want to emphasize how we are moving away from that now, as we make quadruplets where we’re combining monoclonal antibodies with those triplet platforms. As we think to the future, in terms of new quadruplet approaches, in our group we have moved away from RVd plus daratumumab to RVd plus isatuximab. Our own group is presenting here at a meeting the results of the SKylaRk study, which is KRd-Isa, that’s being presented by my colleague Betsy O’Donnell. What Betsy shows in the SKylaRk study is that the combination of carfilzomib, lenalidomide, dexamethasone (KRd) plus isatuximab (Isa), is very well tolerated and exquisitely active. Without necessarily going to transplant, you can harvest, collect, and continue with your KRd plus isatuximab platform. I think as we look to the future, I am very excited by the promise of iberdomide in this setting, iberdomide coming earlier with some of the advantages that it may have over lenalidomide in particular this second cancer signal, where it may be far less associated with the risk of secondary malignancy, makes it very attractive, in my opinion, as an upfront oral agent to the future, that may be a viable alternative to lenalidomide.