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2yr
2L management of RRMM

Multiple myeloma patients who have received at least two prior therapies including lenalidomide and a proteasome inhibitor and have demonstrated progression on/within 60 days of completion of the last therapy may benefit from pomalidomide plus dexamethasone.

In the phase 2, single-arm MM-014 trial of DPd (pomalidomide + dexamethasone + daratumumab), patients with RRMM who received 1 or 2 prior treatment lines demonstrated an ORR of nearly 78.6% in the ITT population. The complete response (CR) was 26.8%; very-good partial response (VGPR), 25.9%; PR, 25.9%.

In other results, patients who relapsed after taking lenalidomide or who were refractory to lenalidomide had an ORR of 81.5% and 77.6%, respectively. As for secondary outcomes, median PFS was 23.7 months in the ITT population and median OS was 56.7 months. Overall, 8.9% of patients discontinued secondary to adverse events.

What is your treatment threshold to proceed to 2L therapy? How do you determine whether to dose adjust medications or change therapy altogether?

  • 2yr
    DPD with the above data is an option, and DKD - the carfilzomib-based regimen is also an option. It all depends on the patient's situation, what prior regimes the patient received, and risk stratification.
  • 2yr
    So with patients on maintenance once levels start going up just by adjusting dose usually buys 6 months on an average. Hence during that time need to start preparing and getting approval for next line of therapy. Results of this combo is good but also is dara with carfilzomib
  • 2yr
    We will monitor patient's symptoms, lab values including paraprotein levels send complete blood count, as well as bone or extremity lesions. If these parameters show significant alterations indicating progression, will consider change of therapy. Triplet therapy would be standard as mentioned already. have had good experience with DPd. Consider CAR T-cell therapy at an earlier stage since Current modalities do not cure the disease
  • 2yr
    Th standard of care for at least 2nd or 3rd line therapy is a triplet. There are a number of triplets available for 2nd line patients relapsed/refractory to lenalidomide. The data from the Phase 2 MM 014 is interesting. However, in the randomized phase 3 trial of DPd versus Pd, the median PFS was only 12 months. Certainly some differences in the patient population but both were at least 2 lines of therapy and refractory to lenalidomide. Options for 2nd line therapy, not necessarily all include elotuzumab-based EPd, anti-CD38 based, either daratumumab or isatuxamab which can be combined with pomalidomide or carfilzomib with good efficacy; proteasome inhibitor, either bortezomib or carfilzomib, such as KPd, VPD, Kd, KCd and the list goes on...
  • 2yr
    it would be to an advantage to continue with this conventional type of therapy.
  • 2yr
    Symptomatic disease progression or most of the time biochemical progression both indications to switch therapy for which DPD is an excellent option.


  • 2yr
    Inc in m spike, ratio, crea, anemia, plasmacytoma, bone marrow disease
  • 2yr
    Biochemical progression or symptomatic progression would warrant change in therapy. DPD is and excellent option with high response rates. DKD would be an alternative option.
  • 2yr
    Agree - symptomatic progression and biochemical progression would want us to change therapy
  • 2yr
    Symptomatic progression with new pain or fractures, would consider DKd or DPd next
  • 2yr
    Progression, usually symptomatic progression,, is a sign a change needs to be made. Usually this comes by way of all of the usual ways we monitor this disease like M-protein, % plasma cells, bone disease, etc...

    Dose adjustments, if not due to metabolic issues like renal dysfunction, usually are made due to toxicity.
  • 2yr
    An increase in Mspike wrrants a change in treatment.
  • 2yr
    Any pain, worsening kidney function or hypercalcemia.
    Also would biochemical recurrence if confirmed in 2 to 3 visits
  • 2yr
    I change treatment if rising m proteins or a substantial rise in free light chains. Also if new bone lesions or end organ dysfunction. Would use a dara based regimen if not included in upfront treatment.
  • 2yr
    Based on rising M-protein, rising SFLC and/or ratio, symptomatic progression are all reasons I would switch therapy. However, if poor performance status or using Darzalex based therapy in first line, keep Dara= and switch the the partner class. I.e proteosome inhibitor to iMID; if already using both classes, change to pomalyst instead of Revlimid and les likely Velcade to kyprolis ( save it for DKd later lines)
    Simply put /DVRd to DPd is what i prefer
  • 2yr
    increasing mprotein ,developing anemia ,or other signs of progression
  • 2yr
    Biochemical progression or symptomatic progression are both indication to switch therapy for me as it is very well that disease tends to become resistant to therapy with progression and early disease control is important.
  • 2yr
    Rise in m protein, worsening bone marrow disease, worsening symptoms
  • 2yr
    symptomatic progression with new lesions and continuous increase in m spike will determine the new line of treatment with new mechanism and new drugs

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