Key opinion leaders in multiple myeloma consider duration of therapy and the possibility of treatment discontinuation for newly diagnosed patients.
Krina K. Patel, MD, MSc: How many of these patients, transplant eligible or ineligible, do you continue maintenance or treatment until progression? Or are you someone who does more of, I’m going to treat to best response, or a certain amount of time, and then stop?
Tejo N. Musunuru, MD: I continue maintenance therapy. I usually don’t stop. Probably with the old mindset, like you said, we’re all millennials, and I still have the same mindset. MRD [minimal residual disease] is just coming into the myeloma world now. Myeloma is a disease that comes back. It’s [not a] matter of when, it’s just a matter of time; it will come back. I always continue some kind of maintenance unless the patient says, “I can’t do this anymore,” I do continue.
Krina K. Patel, MD, MSc: What about you, Dr Becnel?
Melody R. Becnel, MD: I’m kind of a hybrid on that one. I know the data are there that, yes, this will come back, but also probably the most common frustration for our patients is that they always feel like they’re living with treatment. There’s never a break. So, I feel like lately putting the 2 worlds together. If I get to the point where let’s say it’s an older patient especially, if they’ve been on maintenance for maybe 5 years or so, then I would probably restage, assess for MRD. If it’s negative, then I would consider taking them off of maintenance for a bit, giving them a bit of a break.
Krina K. Patel, MD, MSc: What about your trial design for maintenance? There are lots of trials that hopefully will answer this for us.
Melody R. Becnel, MD: Trials are up and coming on this. I would love for this to become a field where maybe less is more, and we can give patients a bit more freedom.
Krina K. Patel, MD, MSc: I think your study is DARA-LEN [daratumumab and lenalidomide] versus lenalidomide and then stopping when MRD negative.
Melody R. Becnel, MD: Exactly.
Krina K. Patel, MD, MSc: Which is awesome. That would be fantastic to see a doublet versus a single agent and deciding if we can we stop finally, and officially use MRD to do it. I agree with you. I think MRD is not quite there yet to tell us, but a lot of us use it now. I do the same thing that Melody does, with especially my standard-risk patients. Especially if they’re having toxicity, maybe not toxicity that is keeping them inside all day, not horrible diarrhea or horrible anything, but if it’s still affecting their quality of life, I tend to try to help them if I can. Again, [there are] more prospective data hopefully coming soon to tell us.
Transcript edited for clarity.