Evolution of Frontline Therapy in Multiple Myeloma

Dr. Saad Usmani and Dr. Shaji Kumar introduce the evolving treatment landscape for newly diagnosed multiple myeloma, focusing on the increasing role of CD38-directed therapy in frontline treatment. Dr. Kumar reviews the progression from doublet to triplet and quadruplet regimens, highlighting how the incorporation of additional agents has progressively improved treatment outcomes in transplant-ineligible and transplant-eligible populations. The discussion describes the development of bortezomib-based triplets and the subsequent addition of a CD38-directed monoclonal antibody, which has been associated with greater depth of response and improved progression-free survival, with longer-term data also demonstrating an overall survival benefit in selected settings. Dr. Usmani and Dr. Kumar then discuss how quadruplet approaches have increasingly become part of frontline treatment for patients who can tolerate more intensive therapy, including transplant-ineligible and transplant-deferred patients. They also consider the evolving treatment approach for patients in the 65- to 80-year age range and emphasize the importance of individualizing therapy based on treatment tolerance and patient characteristics.