Frontline Multiple Myeloma Therapy: Kicking the Can Further Down the Road?

In January 2026, the FDA approved subcutaneous daratumumab and hyaluronidase-fihj (Darzalex Faspro) in combination with bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone (VRd) among adults with newly diagnosed multiple myeloma (NDMM) who are ineligible for autologous stem cell transplant. In a conversation with CancerNetwork®, Saad Z. Usmani, MD, MBA, FACP, FASCO, detailed the clinical implications of this regulatory decision. Specifically, he discussed strategies for sequencing the newly approved daratumumab-based regimen with other lines of therapy for patients with multiple myeloma.

According to Usmani, the goal of frontline multiple myeloma therapies, which usually consist of quadruplet regimens, is to quickly produce a deep response in the first 4 or 6 months of treatment before spreading out subsequent dosing in the maintenance setting. Helping patients achieve an early remission, he said, may prevent the disease from recurring until years down the line, affirming the goal of “kick[ing] that can” of disease as far as one can.

Usmani is a myeloma specialist, cellular therapist, and chief of the Myeloma Service at Memorial Sloan Kettering Cancer Center.

Transcript:

The frontline treatment approaches, now, for a majority of patients would be a quadruplet regimen, unless we have frail patients. The idea is that [in] the initial part of treatment for the first 4 or 6 months, we try to get patients into a deeper response quicker, while managing the [adverse] effects from the treatments. From that perspective, that exposure to the quadruplet is for a fixed duration of time. Then, patients move on to a maintenance period where they’re getting less frequent treatments and [fewer] drugs.

From a treatment schema standpoint, that would be important. If we are able to get a majority of patients into good remissions that last for 4 or 5 plus years, for any patients being diagnosed in 2026, we’re essentially pushing off any potential chances of disease coming back to 2032 or 2033. By that time, we are going to have [better] treatment options for our patients if the disease comes back. That’s the goal: kick that can of the disease, the likelihood of [it] coming back, as [far] down the line as possible.

Reference

FDA approves daratumumab and hyaluronidase-fihj with bortezomib, lenalidomide, and dexamethasone for newly diagnosed multiple myeloma. News release. FDA. January 27, 2026. Accessed February 9, 2026. https://tinyurl.com/47r6r8xf