Evaluating the effectiveness and safety of different first-line regimens for the treatment of patients with newly diagnosed multiple myeloma ineligible for a transplant.

This study evaluated the effectiveness and safety of different first-line regimens for the treatment of patients with newly diagnosed multiple myeloma (MM) ineligible for a transplant. The data showed that first-line treatment should be based on daratumumab (Darzalex)-based regimens or the VRd regimen [bortezomib (V; Velcade), lenalidomide (R; Revlimid), and dexamethasone (d; Decadron)] for these patients.

Multiple myeloma (MM) is a type of cancer that comes from blood cells called plasma cells. Considerable progress has been made in the treatment of MM with proteasome inhibitors (PI) such as bortezomib and immunomodulators (IM) such as lenalidomide. Proteasomes are large molecules present in all body cells. They break down and remove damaged proteins. MM cells rely on proteasomes to multiply and spread. PIs block the action of proteasomes, therefore preventing MM cells from growing and multiplying. IMs stimulate the immune system and can help to block cancer growth. However, relapses (the tumor grows after treatment) are quite common in patients with MM.

Daratumumab is an immunotherapy drug that directly targets cancer cells to kill them. Daratumumab combined with PIs or IMs has been used as a first-line treatment regimen to improve the survival outcomes in patients with previously treated unresponsive MM. However, which first-line treatment regimen is the most effective and safest for the treatment of patients with newly diagnosed MM ineligible for a transplant is still unknown.

The study analyzed 27 studies and involved a total of 12,935 patients with newly diagnosed MM ineligible for a stem-cell transplant. 23 different first-line treatment regimens were analyzed.  

Daratumumab (D) plus lenalidomide (R) and dexamethasone (D) (DRd) had the highest probability of being the most effective and the second safest first-line treatment regimen.

Daratumumab (D) plus bortezomib (V), melphalan (M), and prednisone (DVMP) had the highest probability of being the safest and the second most effective first-line treatment regimen.

Bortezomib (V), lenalidomide (R), and dexamethasone (D) (VRd) was the third most effective and safest first-line treatment regimen.

This study concluded that first-line treatment should be based on daratumumab-based regimens (DRd or DVMP) or the VRd regimen for patients with newly diagnosed MM ineligible for a transplant.

This study analyzed data based on previous studies and not from individual patients. The studies analyzed had differences in the type of drugs used (IMs and PIs), patient population, as well as follow-up period.