Individualizing Frontline Therapy in Newly Diagnosed Multiple Myeloma

In this segment, Dr. Peter Voorhees and Dr. Luciano Costa discuss how treatment selection can be individualized for patients with newly diagnosed multiple myeloma, including considerations when choosing between triplet and quadruplet regimens. Dr. Costa describes his approach to building a frontline regimen incrementally, with CD38 monoclonal antibody-based therapy forming an important backbone for most patients and additional agents selected according to individual circumstances. He discusses factors that may influence the use of a proteasome inhibitor, including baseline peripheral neuropathy and advanced age, as well as the potential for increased toxicity in older patients. The conversation also addresses practical approaches to dexamethasone dosing and tapering, particularly in older adults, and emphasizes that the decision regarding transplant does not necessarily need to be made at the initial treatment encounter. Dr. Costa further discusses tailoring lenalidomide dosing for older patients and those with renal impairment, emphasizing close monitoring and readiness to adjust treatment based on tolerability.