Dr Hossein Kazemi: What Patients With MM Consider When Stopping Therapy

It is important the patient with multiple myeloma has a clear and comphrensive understanding of de-escalating treatment, said M. Hossein Kazemi, medical oncologist and hematologist, Astera Cancer Care.

What are the benefits of de-escalating patients?

Right now, in absence of the prospective trials of deciding length of maintenance, based on [minimal residual disease] MRD, right now, one really important factor that I look at is basically, how much of a burden the maintenance is or pressure is on patients’ lives. And especially for elderly patients, even just single agent [lenalidomide] Revlimid, even at lower doses, a lot of times, it's not a completely trivial thing for a patient to take.

Patients still clearly say in terms of energy, how well they are able to digest food. The off week from Revlimid is clearly different from the 3 weeks that they are on. So that's certainly a factor, the quality of life. That’s the main factor for concern.

Also very importantly, that question at some point becomes, if the patient really needs it or not. For example, I had a patient a few months back that has been that had been on maintenance for over 8 years. And we did a bone marrow biopsy, MRD negative, and the patient has come off maintenance and he’s his last clinic visit, he has been very, very happy that he's not taking Revlimid any longer.