CEPHEUS at 6 Years: Counseling Transplant-Ineligible Patients and Managing DVRd in Frail Populations

In this episode, 'CEPHEUS at 6 Years: Counseling Transplant-Ineligible Patients and Managing DVRd in Frail Populations,' the panelists/expert pharmacists, hematologists, and oncologists explore the following questions:

1. CEPHEUS now shows that nearly 60% of transplant-ineligible patients treated with DVRd were alive and progression-free at 6 years. Could this durability change how you counsel transplant-ineligible patients about their long-term expectations at diagnosis?
2. With efficacy benefits seen across frailty subgroups, and safety described as consistent with established drug profiles, how might you approach dose modifications and supportive care in frail or older transplant-ineligible patients on DVRd moving forward?

The panelists examined the six-year CEPHEUS durability data, showing nearly 60% of transplant-ineligible patients alive and progression-free, and discussed how this level of efficacy meaningfully changes the shared decision-making conversation with patients at diagnosis, offering a more optimistic long-term prognosis while also prompting important questions about whether the impressive outcomes with quadruplet therapy should cause clinicians to reconsider the threshold for transplant eligibility. The discussion also highlighted how this data reinforces the broader push toward quadruplet induction even in borderline or frail patients, with the panelists emphasizing that the definition of frailty must remain individualized, noting that some patients over 80 may be robust enough to tolerate a full quadruplet regimen, while others may benefit from starting at reduced doses of lenalidomide with the option to escalate in subsequent cycles based on tolerability.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'Examining BelaDRd, BCMA Targeting, and Contextualizing Early MRD Data,' features the panelists advancing their conversation on multiple myeloma and focusing on where a BCMA-targeting antibody-drug conjugate like belantamab mafodotin fits into frontline therapy sequencing, the real-world tolerability concerns around ocular toxicity in the upfront setting, and how the early MRD negativity rates observed with BelaDRd compare to those seen with DRd and DVRd.