Patient-Centered Frontline Decisions: Regimen Selection, Frailty Assessment, and High-Risk NDMM Management

In 'Patient-Centered Frontline Decisions: Regimen Selection, Frailty Assessment, and High-Risk NDMM Management,' our panel of experts delve into the following critical questions:

1. The conversation around quadruplet versus triplet versus doublet regimens in the frontline setting continues to evolve. How are you currently thinking about this discourse, and what patient factors most influence that decision?
2. Are you starting with quadruplet therapy, or is there a step-up approach from a triplet regimen?
3. How do frailty and performance status inform your regimen selection?
4. High-risk newly diagnosed multiple myeloma (NDMM) remains one of the most challenging patient populations to treat. How are you approaching frontline therapy in high-risk patients today?
5. Do you feel the current standard of care is adequate for this group? What improvements do you hope are on the horizon?

Led by the moderator, the panelists discussed how frontline regimen selection in multiple myeloma is fundamentally a patient-centered decision that begins with shared decision-making around the patient's goals, comorbidities, and functional status, with quadruplet therapy as the most common starting point for most patients. The discussion also addressed the nuanced assessment of frailty, with the panelists emphasizing that age alone should not drive regimen selection, noting that frailty caused by disease burden such as compression fractures may resolve with treatment, and that using a validated frailty scoring index to understand the root cause of functional limitation is essential to making the right initial treatment decision for each individual patient. The panelists further examined the particularly challenging high-risk NDMM population, agreeing that the current standard of care remains inadequate for this group and highlighting early referral for CAR-T evaluation and bispecific therapy initiation as important strategies, while expressing excitement about the promise of BCMA-directed treatments in the frontline setting, newer CELMoDs in combination regimens, and the potential of dual bispecific approaches to deliver more durable responses for patients.

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

Our next episode, 'From Trial Data to Clinical Practice: DVRd, MRD Testing, and Payer Coverage Considerations in NDMM,' further explores multiple myeloma, highlighting what the DVRd data across both high-risk and standard-risk patient populations means, how MRD testing is informing risk-adapted treatment strategies, and the potential implications of NGS-based risk analysis for payer coverage and formulary decision-making.