A new video from our partners at OncLive discusses how Dr. Fakhri selects treatment regimens for her patients.
Currently, physicians use 2 factors to pick a regimen for a patient—transplant eligibility versus ineligibility and the genomics of their disease, says Fakhri. In transplant-ineligible patients, the use of carfilzomib, lenalidomide (Revlimid), and dexamethasone (KRd) is not universally endorsed because there is the risk of pulmonary toxicity. However, in the relapsed/refractory setting, physicians have encouraging phase II data that indicate an improvement in progression-free and overall survival.
Based on the data in this setting, it makes sense to choose KRd as induction therapy for relapsed patients, states Fakhri. Another important aspect to consider is the regimen’s toxicity profile. Bortezomib (Velcade) is known to cause debilitating neuropathy, so a patient who has bad neuropathy should be kept away from that agent, Fakhri says.