Evolutions in Frontline Treatment Patterns for Newly Diagnosed MM
Key Takeaways:
- The introduction of novel and effective treatments changes the frontline treatment landscape: When triplet and quadruplet regimens emerged as effective therapies for newly diagnosed multiple myeloma (MM), their subsequent adoption led to declines in monotherapies and doublet regimens.
- The utilization of daratumumab-based regimens is increasing: After daratumumab was approved by the US Food and Drug Administration (FDA), its usage increased from 2% in 2019 to 29% in 2022. Based on this data, daratumumab can be expected to have wider adoption across oncology settings.
- Community settings play a vital role in oncology care: Most patients with MM are treated at a community setting, so access to new treatments is important. Awareness of updates in treatment patterns and novel therapies can improve decision-making for patients and physicians.
Frontline treatments for newly diagnosed MM are constantly changing. In recent years, triplet and quadruplet regimens have emerged as the new standard of care after demonstrating significant clinical benefits.
Real-world evidence on the current treatment patterns for MM, especially within community settings, is limited. Therefore, researchers sought to record current therapies for newly diagnosed MM using data from a US community oncology network.
The retrospective study used data from Texas Oncology to assess treatment patterns among 3592 patients with newly diagnosed MM who received frontline therapy between January 2015 and December 2022.
Frontline Treatment Patterns for MM
Monotherapies and doublet regimens have experienced a significant decrease while triplet and quadruplet regimens have increased. From 2015 to 2022, monotherapies declined from 4.7% to 0.4%, and doublet regimens declined from 35.4% to 2.7%.
During the same period, triplet regimens increased from 59.9% to 87.6%. The utilization of quadruplet regimens began in 2020 and rose from less than 1% to 9.4% by 2022.
During the study period, the most common frontline treatments were bortezomib lenalidomide-dexamethasone (59.3%), bortezomib-cyclophosphamide-dexamethasone (16.0%), and bortezomib-dexamethasone (11.2%).
After being approved by the FDA, the use of daratumumab-based regimens rose from 2% in 2019 to 29% in 2022. Daratumumab with lenalidomide plus dexamethasone was the most common daratumumab-based therapy.
Implications for Oncology
This study’s findings showcase the role of community settings in adopting and promoting novel therapies. Most patients with MM receive treatment at community centers, so physicians must be informed of and have access to these new effective treatments.
Although the utilization of triplet and quadruplet regimens rose after their introduction into the frontline treatment landscape, their usage remains suboptimal. Further research is needed to understand drivers of treatment selection.
The National Comprehensive Cancer Network (NCCN) recommends triplet and quadruplet regimens for treating newly diagnosed MM. The researchers note, “This change in the treatment landscape is expected to increase the adoption of quadruplet regimens in the coming years, as there is often a delay between clinical trial data publication and adoption of these treatments into community settings.”
Reference
Paulson RS, Gautam S, Medhekar R, et al. Front-line treatment approaches in multiple myeloma: real-world data from a community-based oncology network. Front Oncol. 2026;16:1736892. doi:10.3389/fonc.2026.1736892
