Case Study - Question 2 | FocusOn Oncology

Decision 2

Case description: Mindy, a 76-year-old patient with MM, returns for an oncology consultation at 12 months after initiation of DRd. She is considered ineligible for autologous stem cell transplantation. Mindy achieved PR at month 1, VGPR at month 6, and complete response (CR) at month 12. She has continued treatment with DRd, with a lenalidomide dose reduction (from 25 mg to 15 mg daily) at month 9.

Comorbidities: Parkinson’s disease remains well controlled with medication and her daily functioning is consistent with baseline (ECOG performance status I).
Current presentation: Chemistry and hematology values remain stable, reflecting CR. Neutropenia resolved after a lenalidomide dose reduction. No new findings have been detected on imaging tests.
Challenge: Mindy’s children share that the patient is getting tired of the medication burden associated with the treatment of MM and Parkinson’s disease, and has decreased adherence (75%) to lenalidomide (15 mg daily). They ask about the possibility of stopping MM treatment and resuming therapy if Mindy experiences a relapse, or finding alternatives to reduce the medication burden.

Choose your next step:

a. Stop daratumumab and continue lenalidomide/dexamethasone

b. Stop DRd and monitor the patient

c. Continue DRd and counsel the patient about the benefits of maintenance therapy