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Editorials
with caution, it may be that an antibody containing quadruplet with VRD will prove to have similar activity to a Cfz triplet without antibody.
In conclusion, given the updated Carthadex results,19,20 Cfz proves to be a potent PI and important component of anti-myeloma treatment in a variety of regimens (KTd, KRd, KCd, Kd) (Table 1). Cfz has been investigated with other IMiD, such as pomalidomide, with different alkyla- tors (e.g. Cfz-Bendamustin-Dex) and antibodies like dara- tumumab or elotuzumab in clinical trials. Due to its sub- stantial efficacy and good tolerability it is used in dou- blets, triplets and quadruplets, both in younger and older, fit and frail patients, and in ASCT-eligible and -ineligible patients. Cfz is considered a potent relapse option in MM patients who have relapsed after and/or are refractory to both Btz and IMiD. Unfortunately, for NDMM patients, Cfz has not yet been approved, and all clinical trials, including the Carthadex trial, have not yet led to a change in Cfz registration status (Table 1). The findings from ongoing phase II and multiple phase III studies will help to determine optimum dosing regimens, to establish the position of Cfz in relapse, first-line and subsequent ther- apies, and for consolidation and maintenance approaches. The evidence from clinical trials should be supplemented by reports of real-world evidence in the near future, as experience with managing the toxicity profile continues to grow.30
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