Multiple Myeloma Coverage from Every Angle

Long-Term Treatment Strategy for Myeloma: Optimal Selections Based on Stage

By: Chase Doyle
Posted: Monday, December 21, 2020

Recent advances have prolonged survival in multiple myeloma, but it remains a chronic disease that requires a long-term treatment strategy. The addition of several new therapies has also added complexity to treatment algorithms, according to Shaji K. Kumar, MD, of the Mayo Clinic Cancer Center, Rochester, Minnesota.

“Deciding which regimen to use has increasingly become a challenge,” said Dr. Kumar at the NCCN 2020 Annual Congress: Hematologic Malignancies. “The treatment paradigm for myeloma has evolved considerably, but it is starting to converge, irrespective of whether the patient is transplant-eligible or -ineligible.” Highlights of this presentation were published in JNCCN–Journal of the National Comprehensive Cancer Network.

As Dr. Kumar explained, the key to achieving the best outcomes for patients is delivering the best ‘package’ of treatment at a given stage. This means using optimal combinations that maximize benefit based on what patients have received before and minimize treatment-related toxicity.

In patients with newly diagnosed disease, the standard initial therapy for several years has been the combination of bortezomib, lenalidomide, and dexamethasone. Switching bortezomib with the anti-CD38 monoclonal antibody daratumumab, however, has led to significantly improved responses. “Clearly, the combination of a proteasome inhibitor with an immunomodulatory drug or a monoclonal antibody with an immunomodulatory drug has been an excellent strategy for achieving good disease response,” said Dr. Kumar.

Clinicians are awaiting data about the impact of adding a fourth drug to the regimen on overall survival, but Dr. Kumar cautioned that continuing patients indefinitely on four-drug regimens will be “extremely difficult from the standpoint of both toxicity and cost.” 

In the relapsed or refractory setting, Dr. Kumar underscored the importance of sequencing of regimens. As new agents and new classes of drugs continue to be approved for multiple myeloma, he commented, future strategies will also utilize more individualized approaches to treatment.

Disclosure: Dr. Kumar reported no conflicts of interest.

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