2017 NCCN Hematologic Malignancies Congress: Treatment Update on Relapsed or Refractory Multiple Myeloma
Treatment for patients with relapsed or refractory myeloma should be tailored depending on the biology of the disease, patient frailty and comorbidities, according to research presented by Natalie S. Callander, MD, of the University of Wisconsin Carbone Cancer Center, Madison, at the 2017 National Comprehensive Cancer Network (NCCN) 12th Annual Congress: Hematologic Malignancies.
In the treatment of relapsed myeloma, immediate considerations include determining the extent of relapse, whether it is biochemical or symptomatic (symptomatic relapse should be treated more vigorously), whether relapse occurred on maintenance or other treatments, and whether or not it occurred early (< 12 months). For patients with early relapse, monoclonal antibodies and triplet combinations with carfilzomib and pomalidomide should be considered, and both lenalidomide- and bortezomib-based regimens have shown superior progression-free survival rates in phase III trials compared with dexamethasone.
In patients who meet the definition of “frail,” Dr. Callander encouraged the use of oral or less frequently administered drugs and the limited use of steroids when feasible. In fit patients with high-risk multiple myeloma who relapse, disease control should be established quickly with a regimen such as VDT-PACE (bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide) or high-dose cyclophosphamide.
Most patients with relapsed or refractory multiple myeloma respond initially but eventually develop refractory relapse. The chance of obtaining at least a partial response in these patients is low, underlining the need for more treatment options.