New Treatments For Relapsed Myeloma
Twenty years ago, multiple myeloma was a disease that had a very limited survival even with bone marrow transplant. Nowadays, new therapeutic agents with different mechanisms of action have changed the survival and redefined the role of bone marrow transplant.
In 2014, the latest information from the American Society of Hematology (ASH) is as follows
Adding carfilzomib to lenalidomide and decadron increased the complete response rate, disease free survival and survival in heavily pre-treated patients. Carfilzomib is a proteasome inhibitor that causes cell death. It is given intravenously.
The three-drug combination was well tolerated and the major side effects were hypertension and shortness of breath. Maintenance therapy with carfilzomib is being studied.
Pomalidomide and dexamethasone (low dose) are now standard of care in the relapsed/refractory setting. Pomalidomide is an oral drug that has anti-angiogenic properties as well as immunomodulatory properties. The response rate in heavily pre-treated patients is >30% with limited side effects. It is currently being studied in combination with bortezomib or carfilzomib.
Another new combination presented at the ASH meeting was ixazomib, lenalidomide and decadron followed by maintenance ixazomib, which was very active. The combination is very well tolerated with rash and some swelling as major side effects. Ixazomib is a proteasome inhibitor the first one of the category to be oral.
A new monoclonal antibody ANT1 CD38 called daratumumab combined with lenalidomide and decadron had a very high response rate in refractory myeloma patients of over 70%.
Currently combining immunomodulatory agents with proteasome inhibitors, anti-angiogenic agents and monoclonal antibodies has given the opportunity to tackle myeloma from multiple mechanisms of actions.
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