In a nutshell
The aim of this study was to review current treatment options and combinations for multiple myeloma.
Advances in first-line treatments have improved response and survival rates among multiple myeloma patients. In recent years immunotherapies and targeted therapies have become a major treatment option. Immunotherapies signal the immune system to attack cancer cells. Targeted therapies target certain proteins involved in cancer growth. Different therapies have different methods of action, and may be useful when used in combination.
Methods & findings
The current study reviewed the use of immunotherapies and targeted therapies in multiple myeloma.
Pomalidomide (Pomalyst) is a treatment that blocks the growth of new blood vessels the tumors need for growth. It also enhances the immune system to attack the cancer cells. It is typically prescribed for multiple myeloma no longer responding to standard therapy (refractory disease). In a study of patients with an average of 5 prior therapies, pomalidomide significantly improved survival when combined with the steroid dexamethasone (Dexasone).
Carfilzomib (Kyprolis) blocks the action of the protein proteasomes in cancer cells. Compared with other biologic therapies, carfilzomib is often associated with more favorable treatment outcomes. One study noted an overall response rate of 77%. The average time to disease progression was 12.6 months.
Ixazomib (Ninlaro) was the first biologic drug used in the treatment of multiple myeloma. It is a safe and effective treatment for relapsed or refractory disease. There is a low risk of side effects with ixazomib. Because of this, it is being investigated as a maintenance therapy (with the aim to maintain remission).
Monoclonal antibodies, such as elotuzumab (Empliciti) and daratumumab (Darzalex), are also being investigated. These are a type of biologic therapy that work by targeting antigens found on cancer cells.
Because many of these treatments work in different ways, combining them may improve outcomes. A recent study examined the benefit of adding carfilzomib to lenalidomide (Revlimid) and dexamethasone in patients with relapsed disease. Overall survival, time to disease progression, and response rates were all significantly improved compared to lenalidomide and dexamethasone alone. Carfilzomib was associated with a 21% decrease in mortality risk.
Similar results were observed with ixazomib in a study of 772 patients with relapsed or refractory disease and 1 to 3 prior therapies. Ixazomib with lenalidomide and dexamethasone was associated with an average time to disease progression of 21 months. This was significantly longer compared to lenalidomide and dexamethasone alone (15 months). This treatment combination is considered safe with a low rate of serious side effects.
Another study examined the effects of adding elotuzumab to lenalidomide and dexamethasone in 646 patients with relapsed or refractory disease. The risk of progression or death was reduced by 30%. The need for additional therapy was also delayed by an average of 1 year compared to lenalidomide and dexamethasone alone.
Similar results were observed in a separate study when elotuzumab was added to bortezomib and dexamethasone. 2-year overall survival was 73% (compared to 66% with bortezomib and dexamethasone alone). The rate of side effects was not significantly increased.
Early studies have shown that daratumumab combined with bortezomib and dexamethasone reduced the risk of progression by 61%.
The bottom line
Authors concluded that new treatments, particularly when combined, can overcome drug resistance and improve outcomes.
Published By :
Jul 15, 2017
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