Blood cancers

Relapsed/refractory multiple myeloma: why what you do next matters

Tuesday, 19 Mar 2019


Addressing Amgen One’s Multiple Myeloma stream, Professor Keith Stewart from the Mayo Clinic in Phoenix Arizona didn’t mince words or dance around the point. Similar to his Harvard Medical School counterpart Professor Noopur Raje, Prof. Stewart was quick to acknowledge the limitations in Australia and emphasised the importance of fighting for funding of the latest treatments. Perhaps an ideal message for funding bodies, Prof. Stewart started his talk on a frank note. “If they are not alive, patients cannot benefit from the most novel and powerful agents we have today.” This powerful statement was met by nods around the room as he highlighted the high rate of attrition with subsequent lines of therapy in multiple myeloma (MM).1

As he discussed the latest trials in the relapsed/refractory setting he noted that carfilzomib trials “are the only ones so far to show an overall survival benefit after relapse.”2,3 Aside from carfilzomib, the other main players that dominated the early relapse scene at ASCO in 2018 were daratumumab, pomalidomide and elotuzumab. “Daratumumab we’re going to see everywhere and with everything, pomalidomide is taking over from lenalidomide in the relapse setting and elotuzumab and ixazomib trials are giving us ideas on how to manage the older patient.” When it comes to treating late relapse, small molecules, antibodies and antibody drug conjugates (ADC) have been making a lot of noise. However, according to Professor Stewart some of these options have limitations such as utility for specific risk factors such as t(11;14) translocation, are prohibitively toxic or are being withdrawn from the market.

Professor Stewart’s snapshot of relapsed/refractory disease today

Summarising his management of the relapsed/refractory MM patient, Prof. Stewart threw these considerations out to the audience:

  • Treat relapse as a fresh start, “we should be looking at whether we need to re-induce again because if its been years since their last treatment they may have been undertreated”
  • Triplet therapy has become standard in the USA
  • Daratumumab will likely be used with everything
  • Is bortezomib really adequate in the relapsed/refractory patient?
  • Carfilzomib dosing is something that will be optimised
  • Pomalidomide is better than lenalidomide4
  • There is a declining role of a second transplant and transplant overall
  • Immune therapy trials are the future

This article was sponsored by Amgen, which has no control over editorial content. The content is entirely independent and based on published studies and experts’ opinions, the views expressed are not necessarily those of Amgen.

References:

  1. Yong K, et al Br J Haematol. 2016 Oct;175(2):252-264
  2. Siegel DS et al J Clin Oncol 2018;36(8):728-734.
  3. Dimopoulos MA, et al. Lancet Oncol 2017; 18(1):1327-1337.
  4. Berenson JR, et al. Blood 2017;130:3106.

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