A question of class: Treatment options for patients with relapsed and/or refractory multiple myeloma

Abstract

A B S T R A C TMultiple classes of agent with distinct mechanisms of action are now available for the treatment of patients with relapsed and/or refractory multiple myeloma (RRMM), including immunomodulatory agents, proteasome inhibitors, histone deacetylase inhibitors and monoclonal antibodies. Additionally, several different drugs may be available within each agent class, each with their own specific efficacy and safety profile. This expansion of the treatment landscape has dramatically improved outcomes for patients. However, as the treatment options for RRMM become more complex, choosing the class of agent or combination of agents to use in the relapsed setting becomes increasingly challenging. Furthermore, treatment options for specific patient populations such as the elderly, those with high-risk cytogenetic abnormalities and those with refractory disease are yet to be defined in the current treatment landscape. When choosing an appropriate treatment approach, physicians must consider multiple criteria including both patient-related and disease-related factors. The aim should be to provide patientspecific treatment in order to gain a clinical benefit while minimizing toxicity. This review provides an overview of the mechanism of action and efficacy and safety profiles of each class of agent and of treatment regimens that combine different classes of agent, with a special focus on treating specific patient populations.

A multiple myeloma that progressed as type I cryoglobulinemia with skin ulcers and foot necrosis

“…Only aggressive and prompt treatment can induce a rapid response of hematologic disease and reduce the organ damage caused by cryoglobulin. [ 22 – 24 ] In our patient, despite the prompt start of an integrated therapeutic approach with prostanoid infusion, [ 25 ] plasmapheresis, [ 23 , 26 ] and chemotherapy, [ 2 , 27 ] vascular damage was advanced and irreversible. Therefore, the patient was subjected to amputation of both feet because of necrosis.…”

Once- versus twice-weekly carfilzomib in relapsed and refractory multiple myeloma by select patient characteristics: phase 3 A.R.R.O.W. study subgroup analysis

“…Multiple myeloma (MM) is the third most common hematologic malignancy worldwide, characterized by excessive proliferation of monoclonal plasma cells 1,2 . The development of novel anti-MM agents has expanded treatment options for MM patients and improved outcomes 3 . Despite recent treatment advances, MM remains incurable, with most patients relapsing and developing treatment-refractory disease 1 .…”

“…Despite recent treatment advances, MM remains incurable, with most patients relapsing and developing treatment-refractory disease 1 . Relapsed and refractory MM (RRMM) represents a challenging disease to treat, given the heterogeneity of the disease and patient population [3][4][5] .…”

Introductory Chapter: Multiple Myeloma in the Era of Novel Therapeutics

“…Different novel therapeutic agents that are usually given in various combinations are currently available for the treatment of patients with RR disease [61,62]. However, in the setting of RR disease, treatment options become more complex, but the aim should be to provide the patient with specific drug combination so as to gain clinical benefit while minimizing drug toxicity [63]. Additionally, studies have shown clinical benefit for continued therapy.…”

“…However, the choice of therapeutic regimen should take disease-related factors and patientrelated factors into consideration [62,63,73].…”