Concise review ‐ Treatment of multiple myeloma in the very elderly: How do novel agents fit in?

Kint, Nicolas; Delforge, Michel

doi:10.1016/j.jgo.2016.08.001

Cited by 12 publications

(5 citation statements)

References 41 publications

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“…[5][6][7] The median age of MM patients at diagnosis is just under 70 years, and MM-related deaths primarily occur in patients ages 65 to 84 years. 8,9 Although there has been an increase in survival for MM patients overall, older patients have not benefitted from novel therapies to the same extent as younger patients. 10 This is highlighted by the stagnant 10-year survival rate reported for patients 75 and older of <10%, while an improvement from approximately 10% to 35% was observed in patients younger than 65.…”

Section: Introductionmentioning

confidence: 99%

“…Commonly used multi‐drug combinations include immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), monoclonal antibodies (mAbs), alkylating agents and corticosteroids 5‐7 . The median age of MM patients at diagnosis is just under 70 years, and MM‐related deaths primarily occur in patients ages 65 to 84 years 8,9 . Although there has been an increase in survival for MM patients overall, older patients have not benefitted from novel therapies to the same extent as younger patients 10 .…”

Section: Introductionmentioning

confidence: 99%

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Effect of age and frailty on the efficacy and tolerability of once‐weekly selinexor, bortezomib, and dexamethasone in previously treated multiple myeloma

et al. 2021

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Elderly and frail patients with multiple myeloma (MM) are more vulnerable to the toxicity of combination therapies, often resulting in treatment modifications and suboptimal outcomes. The phase 3 BOSTON study showed that once‐weekly selinexor and bortezomib with low‐dose dexamethasone (XVd) improved PFS and ORR compared with standard twice‐weekly bortezomib and moderate‐dose dexamethasone (Vd) in patients with previously treated MM. This is a retrospective subgroup analysis of the multicenter, prospective, randomized BOSTON trial. Post hoc analyses were performed to compare XVd versus Vd safety and efficacy according to age and frailty status (<65 and ≥65 years, nonfrail and frail). Patients ≥65 years with XVd had higher ORR (OR 1.77, p = .024), ≥VGPR (OR, 1.68, p = .027), PFS (HR 0.55, p = .002), and improved OS (HR 0.63, p = .030), compared with Vd. In frail patients, XVd was associated with a trend towards better PFS (HR 0.69, p = .08) and OS (HR 0.62, p = .062). Significant improvements were also observed in patients <65 (ORR and TTNT) and nonfrail patients (PFS, ORR, ≥VGPR, and TTNT). Patients treated with XVd had a lower incidence of grade ≥ 2 peripheral neuropathy in ≥65 year‐old (22% vs. 37%; p = .0060) and frail patients (15% vs. 44%; p = .0002). Grade ≥3 TEAEs were not observed more often in older compared to younger patients, nor in frail compared to nonfrail patients. XVd is safe and effective in patients <65 and ≥65 and in nonfrail and frail patients with previously treated MM.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of age and frailty on the efficacy and tolerability of once‐weekly selinexor, bortezomib, and dexamethasone in previously treated multiple myeloma

et al. 2021

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“…Over the last 10 years the development of novel biological agents for the management of MM (proteasome inhibitors-PI and immunomodulatory drugs-ImiDs, amongst others) has improved outcomes for patients with MM such that the median overall survival is more than 7-8 years for younger/fitter patients. However, the impact of these therapies has been less marked in the older/less fit transplant non-eligible (TNE) population, particularly those over the age of 75 years [6]. These patients do not have a greater incidence of molecularly high-risk disease and so these differences are likely to be accounted for by differences in patient physiology, increased treatment-related toxicity limiting delivery of effective therapy and less effective, rigorous anti-myeloma treatment being given (undertreatment) [7].…”

Section: Introduction-the Unmet Needmentioning

confidence: 99%

Defining the vulnerable patient with myeloma—a frailty position paper of the European Myeloma Network

et al. 2020

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As the treatment landscape continues to evolve towards the application of precision medicine in multiple myeloma (MM), there is a clear need to identify those patients who are at risk of not achieving the maximum benefit whilst exposed to the highest level of toxicity. This group of patients, defined as frail, is an unmet clinical need. However, how we define such a vulnerable group of patients with MM remains to be clarified. An integral aspect of this is to define the physiological age and capacity of patients with MM to deal with the burden of their disease and it's treatment. Such assessments may include not only functional and clinical assessments but also laboratory-based biomarkers of frailty, aging and senescent cellular burden. A need to develop, test and validate clinical screening scores before their adoption into clinical practice is mandated. This position paper from the European Myeloma Network aims to review what is known about defining frailty in MM, and how we can advance this knowledge for the design of clinical trials and ultimately how we deliver treatment in the clinic.

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“…It was hitherto treated with surgical resection, radiation, systemic chemotherapy before or after surgical resection including alkylating agents, anthracyclines, vinca alkaloids, steroids, and bone marrow transplantation [1][2][3]. In last decade, the treatment of multiple myeloma has greatly improved by the introduction of novel agents, including proteasome inhibitors (PI) and immunomodulatory drugs (IMiDs) [4]. In the present …”

Section: Discussionmentioning

confidence: 99%

Visible effect of immunomodulatory drugs on rib tumor in multiple myeloma

Shinohara¹

2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Review

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Concise review ‐ Treatment of multiple myeloma in the very elderly: How do novel agents fit in?

Cited by 12 publications

References 41 publications

Effect of age and frailty on the efficacy and tolerability of once‐weekly selinexor, bortezomib, and dexamethasone in previously treated multiple myeloma

Effect of age and frailty on the efficacy and tolerability of once‐weekly selinexor, bortezomib, and dexamethasone in previously treated multiple myeloma

Defining the vulnerable patient with myeloma—a frailty position paper of the European Myeloma Network

Visible effect of immunomodulatory drugs on rib tumor in multiple myeloma

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