The treatment options for patients with relapsed/refractory multiple myeloma are expanding rapidly, notably through clinical trial evidence supporting a number of three-drug combination regimens.
Sundar Jagannath
Sundar Jagannath, MD
The treatment options for patients with relapsed/refractory multiple myeloma are expanding rapidly, notably through clinical trial evidence supporting a number of three-drug combination regimens.
Sundar Jagannath, MD, the director of the Multiple Myeloma Program at The Tisch Cancer Institute and a professor at Mount Sinai School of Medicine in New York City, detailed many of the key research results shaping this new landscape during a presentation at the 19th Annual International Congress on Hematologic Malignancies: Focus on Leukemias, Lymphomas and Myeloma that Physicians’ Education Resource (PER) hosted February 20-21 in Miami, Florida.
“Now we have a panoply of treatment choices,” Jagannath said in an interview, adding that the field has become “more exciting.”
During his presentation, Jagannath referenced five combination regimens explored in these clinical trials:
In presenting these trials. Jagannath noted that the regimen tested in the ASPIRE trial represents a “potential new standard of care in relapsed multiple myeloma.”
“It clearly showed that if you use the three-drug approach, it was quite effective in improving the progression free survival and a trend toward improvement in overall survival,” he said in the interview.
Moreover, he noted that “these three drugs could be combined effectively without added toxicity. …. Surprisingly, the patients who got the three drugs actually stayed on the three-drug combination longer.”
In the pomalidomide trial, the findings showed that patients who received the triplet therapy from the start of the trial experienced a better PFS rate than those who had cyclophosphamide added to their regimen at a later time.
“Perhaps in relapsed myeloma patients, you have a window of opportunity to give the best therapy, because if you wait and they relapse, sometimes the relapse could be more aggressive or the patient may not have a good performance status,” said Jagannath. He also noted that patients could experience renal impairment or that their disease could become more refractory.
Noting the positive results of the other trials, Jagannath observed that “in the near future, we may have additional new agents to tackle these patients.”
In terms of employing new regimens in the clinic, Jagannath advised practicing oncologists to remember that evidenced-based medicine is developed through clinical trials that enroll patients who likely are more fit than those physicians see in their offices.
He suggested that one way to personalized treatment for patients who are over the age of 80 years is to evaluate whether they are fit, unfit, or frail, and then adjust the dosages accordingly. “If you use the evidence-based medicine and apply it in these patients, what is coming out is that the toxicity is prohibitive and they’re not actually benefiting,” said Jagannath. “So you tailor the therapy.”
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