MULTIPLE MYELOMA

Treatments for Relapsed and Refractory Multiple Myeloma

In an interview with&nbsp;<em>Targeted Oncology</em>, Paul G. Richardson, MD,&nbsp;clinical program leader and director of Clinical Research in the Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute,&nbsp;discussed the results from the OPTIMISMM trial. He also shared his insight on the significance of these findings and what he expects to see in the future for this patient population.

Sagar Lonial, MD, details&nbsp;optimal sequencing techniques for patients with relapsed/refractory myeloma in a presentation during the 2018 Pan Pacific Lymphoma Conference.

Sham Mailankody, MBBS,&nbsp;discusses current treatment options and shifting preferences, especially toward triplet combinations, as well as emerging immunotherapy treatment options.

Sarah Holstein, MD, PhD,&nbsp;discusses new approaches to induction therapy for patients with multiple myeloma.

In topline findings from the phase III TOURMALINE-MM3 study, maintenance treatment with the proteasome inhibitor ixazomib improved progression-free survival compared with placebo in adult&nbsp;patients with multiple myeloma who responded to high-dose therapy and autologous stem cell transplant.

Paul G. Richardson, MD, clinical program leader and director of Clinical Research in the Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute, discusses results from the phase III OPTIMISMM trial comparing treatment regimens for relapsed/refractory multiple myeloma. This data compares a regimen of pomalidomide, bortezomib, and dexamethasone versus bortezomib and dexamethasone alone.&nbsp;

Elotuzumab&nbsp;(Empliciti) added to&nbsp;pomalidomide (Pomalyst) and&nbsp;dexamethasone reduced the risk of disease progression by 46% in patients with relapsed/refractory multiple myeloma compared with&nbsp;pomalidomide and dexamethasone alone,&nbsp;according to findings from the phase II ELOQUENT-3 trial presented at the 2018 EHA Congress.

In an&nbsp;analysis of patients with relapsed/refractory multiple myeloma enrolled on the phase Ib MMY1001 trial, daratumumab (Darzalex) was shown to be safe and effective when added to the backbone of carfilzomib (Kyprolis) and dexamethasone. These findings, which were presented&nbsp;during the 2018 ASCO Annual Meeting, signaled promising efficacy in patients who are refractory to lenalidomide (Revlimid), according to lead study author Ajai Chari, MD.

The FDA approved several indications in the month of June, including venetoclax (Venclexta) in chronic lymphocytic leukemia (CLL) and small lymphocytic leukemia (SLL), the combination of binimetinib (Mektovi) plus encorafenib (Braftovi) in melanoma, and bevacizumab (Avastin) in ovarian cancer. The FDA also accelerated approvals for pembrolizumab (Keytruda) in cervical cancer and in primary mediastinal large B-cell lymphoma, while also granting a priority review to glasdegib for acute myeloid leukemia.

Noa Biran, MD, physician, Multiple Myeloma Division, John Theurer Cancer Center, discusses the rationale for selecting stem cell transplant as treatment over a chemotherapy regimen for patients with multiple myeloma.

A supplemental new drug application adding overall survival data from the phase III ASPIRE trial to the label&nbsp;for carfilzomib (Kyprolis) has been approved by the FDA, according to Amgen, the manufacturer of the proteasome inhibitor.&nbsp; Carfilzomib is approved&nbsp;for use in patients with relapsed or refractory multiple myeloma.

Noopur S. Raje, MD, a medical oncologist at Massachusetts General Hospital, discusses chimeric antigen receptor T-cell therapy in patients with multiple myeloma. This therapy has been an exciting advancement in both hematology as well as solid tumors, she notes.

Rafael Fonseca, MD, recently shared the treatment considerations and decisions he makes when treating patients with multiple myeloma. Fonseca, professor of medicine, chair, Department of Internal Medicine, Mayo Clinic, explained how he would treat these patients based on case scenarios during a <em>Targeted Oncology </em>live case-based peer perspectives presentation.

An FDA analysis of data from 2 randomized clinical trials investigating pembrolizumab in multiple myeloma showed inconsistent results regarding the relationship between immune-related adverse events and objective responses. The KEYNOTE-183 and KEYNOTE-185 trials were reviewed during the 2018 ASCO Annual Meeting.

Patients with relapsed/refractory t(11;14) multiple myeloma achieved high rates of responses when venetoclax was added to the combination of carfilzomib and dexamethasone, according to findings from an ongoing phase II study presented during the 2018 ASCO Annual Meeting.

According to the phase III ARROW study, a prolonged progression-free survival was found when carfilzomib was administered with a new dosing schedule of 70 mg/m²&nbsp;once weekly with&nbsp;dexamethasone compared to the standard of care, a twice-weekly schedule, in patients with relapsed/refractory multiple myeloma.

In updated findings from the multicenter phase I CRB-401 study that were presented&nbsp;at the 2018 ASCO Annual Meeting, the anti-BCMA CAR T-cell therapy bb2121 induced a median progression-free survival of 11.8 months and a median duration of response of 10.8 months for patients with relapsed/refractory heavily pretreated multiple myeloma.

Following a planned interim analysis, 2 early-phase clinical trials&nbsp;exploring daratumumab in combination with either a PD-1 inhibitor for multiple myeloma or a PD-L1 inhibitor for non&ndash;small cell lung cancer have been terminated, according to a statement from Genmab, the company codeveloping daratumumab with Janssen.

The use of triplet regimens for the treatment of patients with relapsed multiple myeloma has become one of the most favorable treatments recently. OPTIMISMM, a phase III trial, investigated bortezomib and dexamethasone with or without pomalidomide as another triplet regimen option for use in earlier lines of therapy, said Peter Voorhees, MD.<br /> &nbsp;

Andrew L. Pecora, MD, president of the Physician Services Division and chief innovation officer at Hackensack Meridian Health, discusses the significance of his findings when combining an anti-CTLA-4 and anti-PD-1 in patients with multiple myeloma. He sought out to find whether these 2 drugs could be combined safely after an autologous stem cell transplant.&nbsp;

Roswell Park Comprehensive Cancer Center has selected Jens Hillengass, MD, as its new Chief of Myeloma. Hillengass will continue his research on hematologic malignancies in his new position.