Adriana Rossi, MD, provides clinical pearls on the management of triple-class refractory multiple myeloma.
Adriana Rossi, MD: I think it is challenging for those of us who do nothing but myeloma to keep up with the volume of data, the new agents, the combinations, the new therapeutic approaches. I can only imagine in a community setting, when you still need to know how to care for so many different things, it is not possible to keep track of everything. I would hope that most community physicians are able to partner with someone at an academic institution, or someone who devotes most of their time to myeloma, and have that shared—one of my patients calls it shared custody. Where you have someone who is keeping up to date and hopefully participating in clinical trials to keep a running tally. And you’d have a local oncologist to give the hands-on care to the patient. Maybe that would be one of the silver linings of COVID-19 and all the telemedicine we’ve developed, a little easier access to the academic institutions. If we can help in any way to educate and to facilitate, and to run through cases, it’s one of my favorite things.
This was a great case that offers us a lot of reminders on best practices. This was considered a patient with transplant-ineligible multiple myeloma. She received highly active triplets. Hopefully, again not detailed, but she was maintained on continuous therapy. Once you use a triplet regimen, you have a component of that triplet continued until progression or intolerable toxicity. We’ve talked about the bone health and making sure that patients, in addition to their chemotherapy regimen, have some sort of antiresorptive therapy, be it denosumab or zoledronic acid. Our practice is to dose monthly during active treatment and every 3 months during a maintenance treatment. We also want to make sure they’re being followed by dentists, specifically for that. And we want to be sure we’re monitoring patients, especially an active patient who’s on therapy should be monitored every month. This poor lady went 3 months and got herself into an awful lot of trouble. And selecting drugs; when a patient is relapsing, if it is a clinical relapse, you have to be sure you are picking a new regimen. But in the setting of a biochemical relapse, you could alter one or the other partner and try to gain more mileage out of each agent the patient receives.
Transcript edited for clarity.
Case: A 75-Year-Old Woman with Triple-Class Refractory Multiple Myeloma