Highlights and Challenges in a Decade of New Multiple Myeloma Treatments

In an interview with Targeted Oncology^TM, Prerna Mewawalla, MD, discussed the standout therapies in the multiple myeloma space that have altered the landscape in the past decade. Moreover, she discussed how she goes about sequencing in these therapies in various patients.

Mewawalla, medical director apheresis at the Allegheny Health Network, also looked at the outlook of treating patients with multiple myeloma compared to 10 years ago.

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0:07: I think each class [of therapy], whether it's oral, intravenously given, or subcutaneous, [we've seen] great results. For instance, in the oral realm, of course, we've had lenalidomide [Revlimid] forever, we have pomalidomide [Pomalyst], while in the subcutaneous realm we have daratumumab, and we have drugs in the IV realm as well. So, I don't think the delivery determines the efficacy as much, but I think with having more oral agents, it's more about convenience than efficacy.

0:39: One of the things I do see is the side effect profile, I do see what are the patient comorbidities? Are they going to tolerate this drug if they have cardiac risk factors? What are we using carfilzomib in those patients, things like that. The second thing that I see when it comes to sequencing drugs is what have they had before? Are they refractory to what they've had before? Are they still sensitive to what they've had before, especially [if they are] lenalidomide sensitive vs lenalidomide refractory? If they're lenalidomide sensitive, then I can still use combinations like daratumumab, lenalidomide, and dexamethasone, but if they're lendalidmide refractory, then I can use daratumumab, bortezomib, and dexamethasone. So that's another factor which plays a role in choosing treatments. And the other factor, which I also keep in mind, while sequencing treatments is the biology of the disease. Am I dealing dealing with very high-risk aggressive disease, or am I just dealing with low-risk disease where the M spike is just rising slowly? For example, when I have a patient where it's just the M spike, and it's just increasing slowly, elotuzumab is a very good option to consider in those situations as well.

1:56: I think things have changed a lot for [the treatment of patients with multiple myeloma]. I think it's been a very exciting decade for myeloma if just to say the least, we've had so many biologic treatments available. Every few months, we have a new drug, which becomes available to us. So, from where we used to talk about myeloma where we just have frontline therapies and then maybe second line therapies and then you're like, oh, I don't have that much to go by. Now, we have patients in the fifth line and sixth line, and we still have hope where we can still consider this. So, I think things have changed a lot. It's a very, very exciting time for myeloma and there are still more things to come.