Four new agents were approved for relapsed/refractory multiple myeloma (RRMM) since 2015, providing more options but adding complexity to the treatment of this disease.
At the 2017 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference, Houry Leblebjian, PharmD, BCOP, a clinical pharmacy specialist at the Dana-Farber Cancer Institute in Boston, Massachusetts, discussed new treatment options for RRMM.1
“These patients are relapsing a lot and there is definitely an unmet need for RRMM, which is why 2015 was a very exciting year,” she said.
Panobinostat, the first histone deacetylase inhibitor approved for multiple myeloma, is used in combination with bortezomib and dexamethasone for patients who received 2 prior lines of therapy that included bortezomib and an immunomodulatory agent. “Because it is oral, it is really easy for patients,” Dr Leblebjian noted.
Panobinostat has minimal efficacy as a single agent, but acts synergistically when used in combination. Dosing every alternate week can help patients avoid gastrointestinal and hematologic toxicity, as well as fatigue.
The IgG1κ anti-CD38 antibody daratumumab is approved as fourth-line therapy as a single agent, and as second-line therapy when used in combination with dexamethasone and bortezomib or lenalidomide.
Daratumumab induces apoptosis of CD38-expressing cells, which primarily includes myeloma cells but not normal lymphoid or myeloid cells. Intensive premedication, and early start time, and montelukast can reduce infusion reactions, which most frequently occur during the first or second dose.
Ixazomib is a proteosome inhibitor approved for second-line treatment when used in combination with lenalidomide and dexamethasone. Its advantages compared with other proteosome inhibitors is it is oral with weekly administration. It does not cause peripheral neuropathy, and nausea can be avoided with antiemetic premedication.
The novel anti-SLAMF7 antibody, elotuzumab, is available for second-line treatment in combination with lenalidomide and dexamethasone. Elotuzumab has a dual mechanism whereby it activates natural killer (NK) cells, and promotes the interaction of NK cells with myeloma cells.
Elotuzumab has little single-agent efficacy, but “adding the lenalidomide enhances the NK cell activation and increases the antitumor activity,” Dr Leblebjian said. It is well-tolerated with a low incidence of infusion reactions.
- Leblebjian H. Navigating new treatment paradigms in relapsed or refractory multiple myeloma. Lecture presented at: 13th Hematology/Oncology Pharmacy Association Annual Conference; March 29-April 1, 2017; Anaheim, CA.
This article originally appeared on Cancer Therapy Advisor