Emerging drugs and combinations to treat multiple myeloma

Alessandra Larocca, Roberto Mina, Francesca Gay, Sara Bringhen, Mario Boccadoro, Alessandra Larocca, Roberto Mina, Francesca Gay, Sara Bringhen, Mario Boccadoro

Abstract

In the past few years, multiple targeted therapies and immunotherapies including second generation immunomodulatory drugs (pomalidomide) and proteasome inhibitors (carfilzomib, ixazomib), monoclonal antibodies and checkpoint inhibitors were approved for the treatment of myeloma or entered advanced phases of clinical testing. These agents showed significant activity in advanced myeloma and increased the available treatment strategies. Pomalidomide is well-tolerated and effective in patients with relapsed/refractory multiple myeloma who have exhausted any possible treatment with lenalidomide and bortezomib. Carfilzomib, a second-generation proteasome inhibitor, is active as a single agent and in combination with other anti-myeloma agents. Ixazomib is the first oral proteasome inhibitor to be evaluated in myeloma and is associated with a good safety profile and anti-myeloma activity in relapsed/refractory patients, even in those refractory to bortezomib. Monoclonal antibodies and immune checkpoint inhibitors are likely to play a major role in the treatment of myeloma over the next decade. In phase 3 studies, triplet regimens based on these agents combined with a backbone therapy (including lenalidomide, pomalidomide or bortezomib) were more efficacious than doublet regimens in patients with relapsed/refractory multiple myeloma, with limited additional toxic effects. This paper aims to provide an overview of the recent use of these agents for the treatment of myeloma, in particular focusing on the role of multi-agent combinations.

Keywords: monoclonal antibodies; multiple myeloma; novel agents.

Conflict of interest statement

CONFLICTS OF INTEREST AL has received honoraria from Amgen, BMS, Celgene and Janssen-Cilag; FG has received honoraria from Amgen, BMS, Celgene and Takeda and served on the advisory committee for Janssen, Mundipharma, Takeda; SB has received honoraria from BMS, Celgene, Janssen-Cilag, and served on the advisory board for Amgen, Mundipharma, Karyopharm; MB has received honoraria from Sanofi, Celgene, Amgen, Janssen, Novartis, Abbvie, BMS, and research funding from Celgene, Janssen, Amgen, BMS, Mundipharma, Novartis, Sanofi.

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