Emerging Treatments for Patients with Myeloma Prove Promising Despite Obstacles

Myeloma is a complicated cancer type that can be tough to find a treatment option for which patients will respond to. However, in the past several months therapeutic options for patients with relapsed/refractory multiple myeloma have taken major steps forward.

This in part due to new data from multiple trials including the phase III COLUMBA trial, ICARIA-MM trial, and the phase II ELOQUENT-3 trial. The COLUMBA trial and ICARIA-MM trial were both able to submit biologics license applications to the FDA based on their findings, while the FDA approved the triplet regimen of elotuzumab (Empliciti) and pomalidomide/dexamethasone in patients with relapsed/refractory multiple myeloma who previously received treatment with lenalidomide (Revlimid) and a proteasome inhibitor from the ELOQUENT-3 trial.

“The good news is we have multiple new options that continue to evolve. Every month we have something new—a new horizon or exciting new data emerging,” said Amrita Krishnan, MD, director of the Judy and Bernard Briskin Center for Multiple Myeloma Research and a professor in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope during an interview with Oncology Nursing News®’ sister publication OncLive® at their State of the Science Summit™ on Hematologic Malignancies.

Part of what makes the COLUMBA trial so exciting to oncology professionals is its delivery of daratumumab (Darzalex) going from being given intravenously to a 5-minute injection without comprising efficacy in patients with relapsed/refractory multiple myeloma, along with showing very low rates of infusion toxicity1. When asked about the COLUMBA trial Krishnan said, “We’re all extremely excited about it as a real game-changer, in terms of providing a much easier [method] for patients to receive daratumumab,” also mentioning that many oncologists in the multiple myeloma space have moved to using daratumumab this way.

Combinations of drugs to treat patients with relapsed/refractory multiple myeloma have also taken further steps where doctors like Krishnan are looking at the studies of one drug and already asking the question how it can be used in combination with another. For example, the STORM trial looked into selinexor (Xpovio) looking at advanced refractory patients and only had a 21% response rate but while it “doesn’t  sound earth-shattering, in the context of advanced refractory disease, it was clearly thought to be notable by the FDA and that led to the approval of selinexor,” according to Krishnan. Most physicians will not use this as a single agent due to its findings, but it opens up a path to answer the question of what can work in tandem, with some phase trials already in progress, including one with daratumumab.

Yet for all the current progress, myeloma is very complicated and the durability of responses to these various treatments remains a challenge. Finding out why patients relapse remains a major question for scientists to understand but Krishnan has hope for the future. “The good news is there are so many more treatment options available right now, and I anticipate by next year we’re going to have several more as well. We’re looking forward to commercial approvals of CAR T-cell therapies [in myeloma]. How to sequence these [treatments] is certainly going to be a challenge for us, as well.”

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