UPDATE: What’s New in Myeloma?
Date: January 23, 2014
James R. Berenson, MD
Date: June 27, 2013
There have been several recent breakthroughs for the treatment of multiple myeloma patients that have led to new therapeutic options. With regards to newer agents, there are a number of new drugs in development. The most promising are the antibody-based treatments for myeloma involving proteins on the outside of myeloma cells that are called CD38, CD138 and CS-1. The furthest along in clinical development of these three antibody treatments is the work with the antibody directed against CS-1, elotuzumab, which is now in late stage 3 or randomized studies which may lead to FDA approval in the next two years. This drug seems to increase the anti-myeloma effects of other well recognized effective treatments for myeloma such as lenalidomide (Revlimid) or bortezomib (Velcade). However, when used alone, elotuzumab seems to have very little anti-myeloma activity. The other antibodies which are targeting CD38 and CD138 are in early clinical trials with some promising results.
In terms of already approved drugs, the recent approved drugs pomalidomide (Pomalyst) and carfilzomib (Kyprolis) are now showing more promise in combination treatments. We and others have used both of these drugs in clinical trials with a wide variety of effective anti-myeloma drugs such as steroids and chemotherapy.
Specifically, recent results from our own group have shown that among patients who failed Velcade-based therapy, Kyprolis can substitute and lead to significant anti-myeloma effects with very good tolerability. These results should be very helpful for increasing the number of therapeutic options for myeloma patients. In addition, this drug has also been used in newly diagnosed patients in combination with Revlimid and dexamethasone, a steroid, as well as chemotherapeutic agents such as cyclophosphamide and melphalan with high response rates.
Pomalyst was recently approved by the FDA in March of this year as a single agent or combined with dexamethasone, and has also now been studied in combinations. We presented data at the recent American Society of Clinical Oncology meeting in June in Chicago showing the high-level of effectiveness of this drug when combined with pegylated liposomal doxorubicin (Doxil) and dexamethasone. Other groups are studying this drug in combination with a wide variety of different agents including Velcade as well as Kyprolis. In the laboratory, research is leading to the identification of new potential targets as well as boosting the immune system to improve outcomes for myeloma patients. These studies are in early development.
We’ve also recently identified a new myeloma marker in the blood of myeloma patients called BCMA which appears to be very promising as a new way to follow myeloma patients with a simple blood test.
Overall, the future appears brighter for myeloma patients with the development of new regimens involving already approved drugs as well as the further development of drugs that have not yet been approved for clinical use.