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E.All of the above
With the availability of various immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), histone deacetylase (HDAC) inhibitors, and monoclonal antibodies (mAbs), outcomes have improved for patients with RRMM, but treatment decision making has become much more complex. Few head-to-head trials have identified optimal monotherapeutic or combinatorial regimens for these patients.
The second-generation PIs ixazomib and carfilzomib offer alternative within-class options for patients whose disease is refractory and/or relapsed with bortezomib therapy. Second-generation agents pomalidomide and lenalidomide offer alternative within-class IMiD treatment options for patients with RRMM. Panobinostat is an HDAC inhibitor.
B.PIs and IMiDs
In the phase III ASPIRE trial, adding carfilzomib to lenalidomide plus dexamethasone prolonged progression-free survival (26.3 vs 17.6 months; P = .0001) among patients with RRMM. Patients receiving carfilzomib in addition to the other two agents reported better health-related quality of life than patients in the study’s control arm.
C.The same degree
Newer agents generally offer comparable survival benefits to younger and elderly patients.
RRMM in very elderly and frail patients can be a management challenge because of comorbidities and greater vulnerability to treatment-related side effects. These patients are treated not with the goal of achieving a deep and durable disease response-which would be associated with significant treatment-related toxicities-but rather with the aim of prolonging asymptomatic RRMM for as long as possible without incurring treatment toxicities. Comprehensive geriatric assessments can inform treatment decision making.