Quiz: Role of Proteasome Inhibitors in Relapsed/Refractory Multiple Myeloma

April 19, 2019
Bryant Furlow
Bryant Furlow

How knowledgeable are you about the use of proteasome inhibitors in relapsed/refractory multiple myeloma? Take our latest quiz to find out.

In our April multiple myeloma quiz, you'll get a chance to test your knowledge of the role of proteasome inhibitors in patients with relapsed/refractory multiple myeloma. Here's your first question:
 

1. Relapsed/refractory multiple myeloma is defined as cases in which disease relapse occurs after previous minimal response or better or cases in which the patient suffers disease progression on salvage therapy within ___ days of discontinuation of the previous therapy.

A.40B.50C.60D.70

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Answer: C. 60 days. Subsequent relapses are associated with progressively worse outcomes and shorter response durations with subsequent treatments. This is in part because multiple myeloma acquires genomic alterations that increase the risk of acquired treatment resistance. However, proteasome inhibitors have improved survival outcomes in patients with relapsed/refractory multiple myeloma.

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2. Which of the following was the first-in-class proteasome inhibitor for relapsed/refractory multiple myeloma?

A.BortezomibB.CarfilzomibC.IxazomibD.None of the above

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Answer: A. Bortezomib. Bortezomib was the first-in-class proteasome inhibitor. It was approved by the US Food and Drug Administration (FDA) in 2003 for relapsed/refractory multiple myeloma. Carfilzomib and ixazomib were subsequently approved by the FDA as next-generation proteasome inhibitors.

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3. Findings from the SWOG S0777 trial showed that adding bortezomib to lenalidomide and dexamethasone improved progression-free survival and overall survival compared with lenalidomide and dexamethasone in ___________.

A.Newly-diagnosed multiple myelomaB.Refractory multiple myelomaC.Relapsed multiple myelomaD.Relapsed/refractory multiple myeloma

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Answer: A. Newly-diagnosed multiple myeloma. The SWOG S0777 study confirmed the value of triplet therapy for newly-diagnosed patients with multiple myeloma. However, proteasome inhibitors are now considered important components of combination therapies for multiple myeloma in subsequent settings as well, frequently offering deep responses even in the relapsed/refractory setting.

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4. ___________has greater β-5 subunit selectivity and less off-target activity against nonproteasomal proteases compared with ___________.

A.Bortezomib; carfilzomibB.Carfilzomib; bortezomibC.Bortezomib; ixazomibD.Ixazomib; bortezomib

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Answer: B. Carfilzomib; bortezomib. Compared with bortezomib, carfilzomib exhibits greater β-5 subunit selectivity and less off-target activity. For patients with relapsed/refractory multiple myeloma, this can translate to deeper and more durable proteasome inhibition.

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5. Based on the results of the ASPIRE trial, triplet combination therapy with the proteasome inhibitor ___________, lenalidomide, and dexamethasone was approved by the FDA in 2015 for relapsed/refractory multiple myeloma.

A.BortezomibB.IxazomibC.CarfilzomibD.None of the above

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Answer: C. Carfilzomib.  The ASPIRE study showed median progression-free survival to be 26 months with carfilzomib, one of the longest progression-free survival outcomes reported for relapsed multiple myeloma. The combination of carfilzomib, lenalidomide, and dexamethasone was approved by the FDA in 2015 for treatment of patients with relapsed/refractory multiple myeloma who had received 1 to 3 prior lines of therapy. This is now considered a National Comprehensive Care Network Category 1 preferred treatment option.

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