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Current treatment trends for multiple myeloma are being driven by the increasing prevalence of the disease, improvements in patient care and new therapies. It’s an exciting time to be working in myeloma research and we have seen a number of promising new treatments get approval over the last few years. Key developments include proteasome inhibitors, immunomodulatory drugs and CAR-T cell therapies.
Proteasome inhibitors
Proteasome inhibitors are the latest class of drugs to be approved to treat myeloma. Proteasome inhibitors stop proteasome, proteins needed to break down wrongly folded proteins, from doing their job. They have approved proteasome inhibitors to help people with myeloma who don’t respond to chemotherapy and are at risk of dying because of their cancer live longer.
Proteasome inhibitors prevent the exposure of myeloma cells to specific toxic proteins, including alpha-Fluorodeoxyguanosine (aFdG), which is toxic to the bone marrow. Chemotherapy makes a toxin called aFdG. Too much of this toxin is the most common reason people with myeloma die. Proteasome inhibitors have also been shown to improve the quality of life for some groups of patients.
Immunomodulatory therapy
Immunomodulatory therapy is a promising new treatment option for myeloma patients. Immunomodulatory therapy is a combination of several different treatments to try to bring the body’s immune system back under the control of the patient’s physician. This typically involves the administration of an immunosuppressant, such as Ruxolitinib, or an immunomodulatory agent, such as G-CSF.
Immunomodulatory agents increase the number of T-cells, B-cells, and macrophages in the patient’s body. This allows the patient’s immune system to recognize and attack cancer cells, which makes it easier to treat cancer. Immunomodulatory agents also suppress the immune response, which helps prevent autoimmune side effects that some patients have on immunosuppressive drugs.
CAR-T cell therapies
Chimeric antigen receptor (CAR)-T cell therapies are a new and potentially effective way to treat myeloma. CAR-T cells are engineered to recognize and bind to specific proteins found on the cancer cells. This binding activates the CAR-T cells and causes them to multiply and produce proteins that attack the cancer cells. These treatments are hopeful because they use a patient’s own immune cells to attack cancer cells.
CAR-T cell therapies are currently used to treat several different cancer types, including lymphomas, melanomas and cancers of the skin. While some studies suggest that the CAR-T cell therapies are effective at treating myeloma, the long-term safety and efficacy of these treatments need to be further studied.
Novel therapies and development programs
A growing number of other new and emerging treatment options are being developed for myeloma patients. Immuno-oncology drugs, like Keytruda and Opdivo, and new targeted therapies, like trastuzumab emtansine (T-DM1) and CD28 antibodies, may become more common. Immuno-oncology therapies target both the cancer and the patient’s immune system, which can be very helpful for some patient groups. Targeted therapies can target specific proteins or pathways involved in cancer cell survival, proliferation, and progression.
Emerging trends in treatment of multiple myeloma December 2022
In the treatment of myeloma, the cancer cell survival pathway is a promising therapeutic target that is being looked into. Gene-targeted therapies and immunotherapies may become more common. Immunotherapy approaches to cancer treatment are increasingly being investigated for myeloma patients. Bortezomib is an example of a drug that is being looked at to treat myeloma. It is a proteasome inhibitor. Bortezomib treats people with multiple myeloma who are more likely to get anemia. Bortezomib may become a more common way to treat myeloma because it has increased progression-free survival in patients with high-risk myeloma.
Treatment options for patients with multiple myeloma December 2022
In addition to these new therapies, myeloma patients still have access to a number of well-known treatments. The gold standard in myeloma therapy remains the same as it has been for the last 30 years: the removal of cancerous plasma cells through “consolidation chemotherapy,” followed by autologous stem cell transplantation.
Treatment options for patients with multiple myeloma include chemotherapy drugs, including proteasome inhibitors, alkylating agents, anthracyclines, immunomodulatory agents and newer targeted agents. Alpha-Fluorodeoxyguanosine (aFdG) therapy is an emerging treatment option that uses the toxic byproduct of chemotherapy, aFdG, to protect the bone marrow from over time.
Autologous stem cell transplantation is a non-myeloablative therapy that is done when all other treatments have failed. Clinical trials led to the development of transplantation as a way to treat acute myeloid leukemia.
Treatment options for patients with multiple myeloma include prophylactic plasma exchange, checkpoint inhibitors, and using hematopoietic growth factors to promote blood cell formation. Chronic myelogenous leukemia is being treated with transplantation thanks to the development of clinical trials.
New cancer drugs and biological agents are being tested in combination with established therapies in an effort to improve outcomes and extend survival in myeloma patients with disease progression or high-risk disease.
Emerging trends in the treatment of multiple myeloma December 2022
In treating myeloma, the cancer cell survival pathway is a promising therapeutic target that is being looked into. Gene-targeted therapies and immunotherapies may become more common. In addition, proteasome inhibitors are being investigated as a treatment option for myeloma. Immuno-oncology therapies target both cancer and the patient’s immune system, which can be very helpful for some patient groups. The proteasome inhibitor bortezomib is being investigated as a treatment option for myeloma. Since they have been shown to help people with high-risk myeloma live longer, proteasome inhibitors may be used more often.
Emerging trends in the treatment of multiple myeloma December 2022
New cancer drugs and biological agents are being tested in combination with standard treatments in order to help myeloma patients whose disease is getting worse or who are at high risk of dying from it.
Future treatment trends December 2022
The results of ongoing clinical trials will help to determine which future treatment trends emerge, and which new therapies are most effective. Proteasome inhibitors may become more common, as it has been shown to help people with high-risk myeloma live longer. Gene-targeted therapies and immunotherapies may also become more common.
