Targeted therapeutics for multiple myeloma: the arrival of a risk-stratified approach.
Multiple myeloma (MM) remains an incurable hematologic malignancy characterized by frequent early responses, inevitably followed by treatment relapse. Until recently, few effective therapies existed. Indeed, the use of alkylating agents and corticosteroids had remained the treatment of choice for almost four decades. Several novel agents for MM have now become available, including the immunomodulatory drugs thalidomide and lenalidomide, as well as the proteasome inhibitor bortezomib. Each of these agents is undergoing extensive clinical evaluation in combination with other therapies to produce unprecedented response rates in newly diagnosed and relapsed MM. Nevertheless, relapse remains universal and further therapeutics with broad activity are required. Importantly, it has become clear that pivotal genetic events are the primary harbingers of clinical outcome and novel targeted therapy approaches using existing approved drugs or novel agents, which address that disrupted signaling pathways are now in various stages of clinical testing. It seems increasingly likely that novel drug combinations, which together turn off these critical Achilles heels, will become the standard of care and that treatment will become increasingly personalized and guided by genetic testing and prognostic factors.
Fonseca
Rafael
R
Mayo Clinic, 13208 East Shea Boulevard, Collaborative Research Building 3-006, Scottsdale, AZ 85259-5494, USA. fonseca.rafael@mayo.edu
Stewart
A Keith
AK
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D009101:Multiple Myeloma / Q000235:genetics / Q000628:therapy*; D009194:Myeloma Proteins / Q000378:metabolism; D018570:Risk Assessment
D000970:Antineoplastic Agents; D009194:Myeloma Proteins