Tailoring treatment for multiple myeloma patients with relapsed and refractory disease.
Responses to treatment of relapsed and refractory multiple myeloma are characteristically short, and median survival is as brief as 6 months. Although prognostic factors in the context of relapsed and refractory disease require further characterization, high-risk patients include those with certain cytogenetic abnormalities, high beta2-microglobulin, and low serum albumin. The development of novel therapies targeting disease biology and tumor microenvironment has significantly improved the outlook for patients with relapsed and refractory disease, with bortezomib (Velcade), a first-in-class proteasome inhibitor, and the immunomodulatory agents thalidomide (Thalomid) and lenalidomide (Revlimid) constituting "backbone"agents in this setting. More recent approaches for treating relapsed and refractory myeloma that are recommended by the National Comprehensive Cancer Network include single-agent bortezomib, single-agent lenalidomide, bortezomib/dexamethasone, bortezomib plus pegylated liposomal doxorubicin, lenalidomide/dexamethasone, and lenalidomide/bortezomib/dexamethasone. Individualized treatment of progressive myeloma should take into account the time to progression and/or the type of prior therapy. Additional clinical challenges discussed in this article are renal dysfunction, extramedullary disease, and advanced bone disease. Finally, participation in clinical trials is especially encouraged in this patient population.
Richardson
Paul G
PG
Harvard Medical School, Jerome Lipper Center for Multiple Myeloma, Dana-Farber Cancer Institute, Boston, MA 02115, USA. paul_richardson@dfci.harvard.edu
Laubach
Jacob
J
Mitsiades
Constantine
C
Schlossman
Robert L
RL
Doss
Deborah
D
Colson
Kathleen
K
McKenney
Mary L
ML
Noonan
Kimberly
K
Warren
Diane L
DL
Ghobrial
Irene M
IM
Munshi
Nikhil C
NC
Anderson
Kenneth
K
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019008:Drug Resistance, Neoplasm; D006801:Humans; D009101:Multiple Myeloma / Q000175:diagnosis / Q000188:drug therapy*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000188:drug therapy*; D057285:Precision Medicine; D016879:Salvage Therapy