Joseph Mikhael, MD, a professor in the Applied Cancer Research and Drug Discovery Division at the Translational Genomics Research Institute, an affiliate of City of Hope Cancer Center, and chief medical officer of the International Myeloma Foundation, discusses novel agents used to treat patients with multiple myeloma.

The field of multiple myeloma has undergone many changes over the past few years. Two new classes of drugs have emerged in the treatment arsenal: nuclear export inhibitors such as selinexor (Xpovio) and BCMA-targeted antibody-drug conjugates such as belantamab mafodotin-blmf (Blenrep), says Mikhael.

Multiple myeloma is a disease in which most patients are not achieving cure, adds Mikhael. Almost all patients will become refractory to the main 5 agents that are currently being used to treat this disease: bortezomib (Velcade), lenalidomide (Revlimid), pomalidomide, carfilzomib (Kyprolis), and daratumumab (Kyprolis), Mikhael concludes.

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Joseph Mikhael, MD, discusses novel agents used to treat patients with multiple myeloma.

Dr. Mikhael on the Advances Made in Multiple Myeloma Treatment

Joseph Mikhael, MD, professor, Applied Cancer Research and Drug Discovery Division, Translational Genomics Research Institute (TGen), an affiliate of City of Hope Cancer Center, chief medical officer, International Myeloma Foundation, discusses remaining challenges in high-risk multiple myeloma.

Within the past decade, the average survival of patients with multiple myeloma has significantly improved compared with historic rates, says Mikhael. However, survival has not been improved to the same degree in patients with high-risk disease.

Additionally, patients with extramedullary disease, who can also be considered high risk, remain a challenging patient population to treat, Mikhael explains. Extramedullary disease presents 

 outside of the medullary space. Moreover, these patients can be challenging to image, measure, and treat as they may have heavy disease burden. Future research efforts should aim to identify a treatment strategy for patients with extramedullary disease, concludes Mikhael. 

Joseph Mikhael, MD, discusses remaining challenges in high-risk multiple myeloma.  



Dr. Mikhael on Remaining Challenges in High-Risk Multiple Myeloma

Joseph Mikhael, MD, professor, Applied Cancer Research and Drug Discovery Division, Translational Genomics Research Institute (TGen), an affiliate of City of Hope Cancer Center, chief medical officer, International Myeloma Foundation, discusses unmet needs in triple-class refractory multiple myeloma. 

Within the past year, the multiple myeloma armamentarium has expanded to include the novel XPO1 inhibitor selinexor (Xpovio) and the BCMA-directed antibody-drug conjugate belantamab mafodotin-blmf (Blenrep) for patients with heavily pretreated, relapsed/refractory disease. Additionally, the CD38-directed antibody isatuximab-irfc (Sarclisa) was also approved in combination with pomalidomide (Pomalyst) and dexamethasone for patients with relapsed/refractory multiple myeloma who have progressed on 2 or more prior therapies, including lenalidomide (Revlimid) and a proteasome inhibitor. 

However, despite a multitude of available agents, myeloma remains incurable, Mikhael says. The majority of patients will become triple-class refractory and progress on bortezomib (Velcade), lenalidomide, pomalidomide, carfilzomib (Cabometyx), and daratumumab (Darzalex). 

Treatment selection with these novel agents should be individualized for patients with triple-class refractory disease, Mikhael says. Additionally, future research efforts should aim to evaluate these therapies in combinations and earlier on in the treatment course.

Joseph Mikhael, MD, discusses unmet needs in triple-class refractory multiple myeloma.  


Joseph Mikhael, MD

Articles

Dr. Mikhael on the Advances Made in Multiple Myeloma Treatment

Dr. Mikhael on Remaining Challenges in High-Risk Multiple Myeloma

Dr. Mikhael on Unmet Needs in Triple-Class Refractory Multiple Myeloma