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There are several investigational drugs that target various mutations and pathways being studied in late phase clinical trials in patients with multiple myeloma. These agents have the potential to change the way multiple myeloma is approached in the induction, consolidation, and maintenance phases, comments Sagar Lonial, MD.
Ann McNeil, RN, APN, explains that in her practice, multiple myeloma patients not previously treated with pomalidomide or carfilzomib are offered the opportunity to participate in a clinical trial. She notes that patients who experience disease progression during the trial may be treated with pomalidomide, carfilzomib, or combination therapy.
Monoclonal antibodies will play a major role in the next phase of the disease management pipeline, remarks Noopur Raje, MD. Raje adds that elotuzumab, which targets the CS1 protein present on multiple myeloma cells, is being investigated in conjunction with lenalidomide and dexamethasone therapy.
Raje also highlights molecular inhibitors, such as the histone deacetylase inhibitor panobinostat, that show promise in multiple myeloma. Raje and Lonial discuss the phase III PANORAMA-1 trial, in which patients were randomized to receive panobinostat or placebo in addition to bortezomib and dexamethasone. Lonial suggests that the results of the trial may be practice changing if the data support the approval of panobinostat for multiple myeloma.
Experts are beginning to understand the complexity of the multiple myeloma genome and now know that mutations such as the BRAF mutation and the NRAS/KRAS mutations are targetable, comments Raje. Raje and Lonial also describe how anti-CD38 monoclonal antibodies, MEK inhibitors, and agents that target the PD-1/ PD-L1 pathway may play a role in the future treatment of multiple myeloma.