Keith Stewart, MB ChB
The advent of new agents and new classes of agents for treating relapsed or refractory multiple myeloma (RRMM), a notably complex disease state, has stimulated efforts to identify the optimal way to sequence or combine these therapies. An OncLive®
panel of hematology experts convened to discuss how to manage RRMM, the role of transplant, and the evidence for immunotherapy.
The panelists expressed enthusiasm for the potential of new combinations and sequences to cure a greater percentage of patients, but also recognized the need to temper that optimism pending better data on how to integrate the various therapeutic approaches. Keith Stewart, MB, ChB, who moderated the discussion, noted that the many options available have made it even more important to tailor treatment to the individual patient, especially in the relapse setting.
Relapsed or Refractory Disease After a Lenalidomide-Based Regimen
Several factors must be considered when selecting treatment for RRMM, including timing and aggressiveness of relapse, disease stage at relapse, disease-related comorbidities, eligibility for autologous stem cell transplant (ASCT), prior treatment exposure, and patient age.1,2
At the time of relapsed or refractory disease, many patients with multiple myeloma (MM) have already received lenalidomide (Revlimid), an immunomodulatory drug (IMiD), as part of a first-line regimen that included dexamethasone or as maintenance therapy after ASCT. For transplant-ineligible patients, one option is to repeat primary therapy with lenalidomide, with a possible dose increase.2 Another option is to switch to a regimen that combines an IMiD with a proteasome inhibitor or a monoclonal antibody.3
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