Dr. Munshi on the Role of Checkpoint Inhibitors in Myeloma

Nikhil C. Munshi, MD, director of Basic and Correlative Science, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, professor of medicine, Harvard Medical School, discusses the role of checkpoint inhibitors in multiple myeloma.

Due to recent data, Munshi says, checkpoint inhibitors have taken a backstage role in the treatment of patients with myeloma. There were promising phase III studies in the works looking at pembrolizumab (Keytruda) with lenalidomide (Revlimid) and dexamethasone, and with pembrolizumab, pomalidomide (Pomalyst), and dexamethasone. Both of these trials were prematurely halted because of toxicity concerns in July 2017, when the FDA required that all patients enrolled in KEYNOTE-183 and KEYNOTE-185 be discontinued from further examination. Interim results had shown an increased risk of death with pembrolizumab, the agency cited.

Munshi does not think that checkpoint inhibitors will fade from the myeloma landscape; instead, researchers will find better utilization for these agents. Firstly, checkpoint inhibitors could be effective and better tolerated with an antibody like daratumumab (Darzalex). They can also be used in combination with chimeric antigen receptor T-cell therapy.