Triplet Therapy in Multiple Myeloma

Carfilzomib is a proteasome inhibitor administered intravenously twice weekly as a treatment for patients with multiple myeloma. Recent studies are evaluating carfilzomib at a once-weekly schedule with dose escalation, states Morie Gertz, MD.

Three-drug combinations, such as carfilzomib plus lenalidomide and dexamethasone, are providing levels of response in the relapsed setting similar to what has historically been seen among newly diagnosed patients, states Rafael Fonseca, MD. Data from recent combination trials are beginning to challenge the notion that long-term treatment is needed in relapsed/refractory disease, adds Fonseca.

Combining pomalidomide, an immunomodulatory drug, with dexamethasone, and the proteasome inhibitor, bortezomib, is a well-tolerated strategy, says Noopur Suresh Raje, MD. Triplet combination therapies are preferred, even in relapsed settings, says Raje. This is largely due to clonal heterogeneity and the genetics of myeloma. With every relapse, the disease will clonally evolve, and treatment with upfront doublet therapies will be difficult at this point in the disease, comments Raje.

Oncologists have to take into account what therapies their patients may have received prior to referral. Thus, in the community setting, there may be a role for the combination of pomalidomide and dexamethasone in earlier lines of therapy, says Jatin J. Shah, MD.