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Expert Evaluates Evolving Options in Relapsed/Refractory Myeloma

Caroline Seymour
Published: Friday, Dec 14, 2018

Ajai Chari, MD

Ajai Chari, MD

Altered dosing schedules and accumulating data on triplet regimens are showing greater efficacy in patients with relapsed/refractory multiple myeloma, even in those who become refractory to lenalidomide (Revlimid), explained Ajai Chari, MD.

“The management of relapsed/refractory multiple myeloma [is] really challenging; it's like a math game. We have 6 different classes of drugs with multiple drugs in each class, and you ask, how many combinations are there?” asked Chari, an associate professor of Medicine, Hematology and Medical Oncology, at Mount Sinai Hospital.

In an interview during the 2018 OncLive® State of the Science Summit™ on Multiple Myeloma, held prior to the 2018 ASH Annual Meeting, Chari, discussed some of the available and anticipated combinations for use in patients with relapsed/refractory multiple myeloma.

OncLive®: What was the rationale for the ARROW trial?

Chari: Initially, carfilzomib (Kyprolis) was studied at 20 mg/m2 and 70 mg/m2. On days 1 and 2, patients received 20 mg/m2, and then received 27 mg/m2 on days 8, 9, 15, and 16. It's important to remember that when the drug was being developed in the early 2000s, there was concern regarding cytokine release syndrome, tumor lysis syndrome, and renal dysfunction. Therefore, the step-up dosing, the hydration, and the tumor lysis prophylaxis were implemented. Then, the drug was approved [by the FDA] and it’s clearly an effective drug, but giving patients twice-weekly therapy indefinitely is challenging from a practicality point of view.

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