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Proteasome Inhibitors Paving Promising Path for Myeloma Treatment

Jonathan Alicea and Gina Columbus
Published: Monday, Jul 17, 2017

multiple myeloma
Several novel agents have emerged in the treatment paradigm for multiple myeloma. A key class of agents that is helping to improve patient outcomes is the proteasome inhibitors.

on Hematologic Malignancies, Shain spoke on the emergence of proteasome inhibitors in multiple myeloma and whether these agents will be best used as monotherapy or in combination regimens.

OncLive: You spoke on multiple myeloma at this meeting. What did you discuss specifically?

Shain: I spoke to our colleagues about proteasome inhibitors and their use in relapse/refractory multiple myeloma. I mentioned, essentially, the spectrum of proteasome inhibitors from intravenous (IV), subcutaneous, and oral use.   

We saw data with subcutaneous use of the monoclonal antibody daratumumab (Darzalex) come out at the 2016 ASH Annual Meeting. What are your thoughts on subcutaneous administration of novel treatments in myeloma?

For certain drugs, it’s going to be really important. We’ve learned, with the proteasome inhibitors specifically, that subcutaneous use changed how we take care of patients—not only our patients’ way to get medicine, but also to mitigate some toxicities. That’s with bortezomib, and it has been groundbreaking and changed the practice in our ability to give that drug.

It’s not going to be quite as simple, because it’s going to be something that’s going to take time. It’s going to take some more work, because it’s a lot of volume that has to go in there. There are some stumbling blocks and hurdles we have to overcome to make that a really usable thing for patients. It is more of a delivery change versus a mitigation of toxicity change, and those will be important.

How have you seen the class of proteasome inhibitors in the last year have an impact on the field of myeloma?

It has been an amazing change. Bortezomib was the initial proteasome inhibitor approved as an IV formulation. By itself, it changed the cornucopia, or pantheon, of myeloma treatment. Then came the new IV formulations with carfilzomib, subcutaneous bortezomib, and now oral ixazomib.
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