Ashley Rosko, MD
Practitioners in the field of multiple myeloma are seeking to answer several questions regarding the treatment of elderly patients, a population that, due to comorbidities, may have difficulty tolerating some of the currently available therapies.
“The thing that is important for the overall approach to older adults with myeloma is being able to focus on their quality of life and how to address both bone pain and osteoporosis, and also to meet their needs in terms of fatigue, which are the most common symptoms,” said Ashley Rosko, MD. “Balancing both the toxicities of therapy and achieving a response, as well as meeting their needs when it comes to living independently and having a good quality of life is very important.”
Studies currently ongoing are exploring varying doses of agents used to treat patients with multiple myeloma, Rosko added, as well as oral formulations.
Rosko, an assistant professor in the Division of Internal Medicine, The Ohio State University Comprehensive Cancer Center, spoke on treatment approaches for elderly patients with multiple myeloma at the 2017 OncLive®
State of the Science SummitTM
on Hematologic Malignancies. In an interview, she shared insight on some of these available therapies, others under investigation, and supportive care methods being utilized for this patient population.
OncLive: You lectured on elderly patients with multiple myeloma. What is important to know about this subset?
The bulk of therapy for multiple myeloma is nontransplant based. Not to say that transplant isn’t indicated for older adults because it is, but it is underutilized. This presentation focused on why older adults have inferior survival, the approach in terms of treatment when it comes to older adults with myeloma, and some of the supportive care methods that we’re able to better utilize for them.
When it comes to older adults, early mortality is probably the highest—there is an early death within 6 months. Part of that has to do in relation to kidney failure, underlying comorbidities, and a poor performance status. Older patients with myeloma can get better and do very well with targeted therapy. This talk focused on how we approach an older adult in terms of determining to give them 2 drugs versus 3 drugs. The majority of our focus is on being able to both achieve disease control, put disease into remission, and balance some of the toxicities. With myeloma, there are many approaches to therapy and how we do that is the art of medicine with the science that supports it.
We talked about the SWOG S0777 trial, which looked at VRD [bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone] and its benefits in terms of overall response in patients who are both transplant eligible and transplant ineligible, and the benefits of that therapy. We also looked at some supportive care methods and our history of approaching older adults with myeloma.
When I look at the history of multiple myeloma, melphalan has always been a common agent, and we talked about how that agent can still be incorporated; however, we also discussed some of the toxicities of that therapy. I also reviewed cyclophosphamide-based therapy with more novel approaches to therapy—using things like ixazomib (Ninlaro).