Adam J. Waxman, MD, MS, assistant professor of clinical medicine, Penn Medicine, University of Pennsylvania, discusses the future of treatment in patients with multiple myeloma.

The landscape of multiple myeloma is changing across settings and patient populations. As the data with quadruplet therapy mature, there is hope that the addition of daratumumab (Darzalex) to proteasome inhibitors and immunomodulatory drugs will show a progression-free survival advantage over triplet therapy, says Waxman. If quadruplet regimens translate to an overall survival improvement as well, they could become a new standard of care in transplant-eligible and -ineligible patients, Waxman adds.

Treatment approaches for elder patients are also changing. A year ago, older patients would have typically received a doublet, but have been unable to tolerate it. Now, these patients can receive daratumumab, which is very well tolerated, with either lenalidomide (Revlimid) or bortezomib (Velcade), says Waxman.

In the future, all newly diagnosed patients are likely to receive a triplet, if not a quadruplet therapy, predicts Waxman. In the relapsed setting, the field will see more novel combination treatments. Although multiple myeloma is a chronic disease, there is a growing list of combinations patients can receive to lessen their disease burden, which, in the future, may include BCMA-directed targeted therapies and CAR T-cell therapy, concludes Waxman.

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Dr. Waxman on the Future of Treatment in Multiple Myeloma

Adam J. Waxman, MD, MS, assistant professor of clinical medicine, Penn Medicine, University of Pennsylvania, discusses the STORM trial and using selinexor (Xpovio) to treat patients with multiple myeloma.

The phase IIb STORM trial treated patients with a combination of selinexor and dexamethasone who had been exposed to and were refractory several of the approved drugs for myeloma, explains Waxman. In July 2019, the 

 combined with dexamethasone in relapsed/refractory myeloma who have received ≥4 prior therapies and whose disease is refractory to ≥2 proteasome inhibitors, ≥2 immunomodulatory agents, and a CD38-targeted monoclonal antibody. About one-fourth of patients will respond to the combination and about half of those patients will have durable responses, according to Waxman.

Although the survival outcomes were promising, 18% of discontinued treatment due to adverse events. The challenge now is to address the toxicities associated with selinexor, concludes Waxman.

Adam J. Waxman, MD, MS, discusses the STORM trial and using selinexor to treat patients with multiple myeloma.

Dr. Waxman on Selinexor in Multiple Myeloma Treatment

Adam J. Waxman, MD, MS, assistant professor of clinical medicine, Penn Medicine, University of Pennsylvania, discusses the role of transplant in patients with multiple myeloma.

When considering patients for stem cell transplant, organ function and age have to be taken into consideration, Waxman explains. If patients are older than 70 and have heart problems, lung problems, or kidney problems, transplant might not be recommended.

Most trials have evaluated stem cell transplant in patients up to age 70. Though, the field agrees patients as old as 75 can safely undergo transplant, according to Waxman. As such, age is often used as a surrogate marker for transplant eligibility. Transplant continues to show benefit, despite the use of novel drugs. However, it is a non-curative therapy and should be given to patients at minimal risk for complications, Waxman concludes.

Adam J. Waxman, MD, MS, discusses the role of transplant in patients with multiple myeloma.  

Adam J. Waxman, MD, MS

Articles

Dr. Waxman on the Future of Treatment in Multiple Myeloma

Dr. Waxman on Selinexor in Multiple Myeloma Treatment

Dr. Waxman on the Role of Transplant in Multiple Myeloma