Juan P. Alderuccio, MD, assistant professor of clinical medicine at Sylvester Comprehensive Cancer Center, University of Miami Health System, discusses the use of proteasome inhibitors in the frontline treatment of patients with multiple myeloma.

Proteasome inhibitors are used in the frontline setting. Typically, bortezomib (Velcade) is used in combination with cyclophosphamide or lenalidomide (Revlimid) plus dexamethasone, says Alderuccio. For some patients, bortezomib is a subcutaneous injection, he adds. In patients who are not able to receive lenalidomide or already present with neuropathy, ixazomib (Ninlaro) is an FDA-approved drug that can also be used in this setting.

In patients with high-risk features, such as 17p deletions, carfilzomib (Kyprolis) has been shown to induce deeper responses and better survival, says Alderuccio. Carfilzomib is currently approved by the FDA for use in combination with dexamethasone or with lenalidomide plus dexamethasone for the treatment of patients with relapsed/refractory disease who have received 1 to 3 lines of therapy.

Additional indications list carfilzomib as monotherapy for patients with relapsed/refractory myeloma who have received 1 or more lines of therapy. However, a pooled analysis presented at the 2018 ASH Annual Meeting showed encouraging overall response rates among high-risk, transplant-ineligible patients. Therefore, in this context, carfilzomib may be considered a suitable alternative.

Juan P. Alderuccio, MD

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Dr. Alderuccio on the Use of Proteasome Inhibitors in Frontline Myeloma