Leif Bergsagel, MD, consultant and professor of medicine, Division of Hematology/Oncology, Mayo Clinic, discusses treatment options for patients with relapsed/refractory multiple myeloma.

With the plethora of options for the treatment of patients with myeloma, choosing one regimen over another can be difficult for the oncologist, says Bergsagel. When choosing treatment, Bergsagel says to consider risk factors, previous treatments, and anticipated adverse events. Generally, a 3-drug regimen is superior to a 2-drug regimen in the relapsed/refractory setting, he adds.

Chimeric antigen receptor (CAR) T cells have recently entered the field. At the 2017 ASH Annual Meeting, therapy with the BCMA-directed CAR T-cell therapy bb2121 showed complete remissions for 56% of patients with relapsed/refractory multiple myeloma. The objective response rate for bb2121 was 94%, which consisted of a very good partial response or better for 89% of patients. Bergsagel says that there is question about durability of response for CAR T-cell therapy, but ongoing clinical trials may answer that.

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Leif Bergsagel, MD, consultant and professor of medicine, Division of Hematology/Oncology, Mayo Clinic, discusses treatment options for patients with relapsed/refractory multiple myeloma.
 

Dr. Bergsagel on Treatment Options for Relapsed/Refractory Myeloma

Leif Bergsagel, MD, consultant and professor of medicine, Division of Hematology/Oncology, Mayo Clinic, discusses competing strategies in treating patients with relapsed multiple myeloma.

There are 2 philosophies for treating relapsed multiple myeloma, says Bergsagel. Physicians can gradually introduce 1 drug and then a second. A patient may relapse on lenalidomide (Revlimid) and be given dexamethasone and subsequent ixazomib (Ninlaro). Physicians may choose to follow that with a more aggressive drug like carfilzomib (Kyprolis). If that fails, physicians may pursue daratumumab (Darzalex). That is the incremental approach, says Bergsagel.

If a patient progresses on lenalidomide, the alternative approach would be to completely switch to something else like carfilzomib with cyclophosphamide. In different situations, each of those approaches may be appropriate depending on how the patient is doing, concludes Bergsagel.

Leif Bergsagel, MD

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Dr. Bergsagel on Treatment Options for Relapsed/Refractory Myeloma

Dr. Bergsagel on Competing Philosophies of Treatment in Patients With Relapsed Myeloma