Clinical Experience With Panobinostat in Multiple Myeloma

In a patient who has had a prior autologous stem cell transplant and is progressing on lenalidomide maintenance therapy, the triplet of panobinostat, bortezomib, and dexamethasone is a good option, explains Jatin J. Shah, MD. In this setting, the benefits with panobinostat and bortezomib are maximized, as progression-free survival improves by approximately 4 months with the triplet versus bortezomib and dexamethasone alone.

Another option is retreatment with bortezomib plus carfilzomib, since patients treated with bortezomib have a certain comfort level with carfilzomib, says Shah. This combination is also an option for later lines of therapy, he notes.

A patient who has relapsed early following upfront bortezomib and autologous stem cell transplantation can receive the panobinostat triplet, notes Maria-Victoria Mateos, MD, PhD. One patient in her practice experienced this type of relapse and had a short duration of response with subsequent lenalidomide-based therapy. She was then included in a clinical trial with the panobinostat triplet, explains Mateos, and achieved a complete response. Five years later, the patient is still on single-agent panobinostat and the drug is well tolerated.

Several clinical trials are exploring the use of panobinostat in multiple myeloma, says Andrew Spencer, MD, including a trial in patients who had a suboptimal response with frontline therapy. The data show that about half of these patients have a further reduction in tumor burden with panobinostat. At his practice, some of the younger patients have achieved complete remissions.