Dr. Lonial on Treatment of Patients With Late Relapse Myeloma

Sagar Lonial, MD, professor and chair, Department of Hematology and Medical Oncology, Emory University School of Medicine, chief medical officer, Winship Cancer Institute of Emory University, discusses the treatment of patients with late relapsed/refractory myeloma.

The management of these patients is very challenging, says Lonial. A group of investigators at Winship Cancer Institute put together a series of almost 150 patients with quad-refractory or penta-refractory disease in the daratumumab (Darzalex) era, and showed that their median expected overall survival was about 11 months. The duration of response to the currently available therapies in this space tends to be quite short, Lonial says, so this is a group of patients that represent an unmet medical need.

Selinexor, an XPO1 inhibitor, is a novel agent that has shown potential in this setting, even though a recent regulatory decision has set the drug back. In February 2019, the FDA’s Oncologic Drugs Advisory Committee voted 8 to 5 against accelerated approval of a new drug application for selinexor for the treatment of these patients and recommended delaying a final decision on the drug until results are available from the upcoming phase III BOSTON trial.

Venetoclax is another drug that falls into this category, Lonial adds. Encouraging data with venetoclax as a single agent and in combination suggests that the BLC2 inhibitor could be used in overcoming resistance to other standard therapies. BCMA-directed chimeric antigen receptor T cells and antibody-drug conjugates have also shown promise in recent studies.