Dr. Mikhael on Treatment Selection for Early Relapse in Multiple Myeloma

Joseph Mikhael, MD, professor in the Applied Cancer Research and Drug Discovery Division, Translational Genomics Research Institute, affiliate, City of Hope Cancer Center, chief medical officer, International Myeloma Foundation, discusses treatment selection for early relapse in multiple myeloma.

Treatment selection is challenging in patients with multiple myeloma who relapse early and should be adapted to each individual patient, Mikhael says. Notably, a wealth of options are available that can be tailored based on patient-related, disease-related, and therapy-related factors, Mikhael says.

For example, physician or patient preference may dictate whether a patient should receive oral vs intravenous treatment, Mikhael says. Factors relating to comorbidities or prior toxicities could also inform optimal treatment selection, Mikhael explains. Additionally, disease risk could indicate that one regimen may be superior to another in a particular patient, Mikhael says. Ultimately, these factors must be weighed together to determine which therapeutic option could provide a patient with the deepest and most durable response early on, Mikhael says.

Additionally, key principles of relapse can be used in conjunction with these factors to guide treatment selection. For example, most treatments in the early relapse setting do not feature drugs that a patient has already progressed on, Mikhael says. As such, treatment typically consists of a combination regimen that introduces a new mechanism of action to target the myeloma, Mikhael concludes.