Dr. Mikhael on Unmet Needs in Triple-Class Refractory Multiple Myeloma

Joseph Mikhael, MD, professor, Applied Cancer Research and Drug Discovery Division, Translational Genomics Research Institute (TGen), an affiliate of City of Hope Cancer Center, chief medical officer, International Myeloma Foundation, discusses unmet needs in triple-class refractory multiple myeloma.

Within the past year, the multiple myeloma armamentarium has expanded to include the novel XPO1 inhibitor selinexor (Xpovio) and the BCMA-directed antibody-drug conjugate belantamab mafodotin-blmf (Blenrep) for patients with heavily pretreated, relapsed/refractory disease. Additionally, the CD38-directed antibody isatuximab-irfc (Sarclisa) was also approved in combination with pomalidomide (Pomalyst) and dexamethasone for patients with relapsed/refractory multiple myeloma who have progressed on 2 or more prior therapies, including lenalidomide (Revlimid) and a proteasome inhibitor. 

However, despite a multitude of available agents, myeloma remains incurable, Mikhael says. The majority of patients will become triple-class refractory and progress on bortezomib (Velcade), lenalidomide, pomalidomide, carfilzomib (Cabometyx), and daratumumab (Darzalex).

Treatment selection with these novel agents should be individualized for patients with triple-class refractory disease, Mikhael says. Additionally, future research efforts should aim to evaluate these therapies in combinations and earlier on in the treatment course.