Dr. Raje Highlights Treatment Options for Relapsed Multiple Myeloma

Noopur S. Raje, MD, director, Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, and professor of medicine, Harvard Medical School, highlights the different options available for patients with relapsed multiple myeloma.

There are several options available to those with relapsed disease, says Raje; it really depends on where in their relapse they are. For example, there have been multiple FDA approvals in the context of relapse after 1-3 lines of treatment.

It’s important to recognize what the nature of the relapse is and what kind of treatment the patient received prior to the relapse. For example, did the patient relapse on lenalidomide maintenance? Did the patient receive a triplet combination upfront?

The majority of patients will relapse on lenalidomide maintenance because that is the standard of care in the frontline treatment of multiple myeloma. When this happens, there are several pomalidomide (Pomalyst)-based combinations to choose from. The agent has been approved for use in combination with agents such as elotuzumab (Empliciti) or daratumumab, (Darzalex), says Raje.

Furthermore, a Biologics License Application for isatuximab in this setting has recently been accepted by the FDA. The BLA is based on data from the phase III ICARIA-MM trial which showed that the addition of isatuximab to pomalidomide and low-dose dexamethasone led to a greater than 40% reduction in the risk of disease progression or death versus pomalidomide and dexamethasone alone.

There’s ongoing work with pomalidomide and ixazomib (Ninlaro), and there’s phase II data on pomalidomide in combination with carfilzomib (Kyprolis) as well. Therefore, depending on the nature of the relapse, there are my options available. The agent can either be used with a monoclonal antibody or you can use it with a proteasome inhibitor in this context, concludes Raje.