Triplet Therapy for Relapsed/Refractory Multiple Myeloma

Patients who have had two or more prior lines of therapy, including bortezomib and lenalidomide, appear to benefit the most from the triplet combination of panobinostat, bortezomib, and lenalidomide, states Jatin J. Shah, MD. For transplant-eligible patients who are bortezomib-sensitive, the triplet would be good to consider. It has also shown activity in patients who are bortezomib-refractory; however, the data do not appear to apply to those who are lenalidomide-refractory, states Shah. The combination is commonly used in the front-line for non-transplant eligible patients.

When deciding whether to use a triplet regimen, it is important to consider the efficacy, toxicities, and prior lines of therapy, explains Maria-Victoria Mateos, MD, PhD. The duration of response is also a key aspect to consider. Some patients, at her practice, have used bortezomib for more than 5 or 6 years with good response and acceptable toxicity.

The addition of panobinostat to bortezomib and dexamethasone is best if the patient is still sensitive to bortezomib, says Andrew Spencer, MD. In his practice, the predominant method of administering bortezomib is subcutaneously on a weekly basis. Evidence suggests there are fewer toxicities with the subcutaneous route compared with the intravenous route, he adds. However, there is still a potential for peripheral neuropathy.