How to treat patients with relapsed/refractory multiple myeloma: Evidence-based information and opinions

Massimo Offidani, Laura Corvatta, Fortunato Morabito, Massimo Gentile, Pellegrino Musto, Pietro Leoni, Antonio Palumbo

Research output: Contribution to journalArticle

Abstract

Introduction: Relapsed/refractory multiple myeloma (rrMM) remains a difficult condition to treat despite the availability of new drugs. This review aims to provide evidence to guide physicians in the choice of salvage therapy in certain subgroups of patients. Areas covered: The review attempts to present evidence-based information and suggest possible approaches based on data on previous therapies, previous remission duration and toxicity of previous treatments, patient's co-morbidities and disease characteristics at relapse. Unfortunately, little evidence is available; there are no large and/or randomized trials, direct comparisons of drugs or combinations for rrMM patients to draw any definite conclusion. Expert opinion: Almost all the studies presented here suggest that depth of response is a key factor also for patients with rrMM. Identifying the best approach between combinations and sequential therapies remains controversial. Several studies favor the former approach in early relapse as it leads to a higher complete response rate, regardless of previous therapies. However, in both strategies, achieving maximal response should always remain a main goal. Consolidation/maintenance therapy is beneficial both in combination and sequential therapies also in rrMM. Second generation new drugs, such as pomalidomide, carfilzomib, bendamustine and HDAC inhibitors, will probably expand the rescue possibilities also in this setting.

Original languageEnglish
Pages (from-to)779-793
Number of pages15
JournalExpert Opinion on Investigational Drugs
Volume20
Issue number6
DOIs
Publication statusPublished - Jun 2011

Keywords

  • bortezomib
  • complete remission
  • evidence
  • lenalidomide
  • myeloma
  • novel therapies
  • refractory disease
  • relapsed disease
  • thalidomide

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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