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Multiple Myeloma: Excitement about monoclonal antibodies

Tuesday, December 1, 2015

Morton Coleman, M.D.Morton Coleman, M.D. The best treatment for young, fit, transplant-ineligible multiple myeloma patients is three, not four drugs, but the incorporation of new monoclonal antibodies into four-drug regimens has myeloma experts talking about a potential cure, according to experts at the Lymphoma & Myeloma International Conference.

For such patients, use of four drugs has not shown any additional benefit over the current treatment, said Antonio Palumbo, MD, Chief of the Myeloma Unit, at the University of Torino in Italy. “The only advance of four drugs plus maintenance is mainly for continuous therapy. Continuous therapy improves progression-free survival and overall survival and maximizes benefit. But we never achieve eradication of myeloma. Therefore, complete response and continuous therapy are quite essential.”

The future of four-drug regimens has brightened with the introduction of monoclonal antibodies in myeloma therapy, he continued. Studies are under way adding the investigational human IgG1k monoclonal antibody daratumumab to bortezomib-thalidomide-dexamethasone or to bor-te-zomib-melphalan-prednisone. Also, the anti-CD38 monoclonal antibody isatuximab has been added to bortezomib-cyclophosphamide-dexamethasone.

“Monoclonal antibodies may make four drugs into R-CHOP for myeloma,” Palumbo said, referring to the combination of the anti-CD20 monoclonal antibody rituximab along with cytotoxic therapies, which revolutionized the treatment of B-cell lymphomas.

In an interview, Congress Chair Morton Coleman, MD, Director of the Center for Lymphoma and Myeloma at New York-Presbyterian Hospital/Weill Cornell Medical College, agreed: “We are looking for an R-CHOP-like therapy in myeloma. If we use monoclonal antibodies in combination with second-or third-generation regimens, with or without transplant, we could possibly cure myeloma patients. The next step to a cure is minimal residual disease negativity. With combinations of new modalities, we can start to talk about a cure.

“Young, fit myeloma patients show no benefit from four drugs. What you gain in efficacy you lose in toxicity,” Coleman continued. “However, with monoclonal antibodies, there may be a role for a fourth drug.”

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This is an excerpt of an article that appeared in Oncology Times. Read the full report here.