Dr. Lonial on Treatments in Heavily Pretreated Multiple Myeloma

Sagar Lonial, MD, FACP, professor and chair, Department of Hematology and Medical Oncology, Emory University School of Medicine, chief medical officer, Winship Cancer Institute of Emory University, discusses treatments for patients with heavily pretreated multiple myeloma.

Historically, treatment for patients with heavily pretreated multiple myeloma was limited, says Lonial. However, in July 2019, the FDA granted an accelerated approval to selinexor (Xpovio) for use in combination with dexamethasone for patients with penta-refractory multiple myeloma. Despite the regimen’s activity, it can be difficult to tolerate at the recommended 80 mg dose on days 1 and 3 weekly. Therefore, at Winship Cancer Institute, the drug is given at a lower dose in combination with dexamethasone and a proteasome inhibitor, says Lonial.

Additionally, venetoclax (Venclexta) has shown superior progression-free survival in combination with bortezomib (Velcade) and dexamethasone versus bortezomib and dexamethasone alone in patients who received 1 to 3 prior lines of therapy, particularly in patients with a t(11;14) translocation.

In terms of developmental agents, BCMA-directed CAR T-cell therapy, antibody-drug conjugates, and bispecific T-cell engagers have also shown encouraging activity and could supplement current treatment strategies in the relapsed/refractory setting, concludes Lonial.