Dr. Martin on Biomarker-Driven Therapeutics in Multiple Myeloma

Thomas G. Martin, MD, clinical professor of medicine, Adult Leukemia and Bone Marrow Transplantation Program, associate director, Myeloma Program, University of California, San Francisco, and co-leader, Hematopoietic Malignancies Program, Helen Diller Family Comprehensive Cancer Center, discusses biomarker-driven treatment options in multiple myeloma and currently available regimens.

Multiple myeloma is approaching an era of biomarker-driven therapeutics, says Martin. Currently, the utility of venetoclax (Venclexta) is limited to patients with t(11;14); however, its use may expand to include patients with BCL-2 overexpression. For most patients, there are no biomarkers to drive treatment decisions. However, according to Martin, the search for these markers continues.

It’s important to inform patients of the 3-drug therapies are associated with the longest progression-free survival, adds Martin. However, it’s just as important to discuss the more convenient options that are also available, such as oral options versus subcutaneous and intravenous (IV) alternatives.

Subcutaneous daratumumab (Darzalex), which takes 5 minutes to administer rather than 4 to 8 hours for IV administration or 90 minutes for rapid infusion, offers a more convenient treatment option for patients. As such, once subcutaneous daratumumab becomes available, it will have a widespread use in the early relapse setting, predicts Martin.

With regard to selecting treatments for patients with multiple myeloma, most respond positively to the available triplets, and there are several options to choose from, says Martin. For example, if daratumumab, pomalidomide, and dexamethasone is given for first relapse, a carfilzomib (Kyprolis)-based regimen can be used for second relapse, Martin concludes.