Dr. Nadeem on Sequencing Considerations in Multiple Myeloma

Omar Nadeem, MD, a physician at Dana-Farber Cancer Institute and an instructor in medicine at Harvard Medical School, discusses sequencing challenges in multiple myeloma.

Much of the decision comes down to toxicity, says Nadeem. As such, individual patient factors have to be taken into consideration when determining the next line of therapy. Additionally, the patient’s response to prior therapy should also be taken into account in order to gauge how much benefit they would derive from that class of agents in the subsequent setting.

Cytogenetic risk is also assessed to see if new high-risk mutations have been developed or acquired, adds Nadeem. Here, physicians are looking for the most effective and potent therapies to offset that risk. At this point, the data do not offer a clear directive on how to target specific mutations with available therapeutic classes.

However, venetoclax (Venclexta) does have very significant activity in patients with t(11;14) disease, says Nadeem, and if the safety concerns that have been noted with this medication become manageable, the targeted agent is likely to become available in the clinic for patients with that translocation.