Dr. Siegel on Distinguishing Between Classes of Drugs in Myeloma

David M. Siegel, MD, PhD, chief of myeloma, John Theurer Cancer Center, professor of medicine, Hackensack Meridian Health, discusses a trial distinguishing between classes of drugs in the treatment of patients with myeloma.

The landscape for myeloma, particularly in the relapsed/refractory setting, is crowded with several different FDA approved therapies. Siegel says these options can be divided into 3 classes: proteasome inhibitors such as bortezomib (Velcade) and carfilzomib (Kyprolis), immunomodulatory agents like lenalidomide (Lenvima) and pomalidomide (Pomalyst), and monoclonal antibodies such as elotuzumab (Empliciti) and daratumumab (Darzalex).

There is a dogma in myeloma that when a patients progresses on a certain therapy, they must then be moved onto a completely different class of drug for the next line of treatment. A study presented at the 2018 ASH Annual Meeting seemed to contradict this traditional belief. For example, a study evaluating the safety and efficacy of pomalidomide-based treatment in patients with relapsed and/or refractory multiple myeloma and first- or second-line lenalidomide failure, found that there was no drop-off in outcomes when patients switched from lenalidomide to pomalidomide.