Advances in Treating Multiple Myeloma

Judi Ebbert, PhD, MPH, RN | Jan 26th 2017 Sep 23rd 2017

Reviewed by: Todd Gersten, MD

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Multiple myeloma, a cancer formed by malignant plasma cells, affects about 30,000 Americans with new diagnoses each year. While a cure remains elusive, numerous clinical trials and research continue to lengthen life expectancies.

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Rely on reliable research resources

The Multiple Myeloma Research Foundation (MMRF) has the latest information on treatment advances and emerging therapies that are being offered in clinical trials. Robust clinical research makes progress possible. Use this link to help learn about and find a matching clinical trial.

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Genomic-based personalized therapy

The Multiple Myeloma Genomics Initiative (MMGI) is expediting advances in personalized treatment. That’s because the same type of cancer affects people differently. Genomic research is identifying molecular differences that will contribute to personalized therapies that target specific DNA alterations.

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Treatments that target molecular pathways

MMRF’s focus on multiple myeloma at the molecular level enables the identification of specific changes in the pathway of disease development and progression. Therapies that interfere with those changes are being created and tested, making the results available to those who most need to know: patients in search of a cure.

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Advances in targeted agents and immunotherapy

MMRF reported encouraging study results at the 12/3/16 meeting of the American Society for Hematology (ASH). Novel therapies that modify molecular targets can stop or slow disease progression. Immunotherapy works with the immune system—an example is chimeric antigen receptor (CAR) therapy, which induces T cells to kill cancer cells.

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Selinexor and multiple myeloma

Selinexor is an oral drug being studied in people who have relapsed or are refractive (no longer responding) to multiple therapies. People who no longer responded to Velcade, Kyprolis, Revlimid, Pomalyst, and Darzalex (anti-CD38 antibody) had impressive results. Side effects are low blood counts and gastrointestinal problems.

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Venetoclax and multiple myeloma

Venetoclax, a drug used to treat people with chronic lymphocytic leukemia, was tested in relapsed/refractory multiple myeloma. It significantly reduced tumor size in 21 percent of participants, and in 40 percent with translocated (rearranged) chromosomes 11 and 14. Side effects are gastrointestinal problems, low platelet count, and anemia.

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Pembrolizumab (Keytruda) and multiple myeloma

Keytruda, FDA approved for lung cancer and melanoma, aids the immune system in finding and killing myeloma cells. A study of Keytruda with Pomalyst and dexamethasone in patients with 2 to 3 prior therapies showed promising results in persons with high-risk disease factors. Side effects are low levels of blood cells,shortness of breath, and dizziness.

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Nelfinavir (Viracept) and multiple myeloma

Nelfinavir, used for HIV, was given with Velcade and dexamethasone for advanced myeloma refractory to proteasome inhibitors (PI) like Velcade and Kyprolis. Nelfinavir targets a pathway to resensitize myeloma cells to PI. In people with ≥5 therapies, the combination was effective. Side effects are low levels of blood cells and risk of infection.

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CTL019 CAR T-Cell Therapy clinical trials

Early studies of CAR T in AML, a type of leukemia, had dramatic results. CTL019 is an investigative CAR T-cell therapy being tested in early multiple myeloma clinical trials. The CTL019 CAR-T target is myeloma stem cells, which can create more myeloma cells.

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BCMA CAR T-cell Therapy clinical trials

BCMA teaches T cells to recognize myeloma cells via a B-cell maturation antigen (BCMA). That means the B-cells teach the T cells to find and disable the myeloma invaders. BCMA holds promise for people who have had many treatments. The side effects are delirium, seizures, and brain swelling, all of which can be reversed.

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Antibody-drug conjugate, GSK2857916

GSK2857916 blends (1) an antibody that can identify myeloma cells via attachment to BCMA and (2) the drug monomethyl auristatin F (MMAF), which then kills the myeloma cells. Studies have just started, and side effects to date are manageable eye problems.

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Second-generation CD38 antibody, MOR202

Darzalex is a CD38 antibody that is effective in treating myeloma but with safety concerns related to infusion reactions.  A newer antibody, MOR202, is being studied and is projected to reduce infusion reactions. Early studies suggest that it is effective and has fewer reactions.

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Empliciti (elotuzumab) for high-risk smoldering myeloma

This study is an alternative to the traditional “watch and wait” approach for smoldering myeloma. A more effective alternative may be early treatment prior to progression to multiple myeloma. Combined Empliciti, Revlimid and dexamethasone showed strong clinical benefit, with a 71 percent response rate.

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Take advantage of the MMRF’s services

The Multiple Myeloma Research Foundation has a richly substantive online resource with comprehensive information on multiple myeloma and on finding a support group. It features a drug guide, news of cutting-edge research, a trial-matching tool, and invites users to call a nurse specialist at 1-866-603-MMCT (6628), Mon-Fri, 9-7 ET.

NEXT: Managing Multiple Myeloma Symptoms and Treatment Side Effects