The original FDA approval of selinexor for multiple myeloma was the STORM study. What are the data behind using selinexor for this patient? Consider whether you would feel differently about using another immunomodulatory imide drug at the time of relapse if the patient progressed after being on a lenalidomide-based regimen for 3 months vs 20 months. The way I approach it is refractory to and what mechanisms of action they are naïve or intolerant to. 11 The median number of prior lines of therapy and the cytogenetic risk of the patients were different it’s hard to cross-trial comparisons.
#Vt plus plus#
10 Finally, there was the BOSTON study, comparing bortezomib plus dexamethasone with and without selinexor. 9 Bortezomib plus dexamethasone, with and without panobinostat, was examined in the PANORAMA studies, more recently in the PANORAMA 3 study. Bortezomib plus dexamethasone, with and without pomalidomide, was examined in the OPTIMISMM study.
8 That triplet is not an approved regimen. 7 The elotuzumab, bortezomib, and dexamethasone combination never went very far. 6Ĭan you summarize the bortezomib-containing options for RRMM?īortezomib plus dexamethasone, with and without daratumumab, the CASTOR study. For patients who are lenalidomide sensitive, EHA-ESMO additionally recommends the elotuzumab, lenalidomide, and dexamethasone combination or the carfilzomib, lenalidomide, dexamethasone combination. There are options for a patient who is lenalidomide sensitive, having stopped the lenalidomide, and then either stopping the daratumumab as well then progressing, or continuing on daratumumab alone.
They also recommend venetoclax, bortezomib, and dexamethasone for patients with translocation (11 14). If the patient is lenalidomide refractory, the EHA-ESMO recommends dexamethasone with 1 of the following: pomalidomide plus bortezomib, selinexor plus bortezomib, or carfilzomib. This is a new group of patients that we haven’t dealt with before. What do the European Hematology Association (EHA) and the European Society for Medical Oncology (ESMO) have to say about second-line options for RRMM following treatment with daratumumab, lenalidomide, and dexamethasone? 5 is more complicated, but using a PI is a great way to go. a PI is a great approach from this standpoint. Now we have daratumumab plus lenalidomide starting to some of that treatment, and we have patients entering the second line completely naive. Most patients get bortezomib : cyclophosphamide, bortezomib, and dexamethasone or bortezomib, lenalidomide, and dexamethasone, with or without daratumumab. Most of these combinations, preferred by the NCCN for previously treated myeloma, are supported by category 1 data. There are also some rare listed, like the ixazomib, lenalidomide, dexamethasone combination, and the pomalidomide, bortezomib, dexamethasone combination, especially for a patient who is proteasome inhibitor naive. 1 We don’t yet understand the role of daratumumab sequencing although I don’t treat lymphoma, I hear you can the rituximab along the way and give cyclophosphamide, doxorubicin, vincristine, and prednisone ifosfamide, carboplatin, and etoposide or dexamethasone, high-dose cytarabine, and cisplatin. 1,4 This combination has fallen out of favor, especially because so many patients progress on lenalidomide in the first line.Ī number of daratumumab-based regimens are listed as well, combining daratumumab plus dexamethasone with bortezomib, with carfilzomib, or with lenalidomide. 2,3 That being said, the combination of bortezomib, lenalidomide, and dexamethasone,, was not a phase 3-studied regimen until a few years ago, and we’ve all been using it for a decade. 1 It was studied in phase 2 studies but not FDA approved. RICHTER: the list of the FDA-approved, NCCN-preferred regimens for RRMM, something is that the combination of carfilzomib, pomalidomide, and dexamethasone is not FDA approved. Targeted Oncology TM: What FDA-approved regimens are preferred by the National Comprehensive Care Network (NCCN) for the treatment of relapsed/refractory multiple myeloma (RRMM)? During a Targeted Oncology™ Case-Based Roundtable event, Joshua Richter, MD, assistant professor at The Tisch Cancer Institute Icahn School of Medicine at Mount Sinai and director of Multiple Myeloma at the Blavatnik Family-Chelsea Medical Center at Mount Sinai, discussed the case of a 78-year-old woman with multiple myeloma.