Multiple Myeloma

On February 26, 2021, the FDA accelerated the approval of melphalan flufenamide (Pepaxto; Oncopeptides AB), an alkylating drug, for the treatment, in combination with dexamethasone, of adults with relapsed or refractory multiple myeloma who have received ≥4 lines of therapy and whose disease is triple-refractory to ≥1 proteasome inhibitors, 1 immunomodulatory drug, and 1 CD-38–directed monoclonal antibody.

On December 18, 2020, the FDA approved selinexor (Xpovio; Karyopharm Therapeutics) in combination with bortezomib (Velcade) and dexamethasone for the treatment of adults with multiple myeloma after ≥1 previous therapies. The FDA granted this indication an orphan drug designation.

Bispecific antibodies are showing promise in patients with hematologic malignancies, notably relapsed or refractory multiple myeloma. Results from studies of 3 bispecific antibodies were presented at ASH 2020, showing deep and durable responses.

A post-hoc analysis of a pivotal clinical trial presented at ASH 2020 showed that the recently approved belantamab mafodotin-blmf (Blenrep), a first-in-class antibody targeting BCMA (B-cell maturation antigen), induced deep and durable responses in heavily pretreated patients with relapsed or refractory multiple myeloma. This analysis of the ongoing, open-label DREAMM-2 study focused on 1-year outcomes based on the number of previous therapies. The results were presented by Sagar Lonial, MD, FACP, Chief Medical Officer, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.

At the 2020 NCCN hematologic malignancies conference, multiple myeloma expert Shaji Kumar, MD, Consultant and Professor of Medicine, Division of Hematology, Mayo Clinic Cancer Center, Rochester, MN, discussed the “bonanza of treatment regimens for multiple myeloma.”

The combination of carfilzomib (Kyprolis) with lenalidomide (Revlimid) and dexamethasone (KRd) as induction therapy does not improve outcomes in patients newly diagnosed with multiple myeloma compared with the current standard of care with bortezomib (Velcade), lenalidomide, and dexamethasone (VRd).

Cellular therapy is becoming an attractive option for heavily pretreated patients with relapsed or refractory multiple myeloma.

Orlando, FL—The investigational B-cell maturation antigen (BCMA)-­directed chimeric antigen receptor (CAR) T-cell therapy known as JNJ-4528 induced responses in 100% of 29 evaluable patients with heavily pretreated relapsed or refractory multiple myeloma, according to the results of the phase 1b/2 CARTITUDE-1 clinical trial reported at ASH 2019.

Orlando, FL—The investigational dual-targeted CD38 chimeric antigen receptor (CAR) T-cell therapy achieved an objective response in more than 90% of patients with relapsed or refractory multiple myeloma who had received ≥3 previous therapies and whose disease had spread outside of the bone marrow. Furthermore, the therapy cleared extramedullary lesions in almost all patients with these lesions, according to results presented at ASH 2019.