The Multiple Myeloma Treatment Pyramid: Recommendations ......PRCTIC ID. ccess the actiity, ueling...
1
PRACTICE AID Access the activity, “Fueling Innovation in Multiple Myeloma: Thoughts From the Chair,” at PeerView.com/CSW40 a Can be used once or twice weekly and at different doses. Can potentially cause cardiac and pulmonary toxicity, especially in elderly patients. b Triplet regimens should be used as the standard therapy for patients with multiple myeloma; however, patients who could not be considered for initiation of treatment with a 3-drug regimen can be started with a 2-drug regimen, with a third drug added once performance status improves. c Clinical trials with these regimens primarily included patients who were lenalidomide-naïve or with lenalidomide-sensitive multiple myeloma. d May interfere with serological testing and cause false-positive indirect Coombs test. Type and screen should be performed before using daratumumab. Includes both daratumumab for IV infusion and daratumumab and hyaluronidase- fihj for subcutaneous injection. Daratumumab and hyaluronidase-fihj for subcutaneous injection has different dosing and administration instructions compared with daratumumab for IV infusion. e Consider single-agent lenalidomide or pomalidomide for steroid-intolerant individuals. IMiD: immunomodulatory drug; MM: multiple myeloma; NCCN: National Comprehensive Cancer Network; R/R: relapsed/refractory; XPO1: exportin 1. 1. NCCN Clinical Practice Guidelines in Oncology. Multiple Myeloma. V.4.2020. https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf. 2.https://www.fda.gov/drugs/resources-information- approved-drugs/fda-grants-accelerated-approval-selinexor-multiple-myeloma. Please consult NCCN guidelines for additional information regarding the regimens listed here, including summary of indications for use. Other recommended regimens Preferred regimens Useful in certain circumstances Therapy for Previously Treated Myeloma (If a regimen listed here was used as a primary induction therapy and relapse is >6 mo, the same regimen may be repeated) Category 2A • Bendamustine/bortezomib/ dexamethasone • Bendamustine/lenalidomide/ dexamethasone • Bortezomib/cyclophosphamide/ dexamethasone • Carfilzomib a /cyclophosphamide/ dexamethasone • Cyclophosphamide/lenalidomide/ dexamethasone • Daratumumab d • Daratumumab d /carfilzomib/ dexamethasone • Daratumumab d /pomalidomide/ dexamethasone • Elotuzumab/bortezomib/ dexamethasone • Elotuzumab/pomalidomide/ dexamethasone • lxazomib/cyclophosphamide/ dexamethasone • Ixazomib/dexamethasone b • Ixazomib/pomalidomide/ dexamethasone • Panobinostat/carfilzomib a,b • Panobinostat/lenalidomide/ dexamethasone • Pomalidomide/cyclophosphamide/ dexamethasone • Pomalidomide/carfilzomib a / dexamethasone Category 2A • Bendamustine • Carfilzomib/cyclophosphamide/ thalidomide/dexamethasone • High-dose cyclophosphamide • Selinexor/dexamethasone Generally reserved for aggressive disease • Dexamethasone/ cyclophosphamide/etoposide/ cisplatin (DCEP) • Dexamethasone/thalidomide/ cisplatin/doxorubicin/ cyclophosphamide/etoposide (DT-PACE) ± bortezomib (VTD-PACE) Category 2A • Bortezomib/lenalidomide/dexamethasone • Carfilzomib (weekly) a /dexamethasone b Category 1 • Bortezomib/liposomal doxorubicin/dexamethasone • Bortezomib/dexamethasone b • lsatuximab-irfc/pomalidomide/ dexamethasone • Lenalidomide/ dexamethasone b,e • Panobinostat/bortezomib/ dexamethasone • Pomalidomide/bortezomib/ dexamethasone • Pomalidomide/ dexamethasone b,e Clinical Notes • Selected, but not inclusive of all regimens • Frailty assessment should be considered in older adults • Herpes zoster prophylaxis for patients treated with proteasome inhibitors or daratumumab • Subcutaneous bortezomib is the preferred method of administration. Both weekly and twice-weekly dosing schemas may be appropriate and acceptable • Aspirin (81-325 mg) is recommended with immunomodulator-based therapy; therapeutic anticoagulation is recommended for those at high risk for thrombosis • Consideration for appropriate regimen is based on the context of clinical relapse • Based on results of the ICARIA-MM trial, isatuximab was recently approved by the FDA in combination with pom-dex for the treatment of adults with multiple myeloma who have received ≥2 prior therapies, including lenalidomide and a proteasome inhibitor 1 • The XPO1 inhibitor selinexor was recently approved for use in patients with R/R MM who have received ≥4 prior therapies (including patients refractory to ≥2 proteasome inhibitors or IMiDs and an anti-CD38 monoclonal antibody) 2 Recent Updates in R/R MM Category 1 • Carfilzomib (2 x wk) a / dexamethasone b • Carfilzomib a /lenalidomide/ dexamethasone c • Daratumumab d /bortezomib/ dexamethasone • Daratumumab d /lenalidomide/ dexamethasone • Elotuzumab/lenalidomide/ dexamethasone c • Ixazomib/lenalidomide/ dexamethasone c The Multiple Myeloma Treatment Pyramid: Recommendations for Patients With Relapsed/Refractory Disease 1
Transcript of The Multiple Myeloma Treatment Pyramid: Recommendations ......PRCTIC ID. ccess the actiity, ueling...
PRACTICE AID
Access the activity, “Fueling Innovation in Multiple Myeloma: Thoughts From the Chair,” at PeerView.com/CSW40
a Can be used once or twice weekly and at different doses. Can potentially cause cardiac and pulmonary toxicity, especially in elderly patients. b Triplet regimens should be used as the standard therapy for patients with multiple myeloma; however, patients who could not be considered for initiation of treatment with a 3-drug regimen can be started with a 2-drug regimen, with a third drug added once performance status improves. c Clinical trials with these regimens primarily included patients who were lenalidomide-naïve or with lenalidomide-sensitive multiple myeloma. d May interfere with serological testing and cause false-positive indirect Coombs test. Type and screen should be performed before using daratumumab. Includes both daratumumab for IV infusion and daratumumab and hyaluronidase-fihj for subcutaneous injection. Daratumumab and hyaluronidase-fihj for subcutaneous injection has different dosing and administration instructions compared with daratumumab for IV infusion. e Consider single-agent lenalidomide or pomalidomide for steroid-intolerant individuals.IMiD: immunomodulatory drug; MM: multiple myeloma; NCCN: National Comprehensive Cancer Network; R/R: relapsed/refractory; XPO1: exportin 1.1. NCCN Clinical Practice Guidelines in Oncology. Multiple Myeloma. V.4.2020. https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf. 2.https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-selinexor-multiple-myeloma.Please consult NCCN guidelines for additional information regarding the regimens listed here, including summary of indications for use.
Other
recommended
regimens
Preferred
regimens
Useful in certain
circumstances
Therapy for Previously Treated Myeloma(If a regimen listed here was used as a primary induction therapy and relapse is >6 mo, the same regimen may be repeated)
Category 2A
• Bendamustine/bortezomib/ dexamethasone• Bendamustine/lenalidomide/ dexamethasone• Bortezomib/cyclophosphamide/ dexamethasone• Car�lzomiba/cyclophosphamide/ dexamethasone• Cyclophosphamide/lenalidomide/ dexamethasone• Daratumumabd
• Daratumumabd/car�lzomib/ dexamethasone• Daratumumabd/pomalidomide/ dexamethasone• Elotuzumab/bortezomib/ dexamethasone• Elotuzumab/pomalidomide/ dexamethasone• lxazomib/cyclophosphamide/ dexamethasone• Ixazomib/dexamethasoneb
• Ixazomib/pomalidomide/ dexamethasone• Panobinostat/car�lzomiba,b
• Panobinostat/lenalidomide/ dexamethasone• Pomalidomide/cyclophosphamide/ dexamethasone• Pomalidomide/car�lzomiba/ dexamethasone
Category 2A• Bendamustine• Car�lzomib/cyclophosphamide/ thalidomide/dexamethasone• High-dose cyclophosphamide• Selinexor/dexamethasone
Generally reserved for aggressive disease• Dexamethasone/ cyclophosphamide/etoposide/ cisplatin (DCEP)• Dexamethasone/thalidomide/ cisplatin/doxorubicin/ cyclophosphamide/etoposide (DT-PACE) ± bortezomib (VTD-PACE)
Category 2A• Bortezomib/lenalidomide/dexamethasone• Car�lzomib (weekly)a/dexamethasoneb
Category 1• Bortezomib/liposomal doxorubicin/dexamethasone• Bortezomib/dexamethasoneb
• lsatuximab-irfc/pomalidomide/ dexamethasone• Lenalidomide/ dexamethasoneb,e
• Panobinostat/bortezomib/ dexamethasone• Pomalidomide/bortezomib/ dexamethasone• Pomalidomide/ dexamethasoneb,e
Clinical Notes• Selected, but not inclusive of all regimens• Frailty assessment should be considered in older adults• Herpes zoster prophylaxis for patients treated with proteasome inhibitors or daratumumab • Subcutaneous bortezomib is the preferred method of administration. Both weekly and twice-weekly dosing schemas may be appropriate and acceptable• Aspirin (81-325 mg) is recommended with immunomodulator-based therapy; therapeutic anticoagulation is recommended for those at high risk for thrombosis• Consideration for appropriate regimen is based on the context of clinical relapse
• Based on results of the ICARIA-MM trial, isatuximab was recently approved by the FDA in combination with pom-dex for the treatment of adults with multiple myeloma who have received ≥2 prior therapies, including lenalidomide and a proteasome inhibitor1
• The XPO1 inhibitor selinexor was recently approved for use in patients with R/R MM who have received ≥4 prior therapies (including patients refractory to ≥2 proteasome inhibitors or IMiDs and an anti-CD38 monoclonal antibody)2
Recent Updates in R/R MM
Category 1• Car�lzomib (2 x wk)a/ dexamethasoneb
• Car�lzomiba/lenalidomide/ dexamethasonec
• Daratumumabd/bortezomib/ dexamethasone• Daratumumabd/lenalidomide/ dexamethasone• Elotuzumab/lenalidomide/ dexamethasonec
• Ixazomib/lenalidomide/ dexamethasonec
The Multiple Myeloma TreatmentPyramid: Recommendations for PatientsWith Relapsed/Refractory Disease1
