Elotuzumab in combination with pomalidomide and dexamethasone for the treatment of multiple myeloma

ABSTRACT

Introduction: Despite major advances in the therapeutic management of multiple myeloma (MM), it remains an incurable disease. Several combinations of monoclonal antibodies with novel agents are being investigated with promising results in order to prolong progression-free and overall survival.

Areas covered: This paper aims to critically present available data from clinical trials investigating the combination of elotuzumab with pomalidomide and dexamethasone in refractory/relapsed MM patients and determine its current role in clinical practice.

Expert opinion: Pomalidomide-based combinations with monoclonal antibodies have been shown to be effective in patients with MM who are refractory to or have relapsed following treatment with lenalidomide and/or a proteasome inhibitor (PI). These regimens seem to be more effective than the standard combination of pomalidomide with dexamethasone alone. Taking into consideration that the vast majority of MM patients will receive upfront treatment including a PI and lenalidomide in the near future, pomalidomide-based triplets, such as elotuzumab-pomalidomide-dexamethasone, will become the standard of care in the second line of therapy.

KEYWORDS:

• Elotuzumab
• monoclonal antibody
• pomalidomide
• immunomodulatory drugs
• multiple myeloma
• treatment

Article highlights

• Pomalidomide-based combinations represent an effective therapeutic option for myeloma patients who have relapsed after initial treatment with lenalidomide and/or proteasome inhibitors.

• Combination of pomalidomide with agents with distinct mechanisms of action may confer additional clinical benefit.

• The addition of monoclonal antibodies in myeloma therapeutics has resulted in promising results and it has provided the rationale for evaluating triplet combinations with pomalidomide and dexamethasone.

• Elotuzumab in combination with pomalidomide and dexamethasone is a safe and effective regimen that has been approved for the treatment of relapsed/refractory myeloma patients and may be established for patients relapsing after upfront treatment with lenalidomide and a proteasome inhibitor.

• Adding a fourth drug therapeutic agent along with pomalidomide, elotuzumab and dexamethasone may result in additional therapeutic benefit and such novel combinations are currently being investigated.

Declaration of interest

Meletios A Dimopoulos has received consultancy and honoraria fees from Novartis, Janssen, Celgene, Takeda, Amgen, and BMS. Maria Gavriatopoulou has received consultancy and honoraria fees from Amgen, Karyopharm, Genesis Pharma, Janssen, and Takeda. Efstathios Kastritis has received consultancy, boards and honoraria fees from Genesis Pharma, Takeda, Janssen, and Amgen. Evangelos Terpos has received consultancy and honoraria fees from BMS, Janssen, Celgene, Takeda, Genesis Pharma, Amgen, and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.