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ABSTRACT
Introduction: Novel agents and the availability of autologous stem-cell transplantation have revolutionized the treatment of patients with multiple myeloma. First-generation novel agents namely thalidomide, lenalidomide, and bortezomib have significantly improved response and survival of patients. Second-generation novel agents such as pomalidomide, carfilzomib, and monoclonal antibodies are being tested both in the newly diagnosed and relapse settings, and results are promising.
Areas covered: In this review article, the main results derived from Phase III trials with thalidomide, lenalidomide, and bortezomib for the treatment of myeloma patients, both at diagnosis and at relapse, are summarized. Data about second-generation novel agents such as pomalidomide and carfilzomib are also reported. Newer effective drugs currently under investigation and the promising results with monoclonal antibodies are described.
Expert opinion: The availability of new effective drugs has considerably increased the treatment options for myeloma patients. A sequential approach including induction, transplantation (when possible), consolidation, and maintenance is an optimal strategy to achieve disease control and prolong survival. Despite these improvements, the best combination, the optimal sequence, and the proper target of newer drugs need to be defined.
Novel agents have revolutionized the treatment paradigm of patients with MM.
Thalidomide, lenalidomide, bortezomib are currently used in standard approaches in both patients eligible and ineligible for transplantation.
Novel agents are today incorporated into induction and consolidation/maintenance treatment strategies.
New generation novel agents with improved efficacy and better tolerability, such as pomalidomide, carfilzomib, and also monoclonal antibodies, are under investigation and preliminary results are promising.
New generation novel agents will increase the treatment armamentarium for MM.
This box summarizes key points contained in the article.
Acknowledgments
The authors thank Giorgio Schirripa for assistance in editing, formatting, and submitting the paper.
Declaration of interest
A Palumbo received honoraria from Amgen, Novartis, Bristol-Myers Squibb, Genmab A/S, Celgene, Janssen-Cilag, Millennium Pharmaceuticals Inc, Onyx Pharmaceuticals, Sanofi-Aventis. 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.