Sequential or combination therapy for multiple myeloma

Abstract

In myeloma management, whether to offer sequential or combination therapies has largely remained elusive, partly for the reason that there are no conclusive studies evaluating this question and partly owing to the paradigm shift in myeloma outcomes over the last decade raising the same question again, but now in a different context with active agents such as immunomodulatory drugs and proteasome inhibitors being available. Historically, in myeloma, combination cytotoxic chemotherapy compared with the standard-of-care melphalan and prednisone regimen resulted in similar response rates, raising the question of efficacy of the cytotoxic combination therapies with high toxicities and the preference for sequential therapies in order to lower the toxicity of the chosen treatment. However, with the use of more active novel agents with favorable toxicity profiles such as bortezomib, thalidomide and lenalidomide, re-evaluation of this question is necessary.

Keywords::

• bortezomib
• combination therapy
• cytotoxic therapies
• lenalidomide
• myeloma
• novel agents
• sequential therapy
• thalidomide

Financial & competing interests disclosure

S Lional is supported by the Richard and Annelly Deets Fund for Multiple Myeloma and acts as a consultant for Millennium, Celgene, Novartis, Onyx, BMS, Merck and Acetylon. 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.

No writing assistance was utilized in the production of this manuscript.