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Current treatment landscape for relapsed and/or refractory multiple myeloma

  • Review Article
  • Published:

From Nature Reviews Clinical Oncology

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Key Points

  • There is currently no uniform standard of care for the treatment of patients with relapsed and/or refractory multiple myeloma (MM), but combination regimens are generally preferred over monotherapy

  • Incorporation of immunomodulatory drugs and proteasome inhibitors into anti-MM treatment regimens has improved survival rates in these difficult-to-treat patients

  • Each anti-MM agent is associated with a distinct safety profile that can impact treatment selection and its use in combination with other agents

  • An understanding of disease-related and patient-related factors, as well as treatment-related toxicities, is critical for evaluating appropriate therapeutic options for each patient

Abstract

Recent developments in the treatment of multiple myeloma have led to improvements in response rates and to increased survival; however, relapse is inevitable in almost all patients. Recurrence of myeloma is typically more aggressive with each relapse, leading to the development of treatment-refractory disease, which is associated with a shorter survival. Several phase II and III trials have demonstrated the efficacy of recently approved agents in the setting of relapsed and/or refractory multiple myeloma, including immunomodulatory agents, such as lenalidomide and pomalidomide, and proteasome inhibitors, such as bortezomib and carfilzomib. Currently, however, there is no standard treatment for patients with relapsed and/or refractory disease. This Review discusses the current treatment landscape for patients with relapsed and/or refractory multiple myeloma and highlights disease-related and patient-related factors—such as pre-existing comorbidities or toxicities—that are important considerations for clinicians when selecting an appropriate treatment regimen.

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Acknowledgements

The authors gratefully acknowledge editorial assistance provided by BlueMomentum (a division of KnowledgePoint360 Group, San Bruno, CA, and funded by Onyx Pharmaceuticals, Inc.). The authors also gratefully acknowledge the support of Michelle Maglio, administrative assistant, of the Dana Farber Cancer Institute in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Clinical Therapeutics, University of Athens, School of Medicine, 80 Vas Sofias Avenue, Athens, 11528, Greece

    Meletios A. Dimopoulos

  2. Dana-Farber Cancer Institute, 44 Binney Street, Dana 1B02, Boston, 02115, MA, USA

    Paul G. Richardson & Kenneth C. Anderson

  3. Haematology Department, University Hôspital Hôtel-Dieu, Nantes Cedex 01, 44093, France

    Philippe Moreau

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  1. Meletios A. Dimopoulos
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M.A.D., P.G.R., P.M. and K.A. researched data for article, substantially contributed to discussion of content, wrote the article, reviewed and edited the manuscript before submission.

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Correspondence to Meletios A. Dimopoulos.

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Competing interests

M.A.D. has served as a consultant for Celgene, Centocor Ortho Biotech, Inc., and Onyx Pharmaceuticals, Inc. P.G.R. has served as a member of advisory committees for Bristol-Myers Squibb, Celgene, Genmab, Johnson & Johnson, Millennium Pharmaceuticals, Novartis and Onyx, and has received research funding from Celgene and Millennium Pharmaceuticals. P.M. has served as a consultant and as a member of a speakers bureau for Celgene, Millennium Pharmaceuticals, Inc., and Onyx Pharmaceuticals, Inc. K.C.A. has received compensation as a member of the scientific advisory boards of Celgene, Gilead, Onyx Pharmaceuticals, Inc., and Sanofi-Aventis, and is one of the scientific founders of Acetylon and Oncopep.

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Dimopoulos, M., Richardson, P., Moreau, P. et al. Current treatment landscape for relapsed and/or refractory multiple myeloma. Nat Rev Clin Oncol 12, 42–54 (2015). https://doi.org/10.1038/nrclinonc.2014.200

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