Join Carol Ann Huff, MD, and Ivan Borrello, MD, as they present their multidisciplinary expertise on a range of cases pertaining to Prostate Cancer.

The understanding of key pathways responsible for multiple myeloma (MM) has led to the development of novel agents and resulted in availability of many evidence-based options for treatment of MM with significant improvements in response and survival. The challenge lies in deciding the best treatment to provide maximum benefit to the patient.

Newly-diagnosed MM is responsive to treatment with regimens containing immunomodulatory drugs (IMiDs) such as thalidomide and lenalidomide; proteasome inhibitors such as bortezomib; high-dose chemotherapy and autologous stem cell transplant in appropriate patients; or combinations containing melphalan and prednisone with novel agents.

However, most patients eventually relapse or become refractory to treatment, owing in part to the changing biology of the tumor. Although most agents and regimens used as initial therapy have also shown significant activity and improved outcomes in patients with relapsed or refractory MM, these responses are often of limited duration. In patients who have become resistant to bortezomib, the use of a new proteosome inhibitor, such as carfilzomib, with a different chemical backbone has shown to overcome this resistance. The FDA recently approved carfilzomib for treatment of patients with relapsed/refractory MM who have received at least two prior therapies, including treatment with bortezomib and an IMiD. Another agent that has a role in relapsed/refractory MM is vorinostat, an oral histone deacetylase (HDAC) inhibitor, FDA-approved for the treatment of patients with cutaneous T-cell lymphoma. For patients with MM, the synergistic effect of vorinostat and bortezomib has been proven to significantly improve response rates and prolong disease free survival. Vorinostat is being investigated in combination with lenalidomide and dexamethasone and in combination with PLD and bortezomib.

Several new agents from a range of therapeutic classes are being examined in the relapsed/refractory setting. Specific agents in development include new IMiDs (e.g., pomalidomide), the signal transduction modulators (e.g., perifosine), monoclonal antibodies (e.g., elotuzumab), and HDAC inhibitors (e.g., panobinostat).

In patients with multiple myeloma, clinicians need to be aware of the previous treatment history of the patients. Also, it is important for clinicians to know the extent of the disease, including the transition to systemic disease. The challenge lies in deciding the best treatment to provide maximum benefit to the patient.