Ask the Expert: Any Updates on the Use of the New Immuno-Drugs for Maintenance in Myeloma?

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Topics include: Treatments and Understanding

After receiving a successful treatment, it’s recommended that patients turn to maintenance therapy to help safeguard their quality of life and help control the residual myeloma cells from developing. The landscape for maintenance therapy continues to expand as the potential effects of new immuno-drugs emerge. Listen in as Dr. Gareth Morgan, Professor of Medicine and Director of the UAMS Myeloma Institute, elaborates on the prospective use of these immuno-drugs.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Dr. Morgan, here's a question we got in from Joan.  Joan says, “I'm a three-year myeloma survivor.  Has any light been shed on the possible use of the new immuno-oncology drugs for maintenance therapy?”

Dr. Morgan:

The role of maintenance therapy has been one of the big things that have changed over recent years with multiple myeloma, and most of the data is being generated with Revlimid, stroke lenalidomide, which is an important drug that is well tolerated and acts mainly via the immune system when patients are in remission, and so has become pretty much the standard of care in the U.S. based on good data that which out of Europe, Britain and a variety of places.  So maintenance I think is an important thing.

Your question really was around which other immuno-drugs might you usefully use in the maintenance setting.  There's not much hard clinical trial data that would allow me to be didactic, but a daratumumab, anti-CD38, an antibody which recognizes the myeloma cells directly, clearly is going to have a potential role in maintenance setting in the future.  It's intravenous.  It's probably given once a month.  People tolerate it really without side effects, and in the trials that have been done Revlimid combines very well with daratumumab (Darzalex) as they have complementary mechanisms. And so in the future I can see that's going to be a combination that's going to be used in maintenance.

You really asked about immune-active drugs, but there is information on the role of proteasome inhibition, so there's been one study that looked at long-term bortezomib, which suggests that long-term exposure to bortezomib is effective, so that's Velcade. But the other proteasome inhibitors, ixazomib (Ninlaro) and carfilzomib (Kyprolis) also may have a role in maintenance.  Currently, there's not much information, but there is a specific trial with ixazomib, comparing maintenance ixazomib with no maintenance, and my guess is that the ixazomib arm will win out, though we have to wait for the answer to that.

So the full answer to your question is there is a lot of activity in the maintenance area.  Maintenance seems to be good, and it looks as if it's going to improve outcomes for a lot of patients with myeloma. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on November 8, 2017