Since 2015, several drugs have been approved to treat multiple myeloma. Some drugs can help when the disease comes back after treatment (called a relapse) or when the cancer does not respond to first-line treatment (called refractory multiple myeloma).
Some of these newer drugs are:
Belantamab mafodotin-blmf (Brunnrepp) is the first in a class of drugs called antibody drug conjugates (ADCs).These drugs combine Monoclonal antibodies drugs and chemotherapy in a drug. Belantamab mafodotin-blmf can treat people who have received at least four prior therapies, including:
- An anti-CD38 monoclonal antibody, such as daratumumab (Darzalex). This targets a protein on the surface of myeloma cells called CD38.
- A proteasome inhibitor, such as bortezomib (Velcade). The drug blocks a substance called the proteasome, which helps cancer cells recycle the proteins they need to grow.
- an immunomodulatory agent. These drugs use your body’s defense system (your immune system) to attack myeloma cells. Examples of these drugs are lenalidomide (Revlimid), pomalidomide (Pomalyst) and thalidomide (Thalomid).
Belantamab mafodotin-blmf targets the protein BCMA (B cell maturation antigen), a protein that protects cancer cells.
Ciltacabtagene autoleucel (Carvykti) is a CAR-T treat. This means it uses cells from your immune system to fight cancer. Ciltacabtagene autoleucel can treat adults with relapsed or refractory multiple myeloma who have received four or more different types of therapy, including:
- proteasome inhibitor
- and anti-CD38 monoclonal antibody
Each dose of treatment is tailored for you using your own T cells, a type of disease-fighting white blood cells, to help attack myeloma. Your treatment team will collect your T cells, genetically modify them, and put them back into your body.
You can take this medication alone, in combination with bortezomib (Velcade), melphalan (Alkeran), and prednisone, or in combination with dexamethasone and lenalidomide (Revlimid). It depends on whether you are newly diagnosed, previous treatment did not help you, or the disease has recurred.
Daratumumab targets a protein on the surface of myeloma cells called CD38. It looks for proteins and then kills the cancer cells it attaches to.
Idecabtagene vicleucel (Abecma) It is the first CAR-T therapy to treat adult multiple myeloma. It’s for people who don’t respond to at least four different types of treatment or who have relapsed disease.
isatuximab (Sacrissa) is a monoclonal antibody that acts like daratumumab. It is used with pomalidomide and dexamethasone for people who have tried at least two other treatments. It also targets CD38 and slows cancer growth. It can also be used with carfilzomib (Kyprolis) and dexamethasone to treat people who have tried one to three other treatments.
Isazomi (Ninlaro) It is the first and only oral proteasome inhibitor approved by the FDA for the treatment of multiple myeloma. The proteasome is an enzyme complex that helps cancer cells recycle the proteins they need to grow. Ixazomib blocks the proteasome to kill myeloma cells.
It is used in combination with lenalidomide (Revlimid) and dexamethasone. It is used in people who have tried at least one other treatment for myeloma.
The FDA approved selinexor for the treatment of relapsed or refractory disease. It is used in combination with dexamethasone to treat people who have tried at least four treatments. It can also be used with dexamethasone or bortezomib in people who have tried at least one other treatment.
What’s on the horizon?
Some potential breakthroughs in multiple myeloma treatments are still in the testing phase, but they seem promising, said Hans C. Lee, MD, an assistant professor at the University of Texas MD Anderson Cancer Center at Houston.
For example, T-cell engagers are antibodies that fight cancer cells in two different ways: They look for BCMA and T cells, which are part of your own immune system, Lee said.
One arm of the antibody searches for BCMA on the surface of myeloma cells. The other arm looks for a protein called CD3 on T cells. It’s basically the “kiss of death” for cancer cells, Lee said. The T cell is activated (turned on), it makes contact with the myeloma cell, and then kills it, he said. These drugs are also called bispecific T cell engaging antibodies or BiTEs.
Another positive step in the treatment of multiple myeloma is advances in genomic medicine, Lee said.a doctor can do a biopsyOr tissue samples and see genetically relevant information about your cancer faster and cheaper than in the past. The hope is that doctors will soon be able to use the data in real time, which may help find the ideal way to sequence and even personalize your treatment, Lee said.