Novel agents for the treatment of multiple myeloma: proteasome inhibitors and immunomodulatory agents

Abstract

The integration of novel agents into the treatment of multiple myeloma (MM) has shifted the focus from an incurable disease to one that is chronic, with a realistic hope of someday achieving a cure. Proteasome inhibitors and immunomodulatory agents are the backbone of novel therapies for MM. These agents are particularly important for patients with relapsed or refractory disease, a fate faced by the majority of myeloma patients over the course of their disease. Review of recent clinical trial data for the proteasome inhibitors and immunomodulatory agents, including clinical efficacy and safety information, will assist the advanced practitioner in oncology with integrating these data into the current treatment guidelines for MM.

Table 1

Table 1. NCCN-Recommended Treatment of Newly Diagnosed Transplant-Eligible Multiple Myeloma Patients Based on Selected Clinical Trials

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Table 2. NCCN-Recommended Treatment of Newly Diagnosed Transplant-Ineligible Multiple Myeloma Patients Based on Selected Cinical Trials

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Table 3. NCCN-Recommended Maintenance Therapy Following Stem Cell Transplant or Continuous Treatment in Transplant-Ineligible Patients With Multiple Myeloma

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Table 4. Current FDA-Approved Options for Salvage Treatment in Patients With Relapsed or Refractory Multiple Myeloma Based on Selected Clinical Trials

Figure 1

Figure. 26S proteasome structure. Adapted with permission from Kloetzel (2001).

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Table 5. Mechanism of Action, Dosing, and Route of Administration of Proteasome Inhibitors

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Table 6. Key Clinical Trials for Approval of Proteasome Inhibitors

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Table 7. Mechanism of Action of Thalidomide, Lenalidomide, and Pomalidomide

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Table 8. Clinical Trials of Pomalidomide

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Table 9. Common Adverse Events for Proteasome Inhibitors and Immunomodulatory Agents Used to Treat Multiple Myeloma

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Table 10. Clinical Management of Common Treatment-Emergent Adverse Events Associated With Proteasome Inhibitors and Immunomodulatory Agents Used in the Treatment of Multiple Myeloma